Does Realistic Training Matter?

[TraumaFX]

I have a question for the membership of this forum. How realistic were/are your training scenarios? I mean, did the scene look "real"? You know - did the car you extricated your "patient" from looked as though it had really been in an accident? If you did a disaster drill, was the scene really made up to look like a disaster? Were your "victims" made up to look realistic? Or was it some makeup smeared on, some fake blood splashed on and a vinyl or rubber stick-on wound glued to the skin? Or were you supposed to imagine this was "real"?

I teach EMT classes and have for years. I found that the more realistic I can make the scenes and especially the makeup and wounds on the victim, the better the EMT performed when they actually hit the street. I have found this to be true over and over. Those that didn't have any realism in their training were the ones who would almost "freeze" when they finally saw the real injuries and blood that comes with trauma. They were the ones who weren't sure of how to go about getting to and treating their victims in a real disaster scene.

So, how were/are your training scenarios? Are they what you want?

Thanks in advance,
Bob

 

[csly27]

ours were not very realistic at all. I would have love to have blood and guts. I have only gone on one trauma call and thats when I was doing my ride along. Mabey I am a little twisted but I enjoyed it. I was somewhat excited about seeing the blood. The guy has been jumped by like 5 guys. I did pretty good on that call. no freezing but then again considering what had happened it was not really that bad. I think it is a good idea for instructors to make the senarios as realistic as possible

 

[HotelCo]

I don't know if I'd necessarily care too much about how good the wound looks. I would like the scenarios to be more dynamic. Instead of just walking in and going down the NR sheet, I'd like to have some things thrown in there. Maybe put the "patient" into a confined space, have the family members start arguing. It's easy to run through a scenario when everything is nice and neat, but how about when it isn't? I think it'd help my class to think outside of the box.

 

[Mountain Res-Q]

As real as possible is better IMHO; without really slicing of a students arm to see how the other studnet handles an amputation. When you are forced to imagine the wounds and the scene it makes it harder to preform an assessment that leads to a correct treatment.

 

[csly27]

As real as possible is better IMHO; without really slicing of a students arm to see how the other studnet handles an amputation. When you are forced to imagine the wounds and the scene it makes it harder to preform an assessment that leads to a correct treatment.

I beleive thats true too. you can imagine and picture blood and diffrent types of wounds all day long and go down the nr check list. With out some kind of realisticness you go out on your first call it is not gonna play out all nice and tidy. when you get you first sight of blood and wicked wounds it is definatly not gonna be the same as it was in class. So I am all for more realistic training. When I took my class I wish we would have had more hands on as well.

 

[nomofica]

I'd rather have the training as realist as possible. A little bit of ketchup on the arm doesn't do justice when trying to learn to deal with deep lacerations or amputations, etc. I'd rather know what I'm looking at. Face it, a farmer's arm getting caught in a PTO (power takeoff) shaft is much different than a training dummy with its arm pulled off.

 

[TraumaFX]

I remember when our State Trauma Association held a training seminar for physicians. The "victim" was supposed to be in shock as part of the scenario. The staff putting on the scenario painted the guy's face with clown white makeup (it wasn't caked on, but way too much was added and you could see the streaks from their fingers and makeup sponges), then they took some blue Halloween makeup and put it under his eyes and on the lips. It looked so fake that it was embarrassing to me just to watch this poor guy act like a victim. Some of the physicians were laughing and joking about it, asking the guy if he got into his mother's makeup this morning or how his Halloween night went, did he get much candy? So sad. And I've seen stuff like this over and over - supposedly from professional trainers and instructors.
REAL cyanosis in shock is usually light, light blueish gray. In my 25 years of EMS I've seen it enough to know. And here's the deal: allot of signs you'll see in the street with a real patient can be subtle. You've got to look for it. We train to pick up on these things. I think that's the way training scenarios should be also. If you make it so obvious that a monkey could pick it out, then in my opinion, you've insulted the student's assessment skills. That's just not right.

 

[nomofica]

I'm with you on that, Trauma. Even in my textbook the examples of cyanosis/shock pts are people with very obvious, very white powder. It looks like somebody took a few bottles of talc and dumped it on their faces.

