Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

Abstract

IntroductionWe describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers.MethodsA simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic).Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place.ResultsThis training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS) doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service.DiscussionThe teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by the imagination of the trainers. Significant effort is made to put the participants into "the Zone" - the psychological mindset, where they believe they are in a realistic setting and treating a real patient, so that they gain the most from each teaching session. The method can be used for learning new skills, communication and leadership as well as maintaining existing skills.ConclusionThe method described is a low technology, low cost alternative to high technology simulation which may provide a useful adjunct to delivering effective training when properly prepared and delivered. We find this useful for both induction and regular training of pre-hospital trauma care providers.

The delivery of the new prehospital emergency medicine curriculum: reflections on a pilot programme in the UK

“…The majority of the curriculum elements was fulfilled, with some areas supplemented non-clinical experience via case simulations or courses. Given the opportunistic nature of clinical exposure in the prehospital environment, simulation has become an established training method in HEMS systems,7 and is recommended as a training and assessment tool by IBTPHEM 2. It was not possible to fulfil the curriculum elements focussing on the management of prehospital obstetric emergencies during this placement, as such cases are rarely encountered.…”

Pre-Hospital Advanced Life Support Education – Core Components for Pre-Hospital Professionals

“…The literature identified that education should be realistic and conducted in environments replicating real-world settings the student is likely to encounter (12,13). One way of achieving this is through simulation.…”

“…Providing simulation training in environments similar to that in which the students are expected to perform their skills enhances learning without endangering the lives of real patients. Bredmose et al (12) described their use of outdoor simulation for helicopter medical crews over a 2-year period. The authors identified the use of outdoor scenarios enabled crews to develop crew resource management skills, extrication and experience handling unsafe scenes and administering clinical care in uncontrolled environments.…”

“…Simulation education should be realistic and held in environments not dissimilar to where the student is likely to encounter real patients (12,13). The literature identified that simulation ensures skills can be learned in a controlled environment and mistakes made without endangering patient welfare.…”

“…The literature identified that simulation ensures skills can be learned in a controlled environment and mistakes made without endangering patient welfare. The literature also identified realism in simulation, which includes reflecting the teams and equipment used in the participants' usual work environment, is an important aspect of training (12)(13)(14). The survey completed as part of this research identified that, commensurate with the literature, simulation was used in all courses.…”