Do or Die: The Immediate Need to Standardize Simulated EMS Training
While training to become a firefighter, HealthySimulation.com Founder/CEO Lance Baily recounts “we had several Captains from different cities around Los Angeles donate their time to train our cohort — and while I was happy to learn how to pick up and carry the 120lbs 21-foot extension ladder the unique ways each municipality prescribed, at one point I finally had to ask the Chief of the Academy to explain exactly which method we would be tested on”. While a basic example, the importance of considering standards across simulated learning within EMS is clear. How can we ensure that our learners hit program wide performance benchmarks without standardizing the medical simulation experiences they are all to receive? A recent iSimulate sponsored EMS World article written by Jennifer McCarthy, MAS, NRP, CHSE-A helps us better consider “The Importance of EMS Standards Across Simulation Learning”.
Baily further shared that “during my academy, instructors would just make up rescue scenarios or fire drills on the fly”. “Not only did this fail to standardized training outcomes across different cohorts” Lance continued, “but it was quite dangerous as on several occasions drill fires became real fires due to lack of planning”. He added, “Luckily, a lot has changed since my training 15 years ago”, as now Paramedicine is one of few healthcare professions which requires a 20 medical simulation demonstration during initial licensing.
McCarty explains in her article “After initial licensing recurring competency assessments are often conducted through simulation activities. These assessments are meant to capture continued competence of providers. Despite this high integration and use of simulation, few EMS educators have obtained a certification in healthcare simulation or accredited their EMS education program’s simulation activities. Drawing a quality standard on EMS simulation activities is vital since simulation-based assessments are utilized for determining provider competence and workforce readiness. Shortcutting this level of quality can negatively impact providers and ultimately patient safety.”
Perhaps though none of that should be surprising considering the warning signs from the 2015 descriptive study “Simulation Use in Paramedic Education Research (SUPER)”. The national study found that “Paramedic programs have and have access to diverse simulation resources; however, faculty training and other program resources appear to influence their use.” Frustratingly, the survey also found that “Simulation equipment (of any type) reportedly sits idle and unused in (31%) of programs [with] lack of training was cited as the most common reason.”
McCarty continues on EMS World writing “designed healthcare simulation activities are based on student readiness and level of function, require established objectives, are trialed before being delivered, utilize assessment rubrics, promote participant self-reflection, and are debriefed by experienced facilitators. While this list may appear lofty, it consists of items that are at the core of high-quality simulation practice that should be the hallmark of all simulation activities. These items are essential to evolving simulation practices so they can have the most impact on safety.”
In a similar JEMS article “Standardization of EMS Simulation Activities Improves the Learning Experience“, key areas of focus are explored when considering standardization. Programmatic/institutional standards, Simulation design/debrief, Simulation modality specific, and Individual role/responsibilities are key frameworks, but also important to consider are realism, adherence to objectives, programming, standardized patient training, inter/intra-rater reliability, and debriefing processes.
The bottom line here is that if we fail to standardize simulated training for EMS professionals, we won’t be able to demonstrate improvement of outcomes following hefty investments into advanced technologies. And that means our future requests for increased funding for simulation will quickly fall on deaf ears. As we are still in the early-adopter phase of ems simulation, unfortunately the burden of proof is still ours to bear.
The International Nursing Association for Clinical Simulation and Learning (INACSL) has developed the “Healthcare Simulation Standards of Best Practice” to advance the science of simulation, share best practices, and provide evidence-based guidelines for implementation and training. The INACSL Standards of Best Practice: Simulation provide a detailed process for evaluating and improving simulation operating procedures and delivery methods that every simulation team will benefit from. Adoption of the INACSL Standards of Best Practice: Simulation demonstrate a commitment to quality and implementation of rigorous evidence based practices in healthcare education to improve patient care by complying with practice standards INACSL created a Simfographic to represent each INACSL Standard of Best Practice: Simulation. The Simfographics provide a graphic representation and the criteria for each of the INACSL Standards of Best Practice: Simulation.
And for SPs, check out the The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP), for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the INACSL Standards.
Lance Baily, BA, EMT-B, is the Founder & CEO of HealthySimulation.com, which he started while serving as the Director of the Nevada System of Higher Education’s Clinical Simulation Center of Las Vegas back in 2010. Lance is also the Founder and acting Advisor to the Board of SimGHOSTS.org, the world’s only non-profit organization dedicated to supporting professionals operating healthcare simulation technologies. His new co-edited Book: “Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice” is available now. Lance’s background also includes serving as a Simulation Technology Specialist for the LA Community College District, EMS fire fighting, Hollywood movie production, rescue diving, and global travel. He lives with his wife Dr. Abigail Baily in Las Vegas, Nevada with their newborn daughter and two crazy dachshunds.