 

[mycrofft]

I'm going with "unpopular" and saying "Sort of/No".

You cannot capture the true nature of actual casualty care no matter how well you moulage etc., and if you get to the max 95% realistic you can get, you spend way too much time and effort versus your result.
Now, I'm not saying to stop doing hands on etc., but like in theater and movies, channel and manipulate your representation for maximum effect; it has to be stylized a bit. KNOW YOUR EXERCISE OBJECTIVES, AND DON"T GET TOO AMBITIOUS.

For instance, if you want to exercise triage, casualty control, and casualty movement, don't bother moulaging people to the max, use strap ons or even cards (you aren't exercising diagnostics), but make sure you have lots of materials to use for transport etc and weighted dummies or even sandbags so actual carries (sandbags on litters etc) can be perfomred without risk of injury to the "pt's". (Lifters need some coaching though! ).

Extrication with treatment? Use a real car, but a mannikin in it. Once it's out, replace it with an actor.

Splinting and bandaging proficiency? Strap on wounds ok, if you can get a simulator for an angulated limb that's ok, or just bend a knee or elbow and pretend that is the angulation, but have lots of materials and time and instructors.

Want to inject reality? After basic skills are practiced and have been demonstrated (not that same day, but as a prereq), establish a timeline for each type or each individual casualty and use that to drive a sense of urgency with the pts getting worse and dying. If you don't use moulage, you can have the luxury of a rapid reset and re-run, with greater educational returns.

NOTHING substitutes for real life casualties, but repeated timed graded drills (followed by a BBQ or other postive experience) can go a long way!!

 

[Mountain Res-Q]

I am not a fan of moulage, either, but that doesn’t necessarily mean that the scenarios (not the injuries) can't be more realistic. When we practiced c-spinie/backboarding back in my class we started out doing the textbook NR patient is laying on the floor and we c-spine. Once we got the basic method down we started using student cars of all shapes and sized to see if we could get them out. That's my idea of more realistic. Too often, when I proctor, the instructor has testing set up in a boring manner... everyone is already lying supine on the floor waiting for the textbook hero. Pt/ Assessment is always so NR textbook... patient is lying supine and the "hero" stands nearby and goes through a memorized algorithm; "is the scene safe? How many patients do I have? I am taking BSI. Hello, my name is Bob, I'm an EMT, can I help you? What seems to be the problem? My patient is taking to me so he has an airway and is breathing." TAKE PULSE. "I'm gonna ask you a few stupid questions. blah... blah... blah...." they don’t need a real human patient in this case, because all they are gonna do is recite what their buds at the Fire House to them to. When I run drills I want the "real deal. Get the "patients" in line as to what their condition is and what their response should be (play drunk, disoriented, in pain, etc...) and place them in the real world (park, ball field, bathroom). Give them a “team” of “ffs” who only follow his/her orders. They have to really identify scene safety hazards, talk to bystanders if possible, basically run a “real call” complete with having a full BLS bag, backboard, etc… If they need to board them, then I want a reasonable plan for how to get them to the “ambulance.” ETC... I want them to run a “real call”, not just recite a memorized algorithm in a classroom on patients that are so fake and badly contrived.

 

[AJ Hidell]

I believe it is more important that the setting of the scenario be realistic than the moulage. If someone is supposed to be in a car, they should be in an actual car, not in folding chairs in the classroom. If someone is supposed to be in the mud, they should be in the mud, not a parking lot. If someone is supposed to have fallen down some stairs, they should be at the bottom of the stairs, not in a classroom. While moulage can certainly help the student to visualize the treatment that is necessary, I wouldn't say that is as important a factor. Schools should be giving their students sufficient field time to get comfortable with blood and guts. If they are not, I don't believe that any amount of moulage is going to compensate for that inadequacy.

 

[medichopeful]

It seems like the saying "train how you fight" would apply to this question. I agree with everybody else that the training should be as realistic as possible. I would not want a brand-new EMT treating me or somebody I love that had only done basic training without any realistic practice. Along the same lines, when I become an EMT, I don't really want to get to a scene and see a trauma for a first time (I know realistic training and real life is different, but you get the point)

Eric

 

[mycrofft]

There is also the "Confidence Course" aspect.

