Guest Editorial: Can Simulation Supplement EMS Field Experiences?

The purpose of having EMS students participate in clinical (hospital and specialty area) and field (EMS unit) shifts is to provide them with the opportunities to hone their critical thinking abilities, sharpen their psychomotor proficiency, and demonstrate their affective accountability in a real-world practical environment while being observed and evaluated.

As an EMS educator I routinely hear students voicing their displeasure about how useless their clinical or field shifts were—comments like, “It (the shift) was a total waste. I didn’t get to treat a single patient”; “It was awful. I didn’t get a single decent call in the whole shift”; and “The shift was completely useless. All I got to do was observe.”

In discussions with EMS faculty across the country I continually hear comments reflecting frustration with not being able to provide high-quality clinical and field experiences for students. The acquisition and maintenance of high-quality clinical and field experiences has become more difficult, and in some areas of the country, nearly impossible.

As EMS educators we have begun to embrace the use of simulation in our classrooms and laboratories. Yet the “Simulation Use in Paramedic Education Research (SUPER): A Descriptive Study” performed by the National Association of EMS Educators and published in Prehospital Emergency Care in 2015 showed that EMS educators may not be utilizing simulation to its full potential.

If we cannot acquire and maintain high-quality clinical and field experiences for our students, then I believe we need to reexamine and reimagine how we provide those experiences.

I propose that a solution to the lack of high-quality clinical and field experiences is to design and execute high-quality, real-world EMS shift simulations. These simulations would be designed to immerse the student in the operational, clinical, and emotional aspects of patient care. This would allow the paramedic student to actively apply critical thinking skills, perform patient assessments, and administer the proper medical care, while experiencing the affective and operational aspects of working in a prehospital environment. 

By designing and utilizing simulated EMS shifts, the EMS educator can immerse their students in real-world practical patient encounters intertwined with high-criticality, low-frequency patient encounters that are a rarity in standard field shifts. This combination of everyday, high-criticality, low-frequency patient encounters will help EMT and paramedic students sharpen the knowledge and skills they need to be a high-quality EMS practitioner. 

Just as important as the experience provided by the simulations is the opportunity for direct observation of students during their simulated EMS shifts by experienced preceptors and EMS faculty. This direct observation allows for real-time, quality-driven evaluation, feedback, and debriefing that will contribute to the student’s educational experience and growth as an EMS practitioner.

Length of shifts, configuration of crews, equipment and vehicles supplied are all design and execution considerations that can affect the quality and realism of EMS shift simulations. 

Performance of a needs assessment, development of a plan of action, establishing a reliable evaluation method for the process (design and execution) as well as the EMS student, preceptor, and faculty are critical. 

It’s also important to note that the provision of healthcare in all settings is continually changing; therefore, a continuous evaluation of the quality and accuracy of the scenarios designed to support the EMS shift simulation will be extremely important. I recommend this process be performed prior to the start of each new student cohort. 

Although I am a strong proponent of simulation, I would be remiss if I did not note that EMS shift simulations cannot be the catch-all. There needs to be a balance between live clinical and field experiences and shift simulations. What that balance is will depend upon the availability of high-quality, productive clinical and field experiences, the design and execution of the EMS shift simulations used, the resources available, and the commitment of the educational institution, the faculty, and the preceptors involved.

When properly designed and executed, EMS shift simulations can be a valued component for the education of EMS professionals.

John Todaro, BA, NRP, RN, TNS, NCEE, is assistant director in the College of Nursing at the University of South Florida in Tampa. He is a member of the EMS World editorial advisory board.