My second article explained some of the major challenges faced by first responders who serve in rural areas, as they have limited access to high-tech training opportunities. Rural emergency medicine offers specific challenges, like longer response times, sicker patients prior to EMS arrival, and longer transport time to a care facility. Combined with the fact that the first person to respond at the scene of an accident could be the only responder for an extended period of time, these pressures can cause caregivers to make unnecessary mistakes.
However, thanks to evolving training opportunities — specifically, simulation-based classes and programs developed for rural providers and hospitals — these mistakes aren’t inevitable. Simulation training is important so firefighters, nurses, law enforcement officers and EMS professionals can benefit from real-life simulated cross-training. Education, practice and re-education are critical if these first responders are to become more comfortable and more adept at caring for the sick and critically ill.
The third article in this series emphasized the importance of preparation and the role it plays in our lives as emergency responders. Preparation can mean the difference between life and death for the people whose fate we hold in our hands. As caregivers, we have to professionally prepare ourselves for the common and not-so-common 9-1-1 calls we could receive at any time of the day or night. That preparation can be found in an unlikely place — simulation gaming.
While numerous other industries embraced simulation decades ago, health care has been relatively slow to catch on for three primary reasons:
- Skepticism on the part of an older generation of caregivers who learned their skills through traditional methods
- Limited information sharing until just the last two decades
- The lack of long-term data to prove claims that caregivers’ performance improves due to the use of simulation, a reason that flies in the face of evidence-based science and medicine.
However, simulation and gaming hold so much potential when it comes to teaching first responders, the pros far outweigh the cons.
In this fourth and final article, we’ll get down to brass tacks: how much money does simulation actually cost, and how do the return on investment and the return on expectation compare? Can we learn from other industries that have used simulation training with great success?
The MERI: An Investment in Education
When it comes to medical education, there is one training facility that simply outshines most others in the United States — The Medical Education and Research Institute (MERI) in Memphis, Tennessee. Inspired in 1992 by Dr. Kevin T. Foley, MERI medical director and chairman, this hands-on medical teaching and training school provides educational courses for more than 10,000 physicians, nurses, and other medical professionals from across the country and around the world each year.
Participants, including many EMS professionals, have the opportunity to learn first-hand about the most up-to-date techniques and use the latest technology available to caregivers. The emergency medical training and response instruction is amazingly life-like, with disaster scenarios involving smoke, fire, water, and patient simulators — both live and mannequin. I encourage you to take a look for yourself at www.meri.org/index.php/overview.htm. I think you’ll be pleasantly surprised by the realistic nature of the training events.
As you can imagine, this technology and education doesn’t come cheap. But MERI is 501 (c) (3) non-profit and depends on grants and charitable donations from corporate sponsors, foundations and individuals to help fund the Institute.
MERI is governed by a 12-member board of directors, which includes leaders from its charitable member organizations, including Baptist Memorial Health Care, Methodist-Le Bonheur Healthcare, and Semmes-Murphey Neurologic and Spine Institute. The Institute also recently received a $2.9 million grant from BlueCross BlueShield of Tennessee Health Foundation, which will be specifically used to build team-focused simulation programs and will help purchase new medical simulators, computers and software for training. Additional funding has come from the US Department of Homeland Security for EMS disaster training. And if a state-of-the-art medical training institute weren’t enough, there is Mobile MERI, a mobile training unit that provides courses and support to customers throughout the continental U.S.
You may be wondering why I’ve explained the funding behind MERI, but there is a very clear connection: the financial support MERI has received points directly to the fact that huge corporations, and even the U.S. government, believe so strongly in the value of medical simulation, they are willing to commit millions of dollars each year to using it in the instruction of medical personnel. Basically, they’re putting their money where their mouth is. If your own team or organization questions whether using simulation to educate personnel is really “worth it,” MERI is a shining example that it is.
The Value of Simulation: Real Life Examples
Let’s be honest — health care is years behind other industries when it comes to using simulation in training. For decades, commercial airlines and the U.S. military have made simulation an integral part of their training programs, requiring thousands of hours of flying experience and combat simulation for aircraft pilots and soldiers, respectively. Let’s take a look at two examples straight from the news headlines that show just how important simulation training can be when lives are at stake.
Sully the Hero
People were glued to their televisions on January 15, 2009, when they found out that, against all odds, Captain Chesley “Sully” Sullenberger had brought U.S. Airways Flight 1549 safely down in the Hudson River after having lost both engines shortly after takeoff from LaGuardia Airport in New York, N.Y.
