October 3, 2018By Lance Baily

JEMS: Standardization of EMS Simulation Activities Improves the Learning Experience

A recent JEMS publication by Aaron Dix, NRP, MBA, CHSE, NCEE, CP-C , Jennifer McCarthy, MAS, NRP, MICP, CHSE , and Andrew E. Spain, MA, NCEE, EMT-P entitled “Standardization of EMS Simulation Activities Improves the Learning Experience” concluded that “Standardization is an essential consideration for any simulation activity” and that “the level of standardization must be specifically chosen and incorporated into the design to ensure that each simulation is appropriate and useful.” Furthermore, the research found that “Standardization within simulation activities improves quality and the experience for learners [and] also enhances the efforts of proper simulation design, execution and debriefing making the effort of evidence-based practice worth it.”

In other words skip the “cool” scenario to show off your last shift and focus on creating repeatable simulation experiences that your organization needs to maintain competency for. Even if you aren’t performing EMS simulation experiences, this article is very useful to pointing to the minimum standards your simulation program should be following! Here is a few key points from the full article available on the JEMS website.

JEMS Article Excerpt

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Standardization may sound like a simple notion. To suggest that simulation has some uniformity, at least presumed uniformity, is fascinating to ponder. Just like a medical or trauma condition isn’t uniform in its presentation, simulation may also present itself in myriad fashion, creating challenges for educators.

For the purposes of this article, standardization shall be understood by its definition in Merriam-Webster, “to bring into conformity with a standard.” The goal is to discuss appropriate structure and methodology, yet still allow that simulation to be delivered creatively.


There are many standards that exist that describe the framework for appropriate simulation. Each set has a unique perspective that can help to capture what is needed to design, develop, deliver and debrief simulation activities. For instance:

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  • Programmatic/institutional standards (e.g., Society for Simulation in Healthcare Accreditation of Healthcare Simulation Programs);
  • Simulation design/debrief (e.g., International Association For Clinical Simulation and Learning Standards of Best Practice);
  • Simulation modality specific (e.g., Association of Standardized Patient Educators Standards of Best Practice); and
  • Individual role/responsibilities (e.g., Society for Simulation in Healthcare’s Certification Programs).

Each of these standards has been developed to support quality healthcare simulation. They’re grounded in research and/or data and were developed with input from subject matter experts worldwide. They have varying levels of specificity and each supports the standardization that’s desirable in simulation.

Adherence to Objectives

Designing a simulation activity should always begin with the development of learning objectives. Facilitators must understand the purpose educationally for completing the activity. To maintain a valid and reliable learner assessment, every participant needs to receive the same information related to the scenario with the same progression within the case, providing the same cues or feedback at the same time and with the same inflection or importance.

Utilizing a written script, with timed triggers, as well as providing facilitator briefing prior to each simulation activity, can help overcome the inherent urge of many facilitators to be helpful and freelance within an activity. The case result may differ based on the decisions of the participant, but the standardization in presenting the case the same way for each learner is paramount for accuracy related to skill competence. Equally important is assessment and feedback to the facilitators for quality improvement.


There are many standard methods for conducting a debriefing. Beyond choosing a style or method, there are standards that help prepare for an effective debriefing session. Developing standardized debriefing questions related to the learning objectives assists in streamlining the session. Debriefing immediately following the activity is a standard that enhances the reflective learning and improves the quality of the debriefing. Ensuring a psychologically safe, non-punitive, non-judgmental environment is a standard that’s paramount to shift the EMS culture of safety and improve learning from the simulation activity.

About JEMS

JEMS (Journal of Emergency Medical Services) seeks to improve patient care in the prehospital setting and promote positive change in EMS by delivering information and education from industry leaders, change makers and emerging voices. With a rich tradition of editorial excellence and an unparalleled consortium of subject matter experts and state-of-the-science content, JEMS fulfills its commitment to EMS providers, instructors and administrators through all media channels including online and print.

Read the Full Standardizing Simulation Article on the
JEMS Website Today!

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