Virtual Training Director: Critical Decisions

Greg Friese is a featured speaker at EMS EXPO, October 26-30, Georgia World Congress Center, Atlanta, GA. For more information, visit www.emsexpoevents.com.

The Virtual Training Director is a new bimonthly column for training officers that will utilize the content of feature articles in EMS Magazine to help facilitate training sessions. We know many of you are volunteers or combine your training obligations with other duties. It is our goal to ease the process of training design and delivery by supplying a lesson plan you can adapt to the unique circumstances of your organization, its personnel and its local protocols.

Kyle Bates' continuing education article, Critical Decisions, focuses on critical decision-making at motor vehicle collisions, especially complex incidents with multiple patients. Kyle concludes the article by encouraging training officers to combine elements of scene size-up, hazard mitigation, incident management, triage and patient assessment into training programs. Kyle's article is rich with training opportunities ranging from classroom discussion to single-patient assessment and treatment and full-scale exercises with multiple patients.

Use the four lesson plan outlines below to facilitate training sessions for your service about critical decision-making at motor vehicle collisions. Consider sequencing several training sessions that culminate with a full-scale, multiple-patient training exercise. Before your training sessions, ask members to read Kyle's article.

Time Needed: 1 to 2 hours

Classroom Training Objectives

• Perform a "windshield assessment" to identify scene hazards
• Demonstrate competency with agency triage and incident management tools
• Practice primary assessment and treatment skills with manikins, high-fidelity simulators and/or patient actors
• Practice secondary assessment and treatment skills with manikins, high-fidelity simulators and/or patient actors
• Utilize all skills as part of a response team to a full-scale exercise, multiple-patient simulation.

Session 1: Windshield Assessment

Create a slide show of 10 to 20 actual incidents. Potential image sources include: local media, official photos taken during department operations, or an Internet image search.

1. Introduce training topic--"windshield assessment" of incident scene.

2. Review important concepts and incident management positions.

1. Windshield assessment
2. Incident commander
3. Safety officer

TEACHING TIP: Ask students to define these concepts and positions in their own words.

3. Discuss the immediate, primary and secondary responsibilities of each position using your organization's job action sheets.

1. Incident commander
2. Safety officer
3. Medical branch director
4. Triage, treatment and transport group leader

TEACHING TIP: All students should know the location of these job action sheets and other incident management tools.

4. Divide class into pairs. Show incident scene images.

1. Ask each pair to write down scene size-up hazards based on a simulated "windshield assessment."
2. Ask each pair to predict potential patient injuries based on what is observable about the MOI and any other information provided.
3. In a large group, share and discuss results of image-viewing for hazards and patient injuries.

Session 2: Multiple Patient Triage

Create profiles for 10 to 30 paper patients. Each profile should include assessment findings for students to triage each patient.

1. Present organization's multiple patient triage protocol.

TEACHING TIP: Focus discussion on implementing protocol as written rather than discussing flawed past implementations.

2. Demonstrate proper use of triage supplies, such as a triage tag and tracking board.

3. Divide students into two- to four-person triage teams. Each team should receive the same stack of 10-30 paper patients.

4. After completing triage, teams need to report:

1. Number of patients in each triage category
2. Treatments performed, if any, during triage for each patient
3. Priority of "immediate" patients for transport.

5. End with a discussion on limitations of triage and likelihood of reassessment and over/undertriage.

Session 3: Primary Assessment and Life-Saving Treatments

As Kyle makes clear in his article, EMS personnel need to quickly identify life threats as they approach the patient and deliver some interventions simultaneously. Focus the third training session on primary assessment patient practices using manikins, high- fidelity simulators or patient actors.

TEACHING TIP: Discuss interventions in the context of your local protocols and medical director authorization.

1. Prepare students to play roles of trauma patients with significant MOI and ABC life threats for patient primary assessment, hands-on skills practice.

2. Patient assessment scenarios:

1. Select one-third of group to be patients. The remaining two-thirds will work in two-person treatment teams.

2. Assign one or more ABC life threats to each patient, such as kinked airway, absent breathing or severe blood loss.

   Teaching tip: Ask patients to come up with a scenario and exam findings appropriate to their condition.

3. Add props and moulage as time allows and to increase realism.
4. Number patients so rescuer teams will assess and treat sequentially.

5. After patients are prepared, provide simple dispatch information to rescuers: "multiple patients at a motor vehicle collision."

   TEACHING TIP: Equip each rescue team with BLS assessment and management tools, i.e. OPAs, BVM, suction, c-collar.

6. Give each two-person rescue team 2 to 5 minutes to assess and provide actual or simulated treatments to each patient.

TEACHING TIP: Make sure rescue teams work through patients in order so they are able to assess and treat each patient.

3. Patient extrication scenarios:

1. Use several patients from the previous set of scenarios to practice immobilization and extrication.
2. Combine rescuers into four- to six-person teams. Assign each team a patient to extricate and immobilize.

TEACHING TIP: For an experienced group, assign a complex extrication task and challenge them with a time goal: "ALS air/ground transport will be ready for your patient in 10 minutes or less, but they will not accept the patient unless immobilization is excellent."

Session 4: Secondary Assessment and Non-Life-Saving Treatments

Use a similar outline as Session #3, but focus on secondary assessment and non-life-saving treatments like splinting, pain management and ongoing assessment.

Session 5: Full-Scale Exercise with Multiple Patients

Use Sessions #1-4 to build toward a full-scale exercise with multiple patients. Since it is beyond the scope of this article, browse to emsunited.com/group/virtualtrainingdirector to ask Kyle and Greg about creating a full-scale, multiple-patient exercise to practice and improve critical decision-making at a motor vehicle collision.

Greg Friese, MS, NREMT-P, is an e-learning specialist, author, presenter and paramedic. He has authored hundreds of online education lessons. Find out more about Greg and the work he does at www.gregfriese.com. Connect with him at www.twitter.com/gfriese or emsunited.com/profile/GregFriese.