Practice makes perfect - Medical Simulations for EMS

CarolinaFireJournal - Amar Patel
Amar Patel WakeMed Health and Hospitals
07/05/2011 -
“Practice makes perfect.” It’s something we all learned in childhood. Who can forget sitting on a piano bench and hearing mom say, “If you want to get better, you’ll have to practice your music scales,” or listening to a math teacher explain the value of practicing multiplication tables? Practice made us better little league pitchers, better ballerinas, better students — basically, better people with a solid foundation of fundamental skills.

In the world of emergency services, practice doesn’t necessarily make us perfect, but it certainly does help us to be prepared. And in our line of work, preparation can mean the difference between life and death for people whose fate we hold in our hands. Whether being dispatched to the scene of a car accident or responding to a house fire, we owe it to those we serve to have a solid foundation of critical caregiving skills. Doing so not only increases their chance for survival; it improves the odds for positive long-term patient outcomes.

As an EMS professional, you probably have a “Top-Five List” of the most frequent 9-1-1 calls you receive — things like chest pains, seizures and trauma — and you feel confident in managing those situations, due to their repetitive nature and the experience you’ve acquired. However, there are some EMS calls that take us out of our comfort zone and push our response skills to the limit. Natural disasters like the tornados that plagued the southern U.S. in the spring of 2011 are not commonplace occurrences in the Carolinas, and for those of us who responded in the aftermath, it was an unusually heartbreaking sight. Homes, schools, businesses and places of worship were destroyed, and dozens of lives were lost.

As emergency responders, we each have to ask ourselves this question: if placed in a similar situation, would we be professionally prepared for this type of event? Is there an effective, realistic way we could practice our responses to these unusually demanding crises? The answer may be found in an unlikely place — simulation gaming.

Medical Simulation and Gaming

All EMS personnel are familiar with medical simulation in one way or another. Simulation is simply a technique for practice or learning. The goal is to allow trainees to actively experiment and use their clinical skills and decision making without the actual risk to real patients. If you’ve ever used a mannequin-based simulator to practice CPR skills or participated in a county-wide disaster drill, simulation is nothing new to you.

Simulation got its start centuries ago when caregivers made models of the human body to study. But it wasn’t until the end of the 20th century that health sciences education made the move toward using human patient simulation. That’s relatively slow progress, compared to other industries like aviation, nuclear power, the military, and space flight, which have used simulation for decades. So, why the delay in health care?

Basically, the acceptance of simulation has been slow due to three key reasons:

Skepticism on the part of the older generation of caregivers who learned their skills through traditional methods. Change is difficult, and making the move towards simulation — especially through the use of advanced technology like virtual reality computer software and simulation labs — is a step into the unknown, a step many are unwilling to take.

Only within the last two decades have we had the ability to communicate instantly on a world-wide level via the internet. Up until then, sharing information about any subject — including medical simulation — was limited to print and voice communication, and many medical professionals simply didn’t have access to that knowledge. We can’t use what we don’t know.

Science and medicine are based on facts — information that has been proven and is supported by objective evidence. So it’s difficult for the medical community as a whole to validate simulation education and training when it is still in its infancy. At this point in time, there is no long-term data to prove the claims that caregivers’ performance improves due to the use of simulation.

Why Use Simulation and Gaming?

If there are no hard-and-fast studies about the successes of simulation and gaming, why pursue this style of educational training? Because it holds so much potential and the pros far outweigh any possible cons.

First and foremost, teaching students through simulation and gaming just makes sense. It’s more fun than learning through passive teaching methods like lecturing, and the student retention rate of information is much higher (see “The Learning Pyramid” chart).

Let’s take the example of an online simulation game called “Zero Hour: America’s Medic,” produced by the National Emergency Medical Services Preparedness Initiative (NEMSPI). This game recreates a mass casualty incident, allowing the instructor to determine the factors in the situation: what types and severity of casualties, the weather conditions, and how many responders there are, just to name a few. Players must deal with chaos, panic, large volumes of patients, and needs that far exceed available resources. Each time EMS providers play the game, they have different resources to work with, different scene hazards to deal with, different patients to treat, and different resources they can call upon. The game’s major focus is enhancing and re-enforcing providers’ skills and abilities in four key target capability areas:

  • Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) Detection
  • Triage and Pre-Hospital Treatment
  • Information Collection and Threat Recognition
  • Information Sharing and Collaboration

The students benefit from simulation gaming in multiple ways. As we discussed earlier, practice makes perfect, or at least more prepared. With Zero Hour and other similar games, students have the opportunity to practice over and over again, sharpening their skills in an immersive, yet low-risk environment that replicates the sights and sounds of a real disaster. Instructors can give immediate feedback by critiquing the student’s decision-making during the experience, as well as increase the difficulty level as the student’s skills improve. It’s important to note that this game and others like it not only measure the time-to-task, or how quickly the student responds; it also helps the instructor evaluate the student’s understanding of processes and procedures.

