While medical training often provides those preparing to be first responders with classroom-based instruction or basic mannequin training, those types of training methods cannot prepare these individuals for the unpredictable, high-pressure situations they’ll encounter in the real-world. High-fidelity simulators are designed to replicate the behaviors of real patients, including bleeding and breathing, and in doing so, they are better at preparing first responders to give medical assistance and perform operations in real-world encounters. With all this in mind, the question becomes, how can emergency care leaders and educators effectively use high-fidelity simulation to build resilient, disaster-ready teams capable of making critical decisions in chaotic, unpredictable environments?
The Reality of the “Golden Hour” in Chaos
A downside of classroom-based or low-fidelity simulation training is that when the time comes for first responders to perform operations on actual patients, they often will not be prepared for the cognitive overload and stress of the situation.
This lack of preparation can:
- Impede their cognitive abilities when performing operations
- Cause them to struggle to make proper judgements
- Cause them to hesitate for too long to make important decisions when every second counts.
Examples of the effect that intense and chaotic training situations have on stress levels lie in a study conducted in 2022 at the STRATUS Center for Medical Simulation. The study followed students who participated in a training session consisting of three simulated trauma scenarios while wearing heart-rate sensors. This study used heart-rate-variability (HRV) as a marker of cognitive load and found that “Compared to single-patient scenarios, multiple-patient scenarios posed a higher cognitive load” (Park et al.) This is precisely why it is crucial for first responders to be trained not only on providing the medical care itself, but they also need to be trained on managing their stress and cognitive overload when medical care must be performed in situations of chaos.
This is where stress inoculation comes in, which is the process of putting those training to be first responders in situations of intense pressure so they can better manage the stress of the real-life situations they’ll encounter.
A randomized trial at an EM residence practiced stress inoculation by breaking the process up into three phases: learning the effect that acute stress has on performance, practicing specific in-the-moment mental skills and coping strategies, and applying those strategies to real-world scenarios. Methods such as these help to ensure that first responders are able to maintain proper judgement under immense pressure.
The Power of Immersion with Simulation
Operative Experience’s TCCS Tier 3 Pro and TCCS Plus Pro simulators are examples of products that are used for this type of realistic high-fidelity training. Features of these products include eyes that blink independently, life-like complications in the airways, and a realistic circulatory system that powers wound sites that can experience pulsatile and venous bleeding.
OEI also has Smart Limb technology, which consists of interchangeable limbs that can allow one simulator to be used to represent many different mechanisms of injury.
These Smart Limbs are particularly helpful in situations where resources are scarce and ensure that the best use can come out of a small number of simulators. OEI also has the first fully-instrumented, 100% anatomically accurate female trauma simulator, which replicates actual female anatomy rather than simply taking a male simulator and altering its size.
Training for mass casualty scenarios is not only about having the confidence to properly treat patients. It’s also crucial for training methods in these situations to have environmental fidelity, which prepares trainees for the loud noises, dark surroundings, flashing lights, and tight spaces that they’d encounter in real situations as well. Including environmental fidelity in training ensures that the first responders will be prepared for the unpredictable hurdles that mass casualty settings may involve.
Structuring an Effective Disaster Simulation
High-fidelity simulators are often used in a process known as the Sort, Assess, Life-saving interventions, Treatment/transport (SALT). SALT is a mass-casualty triage protocol that allows trainees to gain practice in situations where there are countless patients with varying severity levels of injury who need to be treated all at once. Trainees must ensure that each patient goes through all the necessary steps listed above without hesitation. “The Model Uniform Core Criteria (MUCC) for mass casualty triage are endorsed by NAEMSP, ACEP, ACS, NAEMT, NASEMSO, AMA, and CDC, and SALT is currently the only triage system that meets all of them” (Cheng et al). Clearly, SALT is a reliable system when it comes to preparing first responders for just how intense mass-casualty events can be.
The Debrief — Where the Real Learning Happens
Another example of realistic training methods is PEARLS, which is “an approach to debriefing that helps facilitators balance emotional processing, critical analysis, and actionable learning” (EMS).
How the process works is that, after a training session is completed, a facilitator will first discuss with the trainees any feelings of stress, confusion, or pride they may have. Secondly, they’ll discuss the steps that the trainee made and what thought process led them to make the decisions and perform the actions that they did.
Finally, they’ll go over what the trainee did well and specific areas for improvement. This is a level of attention to detail in medical training that only high-fidelity simulators allow for. Today, the success of OEI’s simulators remains proof of this importance in life-like medical simulation.
Along with allowing for a thorough training and reflection process, high-fidelity simulations can also provide video capture and vital sign data tracking, and the objective performance data which is crucial for a successful debrief. This is an example of what sets high-fidelity simulation apart from other medical training methods. It not only ensures that the training itself is life-like, but it also can provide debriefs which are just as informative and detailed.
Case Study: Air National Guard Rollout
OEI's 2016 Air National Guard rollout included TCCS Pro male and female simulators in 90 ANG sites. This was one of the largest single training-simulator procurements, which also met the DoD-mandated Tactical Combat Casualty Care training requirements.
This is an example of how OEI is not just preparing its trainees for the necessary steps to provide medical assistance, but also for the intense pressure and stress that real-world scenarios bring.
Conclusion
You cannot predict when or where a disaster will strike, but you can control how your teams react to it. By implementing ultra-realistic, high-fidelity simulation into emergency care curricula, agencies ensure that their responders are not just theoretically prepared, but physically and mentally ready for the unexpected.
References:
- Cheng, A., Grant, V., Robinson, T., Catena, H., Lachapelle, K., Kim, J., Adler, M., & Eppich, W. (2016). The Promoting Excellence and Reflective Learning in Simulation (PEARLS) Approach to Health Care Debriefing: A Faculty Development Guide. Clinical Simulation in Nursing, 12(10), 419–428. https://doi.org/10.1016/j.ecns.2016.05.002
- Education Management Solutions. (2024). Tips for Conducting Effective Debriefs in Healthcare Simulation – Education Management Solutions. In Education Management Solutions – Integrated Solutions. Elevated Healthcare. https://ems-works.com/blog/content/tips-for-conducting-effective-debriefs-in-healthcare-simulation/
- Park, S. H., Goldberg, S. A., Al-Ballaa, A., Tayeb, B., Basurrah, M., Abahuje, E., Miccile, C., Pozner, C. N., Yule, S., & Dias, R. D. (2022). Objective measurement of learners’ cognitive load during simulation-based trauma team training: A pilot study. Journal of Surgical Research, 279, 361–367. https://doi.org/10.1016/j.jss.2022.06.023