An unexpected bird strike had caused both engines to shut down, giving Sullenberger and his co-pilot Jeffrey Skiles just three and a half minutes to determine the best course of action and to land the disabled plane that carried 155 passengers and crew members. Rapidly losing altitude and unable to reach an airport, Sullenberger decided to use the Hudson as an emergency runway.
“The physiological reaction I had to this (situation) was strong,” he told CBS reporter Katie Couric during an interview on the news show “60-Minutes. “And I had to force myself to use my training and force calm on the situation. We’re trained to land in the water near other boats to facilitate rescue. That was where the airplane was headed, and that was a good place to go. I was sure I could do it.”
And he did do it. All 155 passengers and crew members survived the crash with minimal injuries. Sully, a former U.S. Air Force fighter pilot and 30-year veteran as a commercial pilot, specialized in accident investigations and instructed flight crews on how to respond to crises in the air. He had spent hundreds of hours in a flight simulator and thousands more in the cockpit.
“I think in many ways, as it turned out, my entire life up to that moment had been in preparation to handle that particular event,” says Sully.
That sounds like a vote for flight simulation to me.
Osama is Dead
On May 1, 2011, Americans across the world celebrated upon hearing that Osama Bin Laden, the mastermind behind the 9/11 terrorist attacks, had been killed in Pakistan. The heroes in this mission were a group of elite soldiers called SEAL Team Six, part of the U.S. Navy’s Special Forces Group. They were whisked into Pakistan by helicopter, stormed the compound where Bin Laden and his family were hiding, and shot and killed the man who was ultimately responsible for the loss of more than 3,000 American lives on Sept. 11, 2001.
But the SEALS didn’t undertake the mission to capture Bin Laden without proper preparation. These soldiers, who are considered to be the best of the best, endure torturous training for more than 30 months before they are considered to be ready for deployment. They are pushed to the limit both physically and mentally in order to weed out those who may not be able to successfully complete the demanding missions and operations with which SEALS are faced. Their education includes rigorous physical conditioning, SCUBA training, and land-warfare training, a program so difficult that only a select few make it through the program each year. In fact, there are only about 2,500 active duty NAVY SEALS.
The raid on the compound where Bin Laden was hiding required practice, so the SEALS replicated the one-acre compound. Trial runs — NOTE: SIMULATIONS — were held in early April, and the mission was a resounding success. Bin Laden’s death helped bring a bit of closure to the American wounds caused by 9/11, and as President Obama said when he addressed the nation to announce the success of the mission, “Justice has been done.”
Score one for the Navy SEALS, and score one for simulation training.
Dollars and Sense
You may be thinking, “That’s terrific that simulation training works, but how much money are we going to have to invest?” In these tough economic times, budgets are being cut, and organizations have to use their training dollars wisely. The cost of medical simulation training actually depends on a number of factors, including:
- The training location: Is it possible for attendees to participate in training remotely, via computer, or must they go to another physical location? Can the training come to them? If so, what is the associated travel cost?
- The length of the training: how many hours/days/weeks will participants invest?
- The depth of the training: will participants simply take part in computer simulation, or will the training involve interactive, real-life scenarios involving mannequins or human patient simulators? Will there be actual environmental components to the training, such as fire or water? Will EMS vehicles play a role in the training?
It’s only common sense that the more intense the training, the more expensive it will be. Fortunately, there is simulation training available to fit every budget, and a quick search on the Internet can provide a wealth of information about program options. Training organizations understand the limitations of some first responder teams, whether it’s staffing, budget or location issues. Do your research, and I have no doubt that you’ll find a program to meet your needs.
Please keep in mind that after your organization goes through simulation training, the real results will be evident when “the rubber meets the road” — when employees are actually using their new, advanced skills on the job. That’s when you’ll see the real ROE, or “Return On Expectations.” Through their successes on the job, they will build a chain of evidence that demonstrates the bottom line value of simulation training. And I can promise you, the investment will be worth it.
Amar Patel is the Director of the Center for Innovative Learning at WakeMed Health and Hospitals. He 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. The WakeMed Center for Innovative Learning was recently designated a Center of Educational Excellence by Laerdal Medical, one of the world’s leading providers of health care solutions, including products and services for simulation, immobilization, basic and advanced life support, patient care, self-directed learning