By LOUIS M. MOLINO
Fire & Safety Specialists
Maintaining EMS skills can be a major training responsibility in the industrial sector. Thankfully, industrial responders answer far fewer calls than their municipal counterparts. Still, ready responders have demonstrated their lifesaving value in industrial emergencies ranging from heart attacks, falls and even fire. To keep these responders trained, simulators are valuable training tools that provide realistic situations to test and confirm their readiness.
Simulations are not new to the fire and emergency services. From simple smoke mazes to modern computer simulators such as CommandSim, responders have benefitted from the improvement in training. Not only do computer simulations offer reality, but they can be cost effective. Weigh the initial purchase price against the liability to individuals participating in a live-fire emergency exercise gone wrong. Tighter training control assures safe, effective results. Some simulators even provide documentation of training performance for personnel records.
When it comes to EMS simulation training, students are given mannequins that present symptoms of a specific syndrome such as chlorine exposure or cardiac arrest. Another option is developing a critical care environment where students are presented numerous simulated patients with symptoms ranging from changing blood pressure, temperature and even slurred speech. Instead of depending on human patients and their acting skills, simulations can be controlled by a behind-the-scene operator to produce high fidelity symptoms. Students can take blood pressure, monitor lung sounds and even check for a pulse.
Computer controlled mannequins can be used in high risk environments too dangerous for live participants. These “ruggedized” patients can be used in simulations as extreme as a battlefield foxhole or a high angle rescue from a refinery tower. The mannequin can be pre-programmed or controlled by an operator guiding the mannequin’s response to the how they are addressed and treated by the EMS responder.
The trained operator is the key to help the trainee determine the appropriate response questions care providers can ask to pinpoint correct care. The patient may be conscious or unconscious. If conscious, the operator can speak as though the patient is responding to indicate how their condition may be compromised.
Before the “ruggedized” mannequins were available, the mannequins being used were too sensitive to be exposed to high risk environments. Models are now available that can be suspended from scaffolding to simulate a fall victim, or put into a confined space to coordinate with rescue operations.
These mannequins not only avoid placing real people in unnecessary risk during simulation, but give the trainer more control over how the “simulated person” responds to the responder. If you use real people, their blood pressure and pulse rate are not actually going to be elevated. The responder misses that aspect of a real emergency.
You can strap a bleeding wound simulator to a volunteer patient, but the patient’s vital signs are not going to become unstable the way a real patient would under those conditions. Ideally, you want a simulation where you can change the patient’s response according to appropriate or inappropriate patient decompensation. Action such as stopping the loss of blood or CPR will provide appropriate patient reaction. If the operator is so inclined, operations may not produce the expected results. For example, a wound compression may not work, so the responder may need to go to pressure points or, if that doesn’t work apply, a tourniquet.
The operator can observe how well the student compensates. Do they take other actions such as applying pressure and raising the arm above the heart, which may control the bleeding? The operator can determine if the bleeding is to continue or not. Some mannequins on the market allow the trainer to “preprogram.” Rather than begin in extreme trouble, the simulated patient may only be in limited distress.
If the responder does not act appropriately, the condition of the mannequin can get worse, up to and including death. Identical conditions can be repeated until the student responds appropriately. Simulation allows similar patient conditions to occur in different environments so the student is not seeing the same experience repeatedly, but is dealing with the same symptoms.
A trained operator is the key to make each simulation effective for the student to get the most out of it. Remember that the focus in not on the operator but the mannequin that is interacting with the student through the operator. The operator, via the mannequin, gives feedback such as “That hurts” or “That makes it easier for me to breathe.”
Another benefit of the “repeating” function is its value in testing. You can give each student the same objective experience by programming the mannequin to repeat the same scenario in different testing environments.
Simulations do not replace clinical or real world experience. They provide preparation for those experiences by letting students encounter risky situations without a real patient suffering the consequences of an incorrect response. If the student does something to cause pain, the operator can prompt that response from the mannequin. If the student helps the patient to improve, the cooperator can create the appropriate response.
Compare the EMS simulator with a flight simulator that allows the plane to crash if the wrong actions are taken without the real tragedy of a plane crash. When you decide to buy simulated training mannequin, check to be sure about all possible functions it performs. Determine what the operator can control and program it to do. How does it respond to student actions. Most new mannequins are “raising the bar” of what is technologically possible. Compare costs but also compare what can be achieved. If it costs more than your budget allows, check the option for a joint purchase through a mutual aid organization or grant sources to allow the best training affordable.
The main point is purchase a simulator that can deliver patient conditions realistic enough to lead the responder to the correct conclusions. If the student acts properly, the operator, in turn, triggers the correct response from the patient and vice versa. The operator watches for mistakes such as administering medication without checking for patient allergies. The operator’s expertise and recognition of inappropriate actions is the key to the effectiveness of any simulator.
Simulators are not a game. They help those in charge learn if their people are ready or if they need more training. Peoples’ lives depend on their readiness.