Simulation Technology Improves Training Quality

Medical simulation technology has dramatically improved during the past decade. EMS providers are no longer limited to using manikins that are unable to respond dynamically to treatments provided them. Simply purchasing a high-fidelity manikin, however, does not guarantee it will integrate into an agency’s training program.

In 2010 AMR in Grand Rapids, MI, completed construction on a high-fidelity simulation lab complete with a separate control room and debriefing space. That facility was the first EMS-based high-fidelity simulation lab in western Michigan. Along with complementary ALS equipment, the patient room has a table-mounted stretcher with cabinetry to hide the support equipment for a high-fidelity manikin. Multiple cameras and microphones in the patient room record provider interactions with “George,” our patient, and allow for comprehensive debriefing.

In 2016, building on an already-robust training program, AMR purchased three additional high-fidelity manikins based on a top vendor’s integrated learning-application system. While AMR’s original manikin had to remain tethered to the table, the new manikins are wireless and portable. Being able to run high-fidelity simulations in a mobile environment lends another level of credibility to scenarios designed for AMR’s EMTs and paramedics, as well as local hospital staff and fire departments.

Keeping Certification Interesting

Certification classes, while important, can feel repetitive, particularly if a provider takes the course using the same curriculum year after year. AMR has been using high-fidelity simulation equipment in its cardiac and trauma courses since the simulation lab was built 10 years ago. The software that controls the manikin allows the controller to change the patient’s presentation in real time based on the treatment provided by the student. Even more useful is the ability to build specific stages into the scenario and automatically change the patient’s status and presentation based on provider actions.

For example, in a classic megacode scenario, the patient might present with chest pain and tachycardia. Five minutes into the scenario we can have the patient begin to have runs of ventricular tachycardia. If not managed appropriately through cardioversion or medication, he goes into ventricular fibrillation. If CPR is not immediately started and the patient is not defibrillated, then the rhythm progresses to PEA and ultimately asystole. This entire scenario can be programmed, and it requires very little instructor intervention since the manikin can sense CPR and electrical therapy.

In addition to providing more lifelike scenarios, simulation technology has made AMR’s certification courses more consistent. Each student running a particular scenario operates within the same parameters, meaning performance can be compared among peer groups. In addition to providing certifications and continuing education to EMS providers, AMR in Grand Rapids also educates a variety of nursing specialties as well as physicians and midlevel providers—many of whom seek out AMR’s classes.

Improving Community Partnerships

AMR has built a variety of educational partnerships with local agencies, thanks in no small part to the effective implementation of the “sim family.” In the past three years, firefighters from Grand Rapids and Wyoming, Mich., have “responded” while on duty to AMR’s sim lab to run scenarios and be signed off on skills competencies. AMR educators assisted fire department instructors in developing and implementing the content of these training programs. The ability to train alongside the crews they run calls with has proved invaluable. The manikins’ mobility enables educators to share this educational opportunity with rural departments near Grand Rapids that may not be able to train regularly at AMR’s headquarters.

Beyond the world of first responders, AMR has been able to use high-fidelity patient simulators to run no-notice drills for a variety of clinics and hospitals in the greater Grand Rapids area. Manikins have filled in for patients during testing at the University of Michigan Health’s Metro Health campus in advance of its application for trauma designation. AMR also stages code team training with area clinics by placing “Bob,” an ALS manikin, in the lobby and teaching registration staff how to care for an unresponsive person. Staff are eager to jump into the scenario and test the effectiveness of their code response.

Creating Realistic Treatment Situations

In 2016 AMR partnered with Mercy Health St. Mary’s to provide neonatal transport services to the St. Mary’s NICU in Grand Rapids. The neonatal transport team trains monthly in a dedicated ambulance to provide initial and continued competencies for the nurses, respiratory therapists, nurse practitioners and physicians on the team. While initial training focused on orienting the hospital-based team to the mobile environment, simulation technology now allows the team to practice patient management and intervention on the road. A neonatal manikin can be placed in the transport isolette on the cardiac monitor and controlled from the front seat, allowing a proctor to simulate common complications of neonatal transport. This manikin can be intubated and have intraosseous access established. It also has a pulsing umbilicus that can be accessed for IV therapy.

Versatile and Adaptive

High-fidelity simulation manikins are a significant investment for any organization. The return on that investment, however, is the ability to create dynamic scenarios that provide caregivers with interactions that will more closely reflect their work in the field. Improvements in underlying technology allow these manikins to be increasingly mobile, which improves their applicability to EMS and other out-of-hospital providers. EMS agencies can leverage these strengths to effectively train their providers as well as collaborate with organizations in their communities in ways they previously have not.

Patrick Lickiss, BS, NRP, has worked in EMS for the past 16 years and is currently located in Grand Rapids, MI. A former EMS blogger and regular columnist he is interested in education, technology and quality improvement. He continues to advocate for incorporation of evidence-based guidelines in his local system and nationally.