Photo credit: Zach Spicer | The Tribune

Since 2018, Indiana has experienced an increase in ambulance calls but a decrease in EMS workers[1]. This has created longer wait times for ambulance services, which could negatively impact outcomes, especially during emergencies like a stroke or traumatic injury. Thus, EMS in the state often relies on volunteers to fill open positions, despite a lack of funding to train these workers. However, the Indiana Mobile Simulation Laboratory is helping address training gaps by bringing hands-on, simulation-based training to first responders across the state, ensuring they are prepared for real-life emergencies and that patients receive high-quality care.

Simulation is addressing EMS training needs in Indiana 

Members of the Seymour Fire Department and Jackson County Emergency Medical Services participated in joint training facilitated by the Indiana Mobile Simulation Lab. They are among the EMS and fire personnel across Indiana that regularly receive training thanks to this free educational resource provided by the Indiana Department of Homeland Security. The sim lab is a repurposed ambulance equipped with high-fidelity patient simulators designed to provide training to students and seasoned EMS workers.

For the past ten years, the sim lab has exposed participants to real-world situations in a safe environment. The simulators allow instructors to recreate emergency events and provide hands-on training in standard EMS invasive procedures, such as intubation, IV and IO access, and needle and surgical cricothyrotomy. The participants use real equipment to repeatedly practice and hone the skills needed to provide immediate lifesaving interventions.

Indiana defines EMS as an essential public service but does not set funding or training minimums[2]. Therefore, wealthier communities have the resources to provide more training for their EMS workers. Impoverished communities, which tend to be in rural areas, struggle to meet their workers’ training needs, contributing to worse health outcomes for people in these areas. Addressing training disparities is essential to the equitable delivery of this valuable service across the state.

As such, the mobile sim lab plays a significant role in filling training gaps. Through experiential scenarios, EMS workers and first responders can apply and practice skills until they develop the knowledge and competence needed to stabilize and transport patients during life-threatening emergencies. These simulated events allow participants to practice and hone skills and procedures hands-on, ensuring they are ready to enter the workforce.

Since Jackson County is largely rural, opportunities to practice certain skills and procedures are rare. Thus, the participants received hands-on training in prehospital care guidelines and procedures for adult and pediatric patients. These experiences required the participants to think critically, engage in decision-making, and apply interventions judiciously. An instructor evaluated their performance and provided valuable feedback during debriefing sessions following the simulation.

How simulation is helping improve pediatric prehospital training 

The sim lab ensures that EMS workers across the state achieve the same level of readiness, so they know what to do during emergency events and can provide high-quality care every time. This includes rare, low-frequency events involving children. Only about 10% of EMS calls are for children, but they can be highly stressful for EMS workers as they are often more familiar with adult anatomy, procedures, and treatment guidelines[3] [4].

It would be unethical for an inexperienced EMS worker to practice on a real pediatric patient. So, many programs lack hands-on training experiences and education specific to pediatrics, which contributes to the doubt and stress EMS workers feel when responding to pediatric emergencies. As a result, there is a higher risk of making a mistake that could cause severe morbidity or mortality.

Thus, the joint training provided to the EMS workers and firefighters facilitated opportunities to gain experience caring for children in the prehospital setting. The participants used the Pediatric HAL® S3005 simulator to receive hands-on instruction on assessing a pediatric patient. During the three-day training, the participants experienced common pediatric emergency scenarios, like treating trauma injuries and seizures.

HAL’s features allowed them to become familiar with a child’s anatomy and physiology as they applied advanced skills specific to pediatric patients. They also used the same equipment and tools found in an ambulance to practice vital lifesaving procedures, including airway management. Rather than sitting in a classroom and absorbing information from a book, the sim lab gave them opportunities to apply their knowledge hands-on.

Since learning in the sim lab is experiential, the participants must reflect on their actions and demonstrate their understanding of the expected consequences of clinical interventions. Moreover, participants can make mistakes in the sim lab and receive instructor feedback during the debrief. They then repeat the scenario as needed, applying the feedback to improve their performance, which helps cement important lessons and hone procedural skills safely.

EMS workers practice lifesaving procedures on the Pediatric HAL S3005 simulator.

Preparing first responders for the realities of emergency care  

Additionally, the joint training used an adult HAL S3201 patient simulator to facilitate emergency scenarios. To make the simulation as realistic and immersive as possible, the EMS workers and firefighters responded to simulated 911 calls throughout the day. Participants were then able to practice advanced trauma life support skills using real equipment found in the ambulance.

Since HAL’s vital signs and physical symptoms responded to the providers’ interventions, the participants experienced the consequences of their actions in real time. Thus, the scenarios recreated the fast pace and stress inherent in emergency events, helping the participants get accustomed to working under pressure. This also allows them to develop their ability to think clearly and work effectively during emergencies.

Furthermore, the participants worked collaboratively, as they would during an actual call. Although EMS workers and firefighters work together on the scene, these groups rarely train together[5]. Effective collaboration is crucial in accomplishing shared goals, so the scenarios facilitated communication and teamwork. By training together, each group could improve their ability to work quickly and efficiently as a team.

The participants practiced effective communication skills, honing how to deliver clear, complete, and timely information. Rather than having them struggle to work as a team during a real event, the sim lab facilitated safe training. As a result, the participants better understood their roles and how to work with the other team members. They could delegate tasks and coordinate procedures quickly, improving team performance for both groups and ensuring the patient received optimal care.

Training solutions are available but funding remains a problem

There are significant barriers to providing adequate training for EMS workers and other first responders in Indiana. The availability of funding has created a fragmented system that does not meet the needs of people, especially those in rural areas. However, simulation is an effective tool in EMS training that can help fill in gaps and ensure every worker achieves the same level of readiness. Indiana’s mobile sim lab helps standardize training across urban and rural areas, facilitating opportunities to practice vital lifesaving skills until they become second nature. Through simulation-based training, first responders across the state will have the knowledge and competence to ensure every patient receives safe, high-quality care.

Click on the link to read the full article and learn more about the Indiana Mobile Simulation Laboratory. To learn more about HAL S3201, Pediatric HAL S3005, or any of Gaumard’s other patient simulators, click on the link or visit our product page.

[1] Staff, Jeff. “Indiana EMS Facing Tough Challenges.” Journal of Emergency Medical Services, https://www.jems.com/news/indiana-ems-facing-tough-challenges/. Accessed 16 Jan 2023.

[2] Downard, Whitney. “Indiana’s EMS falls short in covering rural areas.” Pharos-Tribune, https://www.pharostribune.com/news/article_d5a28cce-0227-11ed-aef1-9f449cb9cfa7.html. Accessed 16 Jan. 2023.

[3] Bradlee, Victoria. “A Review of Education Deficiencies and Ways to Improve the Care of Pediatric Patients.” Journal of Emergency Medical Services, https://www.jems.com/patient-care/a-review-of-education-deficiencies-and-ways-to-improve-the-care-of-pediatric-patients/. Accessed 16 Jan. 2023.

[4] “Why EMS providers are at high-risk of pediatric treatment errors.” EMS1, 15 May 2016, https://www.ems1.com/ems-education/articles/why-ems-providers-are-at-high-risk-of-pediatric-treatment-errors-KU5VzsRSrbYgc46x/.

[5] Tomek, Scott. “Combined Team Training.” EMS World, https://www.hmpgloballearningnetwork.com/site/emsworld/article/10321218/combined-team-training. Accessed 16 Jan. 2023.