Anyone involved in EMS knows that we serve others as a team. Cooperation between caregivers is a necessity if the end goal — saving lives — is to be accomplished. One of the unique things about medical simulation and gaming is its ability to serve as a team builder. In addition to evaluating an individual’s caregiving and decision-making skills during a virtual-reality experience, trainers are able to test a student’s communication with other responders. EMS professionals who are playing the game must work together with different types of clinicians — nurses, physicians, respiratory technicians, pharmacists and others — to solve problems and work through real-time emergency situations. After going through the simulation, teams meet with trainers to debrief the experience. They can watch the events of the scenario on video and discuss what they learned and what they would do differently next time. At the end of the event, players have a better understanding of each other’s responsibilities, as well as a clearer vision of how to streamline emergency responses.

Another important benefit of simulation gaming is an obvious one: the absence of danger to the patient. Patient safety depends on the prevention of human error. So it’s logical that the more practice a caregiver has performing a given task, the more likely he or she is to do it well.

There will inevitably be a first time for a responder to perform a high-risk procedure or resuscitation in real time on a real patient, but before that happens, shouldn’t that responder have access to the most extensive, true-to-life training available? When all is said and done, do we or do we not want our responders to save as many lives as possible? Do we want them to make mistakes, or do we want them to master their field?

The Money Matters

During its infancy, medical simulation was thought of as an expensive novelty. But as information spread about its effectiveness in teaching caregivers, interest in different types of simulation grew. After electronic simulation using mannequins was featured at a number of safety conferences in the late 1980s, there was a slow and steady increase in the investment of money and resources dedicated to its development. The National Board of Medical Examiners (NBME) began funding research on the effectiveness of simulation in teaching medical students, and by the mid-1990s, surveys showed that more than three-fourths of medical schools reported using some form of patient simulation in their curriculums. Finally, in 2004, the NBME implemented patient simulation as a requirement during the clinical portion of its national medical licensing process for physicians. The popularity of simulation in educational settings grew from that point.

These days, because major medical schools and forward-thinking hospitals want to take full advantage of the capabilities of simulation technology, many are creating their own learning centers, much like a virtual hospital. These “simulation labs” mimic health care settings, such as an emergency department, an ICU, a birthing room or surgical suite, and students care for electronic adult and pediatric patients alike. The advancement in the technological abilities of these mannequins students care for is astounding. Simulation lab instructors can program them to speak to students until they “lose consciousness.” The mannequins breathe with realistic gases, have measurable pulse and blood pressure, and urinate. They even open and close their eyes, and their pupils dilate, reacting to light. Students can monitor the mannequins’ cardiac rhythms on attached monitors, administer medications to them, and watch as they respond based on their programmed age and sex. Depending on the level of financial investment, some centers have installed control rooms for video recording the student caregivers during these role-playing activities, as well as conference rooms for student self-assessment and peer evaluation.

From Hollywood to Home

In May of 2010, Newzoo, an international market research firm that focuses on the games industry, estimated that American consumers spend more than $25.3 billion on video games each year — yes, that’s billion with a “b”. And that doesn’t include the sales of brand new game console hardware and accessories in the U.S., which accounts for an additional $9.7 billion. As you can see, gaming is big business.

While video games were originally created for entertainment purposes, they have evolved into so much more. There are multiple software companies committed to producing the medical education and training games mentioned earlier. One such company is Virtual Heroes, based in Research Triangle Park, North Carolina. Their latest software, HumanSim, will soon provide health care professionals with one of the most realistic training opportunities on the market. The folks at Virtual Heroes have even partnered with Apple to make it possible for consumers to purchase and download HumanSim to their Ipads, enabling users to have a mobile medical education experience.

Wii is another producer of medical simulation software. Fans of computer gaming are all too familiar with Wii, the home video game console created by Nintendo. Their latest medic software is called Trauma Team, which allows multiple players to take part in the caregiving experience. While Trauma Team wasn’t specifically created to train real caregivers on how to do medical procedures, it shows that software companies see a unique niche in medical simulation and gaming.

The Future of Simulation and Gaming

What will medical simulation and gaming look like in the future? It’s where health care education will have to go if we are to meet the needs of caregivers — and our patients — in the 21st century. Our lives are becoming more and more digitally-based; practically everyone these days has a mobile phone with internet access. Why shouldn’t emergency responders have access to the best education tools available? If that means computer gaming, let’s pursue it.

Amar Patel is the Director of the Center for Innovative Learning at WakeMed Health & Hospitals. Mr. Patel is responsible for integrating technology based educational programs to include human patient simulation, healthcare gaming, and hybrid education into regional educational programs. As a member of the Center for Patient Safety, Patel strives daily to make changes to processes in healthcare that will directly improve patient and provider safety.

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