Simulations in training...thoughts? Policies?

mycrofft

mycrofft

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I just angered some folks by telling them that despite the emperor's new moulage being so artful and realstic looking, it cannot teach you diagnosis.
OK, what are the forum's thoughts about "simulations" in training? A recent thread was started and a responder said his/her class was not allowed to actually open up and play with real compresses and bandages. What does that say aout the training entity's respect for these trainees? How about manikins? Tearing apart real cars for extrication versus "simulating" damage on an intact junker? Not actually carrying victims during drills (maybe a weighted and jointed manikin?). Starting IV's...I didn't mean to say that one...
 
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Yes to all.

We were required to run simulations several times a day for a large chunk of our practical grade. We would do all of the above. We'd use a combination of real people and dummies, we'd load up the patient into the ambulance we have, and we'd drive them around town as the students continued their care en route. We'd then call actual members of the local ER and give radio reports. We did everything possible to simulate the real thing. It's impossible to do so exactly, but it was good enough to really be a valuable part of training.

Edit: Only tore apart cars during extrication training. We have more money than some EMS programs, but not THAT much.
 
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Your trainer was a good one.

I hate simulations because so much vital stuff I needed to learn was "simulated" so poorly. Yours sounded to be used properly.

A tangent: anyone know a good source for plans to build jointed weighted dummies one could use for mass cas or pt movement training?

PS: I put my money where my mouth was and let them handle me instead of a manikin and got injured. Shame on me!
 
mycrofft said:
I hate simulations because so much vital stuff I needed to learn was "simulated" so poorly. Yours sounded to be used properly.

A tangent: anyone know a good source for plans to build jointed weighted dummies one could use for mass cas or pt movement training?

PS: I put my money where my mouth was and let them handle me instead of a manikin and got injured. Shame on me!
Click to expand...

No, no ideas. Hard to simulate a human patient. That is why they charge thousands and thousands of dollars for those dummies. We were fortunate to have several really neat dummies. The kind where you could program vitals into them...hell, they'd even talk. And they weighed a ton.

That being said, we just used real people for an MCI events. Real people and moulage, which you seem to be less than a fan of.
 
I used to do moulage. It has its place.

It can inject an emotional note, but as with stage makeup, it has to use a degree of stylization to work because it isn't real, it has to simulate real. Our local DMAT does a heck of a job as does one nurse from the local Kaiser hospital, on her own time.

I was thingking of a wooden "skeleton" with hinges, a canvas skin stuffed with sand and sawdust..bends right, weighs right.
 
I refuse to teach without simulations. For example my Basic class had to work a person under a backhoe as one of their first simulations. One of the students was fully moulaged and as well 250 ml of "blood" was placed surrounding the patient so they could begin learning what estimation of blood loss looks like. As well, they are just now into the patient assessment portion of their class. The first was to teach about scene safety as a person from the school (maintenance) was found outside. Of course the 3 assigned rescuers were eager to help and asked if the scene was safe, and the co-worker said it was "okay". They proceeded and was immediately "zapped" and informed they had just been killed.

"But the scene was safe?" I pointed out .. "Would you trust the person, that just got his coworker killed?"... Point being.. be sure for your self!

Yesterday, I was teaching the new on-line Paramedic students at a college I teach at. It just open a brand new building and lab (which is awesome!). I was teaching advanced detailed patient assessment. We are fortunate that there are several mannequins located in the lab. All have individual electronics so they will have ECG, lung sounds, heart tones, bowel sounds, cough, sneeze..etc. All just by the instructor pointing & using a remote control. Scenarios were played out and the patient then was continually treated in a Peterbuilt ambulance (also is located inside the EMS lab) that has everything working inside and outside on it (again, did I say its awsome!). I have to admit it was nice to have the needed equipment and the ability to teach foley catherization, NG tubes on neonate and adults.

Simulations (if done properly) is NOT a total replacement for the real thing. No one should ever assume such but it will help prepare one for the understanding of team work, equipment functions, and develop team leadership. Each student should play the role of each (patient, first responder, medic, lead medic) multiple times before leaving the program (even at the basic level).

My basic class I teach is a 4 hours. Two is usually spent didactic and the rest is lab or simulations. Each simulation lasts from 15 minutes to 30 minutes. Every student will be a team leader (over seeing other EMT and first responders) at least once to twice a week for ten weeks.
 
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Rid, you ought to be a "cadre instructor" also (teach the teachers).

I'm beginning to think my exposure to simulations was defective and deficient mexcept folr auto extrication. A local junkyard would pull three junkers out to a flat spot and let us force our way in while protecting a patient inside.
 
Our medic class is actually part of a case study this year where half of the students will do half of their clinical hours in the lab using the human patient simulators like rid described that talk and do everything fairly normal. I think it is a great program in case I kill a patient they just have to click a button then we learn what went wrong. Also in the time that the ambulance crews are sitting around waiting for the tones we can continuously work on patients, reset and work again. Just the other day in class we had IV arms tied to the bottom of the tables and all the lights were turned out and we had to get an IV flowing to simulate an entrapment at night.

We also have a OB unit that can automatically push out the baby with any of the complications that we could get elsewhere but the blood bath is optional :P

Like the others I feel simulations are wonderful and help prepare people for when they get on the rig but I think you'd be a fool if you tried to completely replace clinical time with simulations no matter how expensive your mannequin is.
 
Ridryder911 said:
Each student should play the role of each (patient, first responder, medic, lead medic) multiple times before leaving the program (even at the basic level).
Click to expand...

I found my experiences playing a patient in scenarios just as valuable as playing a rescuer.

My EMT class was 9 hours a day with 4 hours of lecture, hour for lunch and 4 hours of hands-on, mostly scenarios. We cut up real cars for an extrication lab, landed a medical helicopter, learned vitals in the back of a training ambulance with the doors open to a busy, noisy road, had a pediatric day where everyone brought in their kids so we could practice vitals, backboarding, assessment, etc, on real, live squirmy children, and had an MCI day when we ran around with radios and triage tags playing medical officer, IC, triage officer, etc.
 
I have had a stunted past!!! (sniff sniff)

I was thinking in the way home from work today. Ths post can be interpreted as a challenge to the use of simulations at all. I didn't mean it that way, but that's proven fruitful, so be it.;)
 
In my youth I worked for the company that put on the big Seattle radio station haunted houses and yes indeedy, I was a makeup artist. So I'm pretty particular with my moulage. I hate poorly done moulage! Doing blood and guts is an art and needs to be respected as such.

One of the best demonstrations I've done was to use a full body manikin and little round stickers. I put the information on the dummy where you would be finding it in a P.E. For example, heart rate was listed on both wrists both rate and quality, edema to extremeties was placed on the foot, under the socks. I tried to find a way to booby trap a bleed under the pant leg so it would actively bleed if they pulled the fabric away from the leg, but ran out of time before I came up with the mechanism.

I've also conscripted my kids. My youngest has gone out and hid in the woods for SAR drills (I always put a Rhino GPS on him first) and my oldest actually got used as a human white board for a class. Maybe that's why they moved out so quickly.... hmmmmmmmm....
 
That's an awesome facility R/r. My school is planning on building a similar training area within the next 2 years.
 
Really awsome facility Rid

Incidentally I use to live in Moore and then right outside Midwest City. But the May 3rd tornado blew me back to my home state lol.
 
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