Some instructors do things to discourage their trainees, "teach them humility". Better to feed them successes and partner them with good troops when they get out in the real world.
("Confidence Course" is that little obstacle course dealie you do to help finish basic military training. No one shold reach that course without the porper fitness to pass it, it is not a test but an ego rebuilder).

 

[Mountain Res-Q]

I believe it is more important that the setting of the scenario be realistic than the moulage. If someone is supposed to be in a car, they should be in an actual car, not in folding chairs in the classroom. If someone is supposed to be in the mud, they should be in the mud, not a parking lot. If someone is supposed to have fallen down some stairs, they should be at the bottom of the stairs, not in a classroom. While moulage can certainly help the student to visualize the treatment that is necessary, I wouldn't say that is as important a factor. Schools should be giving their students sufficient field time to get comfortable with blood and guts. If they are not, I don't believe that any amount of moulage is going to compensate for that inadequacy.

Exactly. How often do we find a spinal pt/ lying supine on a class room floor, in an anatomically correct position, answering every question in a calm well formulated manner? Put them sprawled out at the bottom of stairs, in a car, etc… Make the scenario, if not the fake patient, realistic. I want to see them walking up to the scene and actually get a scene size up that isn’t dictated to them by a preceptor.

 

[ochacon80]

My class scenarios were not very good at all, the assistants were just going through the motions and were not very interested at all, it was pretty basic. No realism, and there were many short cuts. The program is ran by 4 current paramedic/FF, and they lecture very well, but there assistants are very poor.

 

[Buzz]

My scenarios were pretty much just someone laying on the floor: No attempt at even making them look sick or act sick. The situations in which they were hurt were random, and often a mix of several actual calls resulting into an absolute train wreck of trauma and underlying medical conditions.

It worked though.

I've realized since I started working: I look for the things that could be underlying conditions or affect the patient. The first time I ever saw uremic frost, I was like "OH! That's what that looks like."

There's also that 'look' that the really sick patients have. You just sort of know. Any attempt at faking it looks cheap and doesn't capture it anyways.

 

[Sasha]

I'd rather an instructor spend their time coming up with good, realisitic and challenging scenarios than play with make up and trash a room.

 

[Coptrainer]

As a California POST Master Instructor, I can tell you that the more realistic the training, the better students will learn. With that said, just do the best you can with what you have and I'm sure the good students will learn.

 

[TraumaFX]

Everybody has good points! This discussion is not about what's right or wrong, just what do you prefer.

There are some views that I disagree with however. You can certainly use tags during an MCI drill to learn the procedure, but little else. Nothing wrong with that if you're just testing the system. I prefer to have the entire training as realistic as possible. Why not? Everybody is there. Everybody has their job to do. Why just focus on one part of it? Procedures and protocols can be done on a tabletop if that's what you want to do. You can't take seriously the giggling high school girl with a tag around her neck that explains she's a critical patient. Sure, she'll eventually get the to right place and receive the right treatment required in the MCI's procedures and flowcharts. But who really loses out when it's done like that? The EMT and other responders (including the hospital staff) who should be training in triage, evaluation and treatment. Make it real - take the time - and everyone involved will benefit.

I know some instructors who don't do realistic moulage makeup because they say they don't know how. I understand. I tell them to get the help of their local theater groups to help them with the makeup - usually free and do a great job. Or hire somebody - it's worth it for your students or those involved in the MCI drill. It's one of the things I do for a living now and you'd be surprised at the comments I get from the people I help. 99% of them say they will never do it any other way. They didn't realize how much of a difference it made compared to their usual way of doing things.

Everybody has their own way of doing this, I know. Like I said earlier, nobody's right and nobody's wrong. I've just chosen to to provide the best possible training that I believe my students need.

 

[Mountain Res-Q]

I've just chosen to to provide the best possible training that I believe my students need.

Exactly! Everyone who is put into a postion to train others and affect how the future of the profession learns needs to do the best they can. What works best for our area and our people? And we should never be affraid to try something new to enhance the learning experience.