911 Innovation Avenue: Creating an EMS Sim City

     You've seen manikins simulating patients; you've seen "sim rooms" simulating ORs and EDs; and you've seen ambulances simulated inside 60-foot roving EMS mobiles and free-standing inside classrooms. The case for training medical providers in simulated environments is being made all over the country and simulated environments are getting more and more sophisticated. But the training space at the Community College of Aurora (CCA) in Denver, CO, just might take the cake. The EMS program here has created a simulated single-family house and given it the address 911 Innovation Avenue.

     The $200,000 project was partly funded by the Colorado Department of Public Health-EMS Division with the proviso that it would also conduct the country's first long-term study on the effectiveness of simulated training for EMTs and paramedics, says one of the project's designers, Primary Instructor Ken Forinash, BS, EMT-P.

     "There's a lot of evidence in other industries that education in a simulated environment is better-airlines and the military, for example-but there's been nothing in EMS to prove it for our industry," he says. "The state came to us and said, 'If you'll agree to do that study, we'll help fund your first simulation room.' So, we have an 8-12-year research project to prove or disprove that theory."

     The 1,200-sq.-ft. "home" is situated inside one of four large classrooms in a building that was once part of Denver's Lowry Air Force Base. It has a fully furnished living room, bedroom, dining room, kitchen and bathroom; and "an assortment of full-size, high-end manikins," including one that gives birth and another that can present with 85 different heart rhythms.

     Constructed somewhat like a Hollywood soundstage, each room's eight-foot walls fall several feet short of the ceiling, where, along with the HVAC and sprinkler systems, run rows of lights and cameras. The whole scenario, from dispatch to drop-off, can be video- and audio-recorded.

     That's right, from dispatch to drop-off: Outside the residence, there is a simulated ambulance, revamped from an actual box-type rig, and a simulated doctor's office/emergency department.

     "We teach our students isolated psychomotor skills-how to insert an OPA, for example-in a separate classroom," without any distractions, says Forinash. "We reserve the simulated environment for the integrated scenario-based calls. But come lab day, we take a group of students, give them a radio and dispatch them to a call."

     Students then ring the doorbell at the residence and the scenario begins: "Man with chest pain in living room," say, with the team leader wearing a wireless mic to catch the interchange.

     "Then they run the call as they would ordinarily, or as we'd like them to; load the patient onto a stretcher, exit that environment and actually go out of the building-out the back door of the simulation room-bring them back in where the ambulance is located, load them into the ambulance, simulate transport, unload the patient, go back outside, and back in again to the ED room and do a hand-off report," Forinash says.

     The whole scenario is monitored on video by the instructor in a control room, where he can advise if necessary or alter the scene by operating the manikin remotely. Afterwards everyone gathers there to review the video together and discuss what occurred.

     Besides learning to apply their skills in realistic settings, students are learning things that are unquantifiable yet integral to an EMT's job that even the designers had not fully appreciated at the outset, says Forinash. "Watching themselves on video, they're saying things like, 'I had no idea I was towering over the patient like that.' Or 'Look, we left that patient's living room all rearranged and we didn't put it back.'"

     Similarly, while the data collected so far is way too preliminary to assess-years of findings on the students' acquisition of psychomotor skills are still needed-corollaries that were never predicted are already evident, he says. Project researchers have determined that "the students who went through the simulations environment learned things like patient rapport and scene-management issues-the critical-thinking skills-quicker and better than the students who were running their scenarios in the classroom."

     Construction has already begun on a second sim classroom in an adjacent space of the same size that will be "light-years ahead" of this sim house, says Forinash. Moveable sets and projected images, courtesy of the college's film and video department, will make dozens of scenarios possible in different kinds of neighborhoods and surroundings, with different levels of safety and onlooker behavior.

     "If we want our students to be working on a sidewalk, we'll be able to create that environment with cars going by or a crowd gathering projected onto a screen. If the next day, we want them to be working in a nursing home environment, we can create that setting in the same area. We'll be able to control the lighting to make it the middle of the night, or bring in ambient sounds of street traffic, a domestic dispute or barking dogs, whatever we want."

     Both will be used to cross-train with other public-safety programs, including the school's fire and police academies. The facility is also available to other training centers and provider agencies for continuing education.

     A long-term goal is to make the DVD product Web-capable, he says, "so the medical director or the QA person can sit at their desks and actually watch their crews on the Web as they're running calls in our classroom."

     Forinash acknowledges that they've been very fortunate getting the funds for the Aurora facility. Money came through several different sources, including the college's foundation, its dean's office and the state of Colorado.

     "Everybody I've talked to in EMS education has had dreams of doing what we're doing. And we finally said, let's just do it. The first step is to find a facility and build a floor plan, then go from there. You have to just put it on your calendar: Today we're gonna work on the sim room."

     For more, visit www.ccaurora.edu/EMS.