FEATURED CASE STUDIES

Simulation-based Training for Emergency Medical First Responders

FIRST

The Problem

The EMS Division of the National Highway Traffic Safety Administration 2001 roundtable identified “limited access to simulation training technology" as a challenge for EMS patient safety. In addition to training in relevant taskwork skills, there is a need for first responder training in cognitively-based skills such as situation assessment and decision making. The roundtable concluded that a major stumbling block for widespread incorporation of simulators into EMT training, especially into smaller regional EMS units, was the limited availability of curricula infrastructure and expertise for effectively linking scenarios with skills and measurements.

The Solution

To meet the need for targeted simulation training focused on cognitive skills, Aptima developed the First Responder Simulation Training (FIRST) training program in conjunction with our partners, Beth Israel Deaconess Medical Center, the Center for Medical Simulation at Massachusetts General Hospital, and the Monroe Community College Patient Safety Center in Rochester, NY.

The program uses mannequin simulator technology and is comprised of:

five detailed scenarios;
evaluation instruments and debriefing guidelines for each scenario;
a multimedia tutorial that explains how to use the evaluation and debriefing instruments;
a detailed scenario guide for administering the scenarios.

Together the FIRST scenarios are designed to cover four high-level cognitive skills that are critical for EMS success: communication, situation awareness, prioritization, and resource management.

Each scenario is centered around two critical events that exercise targeted cognitive skills. For each scenario, there is a detailed outline of the scenario events, a description of the skills that are targeted and where in the scenario they are exercised, and instructions on how to set up the scenario including a list of required props, specifications on how to configure the simulator, and, where necessary, scripts for confederates who are needed to play specific roles in the scenario.

Instructors use an observer-based evaluation instrument that is filled out while the trainees are carrying out a scenario, rather than after the scenario is done. This approach helps instructors link events in the scenario to the debriefing. Importantly, the FIRST program provides debriefing guides for the scenarios that allow any instructor, even those unfamiliar with cognitive skills training, to conduct effective After Action Reviews.

The Results

FIRST provides an off-the-shelf training program for medical first responders. The program is modular, portable, affordable, can be tailored to simulator availabilities, targets cognitive skills, and can be administered without an expert trainer or simulation expert. The program has been evaluated for usefulness and usability at an accredited National Registry EMT Paramedic Training and Test Facility, and has been well-received by both instructors and participants.

The FIRST program represents an important step towards extending the integration of simulation-based training into medical curricula to improve patient care.