November 6, 2012By Lance Baily

What Can Medical Simulation Learn from Scuba Diving?

medical simulation scuba diving

Recreational scuba diving provides us an amazing opportunity to explore the world’s sea life up to a maximum depth of 120 feet.  While hundreds of thousands of people enjoy scuba diving safely every-day all around the globe, the sport is not without serious risks.  Decompression sickness, narcosis, wildlife dangers and suffocation are all moments away for individuals who do not adhere to strict guidelines and procedures taught by professional societies such as PADI, SSI or Naui.

Last week my girlfriend Jackie and I traveled to Roatan, an island off the coast of Honduras for a scuba-diving adventure. We spent several days diving anywhere from 35 to 103 feet in warm 85 degree water to experience amazing sea life on the coral reef including thousands of species of fish, sting-rays, jellyfish, lobsters, crabs, sharks and even an octopus!  As a certified PADI Rescue Diver, I have accomplished dozens of dives in open ocean-water environments before… but as a new diver who had only recently completed her Advanced Open Water training in the lakes near Las Vegas, these off-shore boat dives offered some new challenges for Jackie.

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For example, in Kingman Wash of Lake Mead, if Jackie had overweighted herself and sunk to the bottom during her open water training course the maximum depth of our area was 25 feet – which has little health ramifications.  In Roatan, however, if she had lost the same control she could have easily hit 120+ feet which is dangerous because 1) compressed air at that depth means she has much less oxygen than at 25 feet and 2) anything over 130 feet requires several ‘decompression’ stops back up to the surface to prevent ‘decompression illness’ which could require more air than she has available on her back.  While new divers like Jackie can appreciate these lessons theoretically from the book or after imaging that the lake’s 25 feet bottom was 125 feet, it is a much different experience to look down after jumping into the water from the boat and not being able to see the ocean’s floor.  As with healthcare education and training, nothing can prepare us for the real thing like the real thing.  But that being said, “leveling up” to that phase of the training through book work, classroom reviews, multiple choice exams, pool training, and lake diving provided Jackie with enough grounded experiences to prepare her for this first ‘ocean’ journey.

Click the link below to read on and learn how professional diving groups have created certified training programs which rely heavily on simulation to provide novice adventurers with the tools necessary to enjoy the world’s oceans safely and successfully – and what our medical simulation community can learn from scuba diving.

healthcare simulation scuba

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Let’s explore further how professional societies like PADI train us to become certified in safe-diving experiences.  After reading a 250 page manual, learners answer 5 knowledge review quizes which are then gone over during a five hour class.  During this classroom session topics such as diver safety, gear, hand signals, nitrogen levels, depth restrictions, buoyancy, and more are covered.  Learners are instructed on the theories of diving and explain what skill sets will be practiced in the pool.  Next, learners spend a full day in a pool with a maximum depth of 14-feet.

The pool is the learner’s “simulated” open-water environment 

After learning how to properly setup their gear learners start their first pool session. To begin their simulated experience, learners kneel in the shallow end of the pool and practice removing and ‘clearing’ (the process of expelling water) their masks and finding their air regulator if it comes out of their mouth.  Of course in this low-fidelity skill situation there is almost no danger that the learner will drown as they are able to simply “stand up”. Throughout the rest of the day, learners become comfortable practicing more complicated skills such as submerging and descending/ascending safely, using hand signals to indicate low-air to their buddy and “sharing air” from their emergency regulator. Each skill must be demonstrated precisely to the instructor at depth to be “checked off”.

scuba simulation

For the next two days, divers are taken to an “open water” location which could be a lake or an ocean. During this weekend, divers are required to repeat the same skill-sets demonstrated in the pool. Some might ask then “why not just skip the pool training and complete the skills education with an additional day at the open water location?”. Consider these additional factors which allow learners and their instructors to specifically focus on the skills they need to be safe:

The pool…

  • is smaller and provides instructors with more physical control over new divers.
  • is temperature controlled whereas open water locations can be as low as 47 degrees, making learning or practicing new skills much more difficult.
  • does not have a current which could take the novice learner away unexpectedly.
  • is very shallow compared to open-water environments which can psychologically overwhelm a new diver.
  • has limited depth which means emergency rapid ascension to the surface cannot inflict much damage due to over-expanded lungs.
  • has multiple exit points whereas an open water location may only have one, and is usually closer to EMS systems.
  • does not have additional sea-life which could be poisonous or otherwise dangerous.
  • has boring concrete walls which offer little distraction to new divers compared to exciting open-water environments.
  • is not salt-water based which can add additional buoyancy making tasks harder to accomplish.
  • can have controlled lighting installed or be in-doors and thus not affected by rapid weather changes.
Many of the reasons above could be directly connected to similar benefits of a clinical simulation lab, which is also a controlled environment to learn and practice skill sets which in the real world can be dangerous or overwhelming. While the size of our healthcare simulation lab might not be a direct concern for learners, understanding where supplies are located in that room and how to put them to good use sure is.  Why risk these learning opportunities on real patients when a simulated lab can provide the same experience without any long-term risk?  In other words, in medical simulation we put healthcare learners into simulated environments (sometimes designed to be considered unsafe) and then ask them to make cognitive, behavioral and communicative decisions and actions based off their findings. As with medical simulation, after each underwater session instructors debrief with learners and go over what was learned, answer questions and reflect on shared experiences.
Diving takes practice to do right. I myself did not learn how to achieve neutral buoyancy (the ability to remain still underwater in one place without losing control) until diving about 25 times. There were times I dawned my scuba gear and jumped in my local pool just to practice the skill without other ‘diving’ objectives. Having a safe place to simulate an ocean experience that was easily accessible provided me with the opportunity to better my skill-set before entering into life-threatening or otherwise stressful environments. By “leveling up” my training, or taking the next logical step in progression as I moved from the bookwork, to the classroom, to the lab, and then out into the real world gave me the best opportunity to “try on the shoes” and “reach” for the next level of understanding from a safe place. I would bet that any healthcare professional who is also a scuba diver would agree that this tiered and structured approach to learning performance-based skill sets eased the learning process for the sometimes overwhelming process of diving.
Medical simulation adds a safe “pool” to learners educational career
By providing a safe-space for new healthcare students to learn or healthcare professionals to rehearse we enable them the ability to better focus on perfecting specific skill-sets that are necessary to perform well in stressful environments. Regardless of whether or not those environments are life-threatening or not, real-life critical healthcare situations are similar to the ocean in that they always contain an element of the “unknown”. In healthcare, by being able to work on what can be known ahead of time, (such as team-communication, IV insertion, chest compressions, patient assessment), we better prepare our learners to handle those “unknowns”. In this day and age, every healthcare provider should be provided with the same opportunity to experience the role of “provider” before actually jumping into shark-infested waters of patient care.
Are you a diver or do you agree that medical simulation provides learners with a unique space to learn safely? Drop us a comment below and share your thoughts!

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