Simulation Training Hits the Road

Technology is changing the business of medical education as surely as it’s changing everything else in the modern world. Cutting-edge computer and simulation technologies, audiovisual enhancements and theatrical special effects are coming together to create three-dimensional learning environments that mimic real life—without the risks. Until now, learning new techniques and practicing patient care has depended upon real-life emergencies presenting themselves without warning, which doesn’t always turn out well.

In point of fact, most providers still learn that way; state-of-the-art simulation education is out of reach for many, especially in small towns and rural communities. But if you’re in Florida, the Mobile Simulation Lab will come to you.

One of numerous projects of the Emergency Medicine Learning and Resource Center (EMLRC) in Orlando, FL, a nonprofit organization that has provided continuing education and resource opportunities in emergency and disaster medicine for 20 years, the Mobile Simulation Lab is designed for training emergency responders in Florida’s 33 rural counties, which have more than a million residents, but lack existing training facilities.

This 45-foot motor coach features two segments—one an ED setting and the other an ambulance—and is equipped with Laerdal’s human patient simulators, SimMan and SimBaby, as well as AirMan, a head and chest airway trainer. The labs can be configured for custom training or testing scenarios aimed toward physicians, nurses, physician assistants and paramedics/EMTs.

“It can be utilized by nearly any medical organization—EDs, clinics, public health systems, community colleges, nursing programs, paramedic programs,” says John Todaro, REMT-P, RN, TNS, director and COO of the EMLRC. “A couple of emergency medicine residency programs that have in-house labs are talking to us about using this just because it’s unique.”

Since the rollout, the contracts have poured in. “People had said, ‘Well, I’ve got to see it first,’” says Todaro. “Now, we’ve got ED doctor groups, some hospitals, community colleges and EMS agencies. All they have to do is call Karen and set it up.”

That would be Karen Crowe, REMT-P, RN, project manager and clinical coordinator. An active member of a disaster response team for FEMA and the Department of Homeland Security, and a certified instructor in many disciplines of both emergency medicine and disaster response, Crowe is completely responsible for the vehicle, driving to each site, handling the scheduling, programming the scenarios and operating the control room. “I don’t change the tires,” quips the 5´4" Crowe, “but I do service the generator underneath and I’ve learned how to adjust belts on the engine. I can even parallel park it!” Add to her credentials a commercial driver license, Class B with air brakes.

Crowe directs the training from the control room situated between the two segments using laptops that run the manikins, and audiovisual equipment for an infinite possibility of scenarios. Trainees have at their disposal such instruments as crash carts, cardiac monitors, blood pressure cuffs and suction units.

“If it’s in an ED unit or the back of an ambulance, we have it in the lab. Anything you would do in an emergency or disaster setting, you can do in our labs with these manikins,” says Crowe.

Realism is key, says Todaro. There is an intercom system, so when trainees call the report into the hospital, as they would from the ambulance, Crowe answers back as an ED would. She can also respond as their base physician at a remote location, or medical control, simulating every aspect of an emergency medical response.

“We even pipe in extraneous sounds—” says Crowe, “sirens, road noise in the ambulance simulator, ED noise in the ED simulator, with everybody moving around and equipment beeping—all of it.”

Making it even more real, the lab can simulate a power outage or fill with smells. The manikins seize and tremble; they’re equipped with built-in speakers allowing them to talk, cry, cough, emit heart sounds, lung sounds; and they bleed.

“We bought almost every component Laerdal had,” says Todaro. “We bought the amputation set, the WMD component, the nursing component, the trauma component—there are 10 or 12 box modules that you can add on to the manikin.”

Equipped with a tracking camera in the ceiling that Crowe controls as well, each training package will also provide the raw footage in either VHS or DVD formats.

The $750,000 vehicle was refit by Entertainment Coaches of America out of Leesburg, FL, a company that provides first-class travel arrangements for touring rock and country-western bands. Paid for in part by a $460,000 grant from the Florida Department of Health-Bureau of EMS, as well as donated equipment and labor, nothing is owed on the mobile sim lab. From here on, however, operational costs—including gas at 7.8 miles per gallon—will be picked up by the EMLRC and supplemented by users.

“Mobile Sim Lab is a vital part of the center,” says Todaro. “It’s our arms outside the building.”

In fact, Todaro—who is in the midst of raising $6 million to build a new, 35,000-sq.-ft. educational facility—says the sim lab will be able to drive right into the new building, incorporating it into the teaching environment when not on the road.

Until then, there are two ways Florida healthcare organizations can use the sim lab. They can hire it for an 8–10-hour training day at $2,000/day. Or they can join the EMLRC’s mobile sim lab cooperative, which guarantees a minimum of six days a year for $1,500/day, paid in advance like a time-share.

“We came up with the six-day minimum by looking at standard shifts in an EMS or ED schedule,” explains Todaro. “Two trainings a year, three days in a row to get all the shifts in—that’s six days. Likewise, a program at a college could do midterm skills exams and final skills exams on this lab and there’s their six days.”

“It helps us to know the schedule in advance,” says Crowe, “and gives us operating capital in advance. So, we offer it for a 25% discount and give co-op members preferential scheduling to make sure they get their six days in.”

For more, call Karen Crowe at 800/766-6335, or visit www.emlrc.org/emlrcmslab. The Mobile Simulation Lab can be seen at EMS EXPO in New Orleans, LA, August 25–27. For more information, call 877/EMS-EXPO.