Simulation in Motion mobile training program for rural emergency healthcare

Mock emergency room ... Personnel of Philip Health Services practiced real-life scenarios in the SIM–SD trailer, using simulation mannequins that gave all the medical information, plus the annoyances, of a real person. Everything was recorded on paper and on videotape for a debriefing afterward.

Members of the Philip Ambulance Service and the Philip Health Services, Inc. received hands-on training through a high-tech program called Simulation in Motion - South Dakota.

First, on Wednesday, October 12, the emergency medical technicians and paramedics of the ambulance crew got their chance to work with the realistic training manniquins and go through scenarios in the simulated back of an ambulance. Then, on Monday, October 17, the PHSI personnel worked with the almost-real patients in a simulated emergency room.

These are not the manniquins that first-aid beginners use to practice CPR. "They are far different from those hunks of plastic you used to use," said Darrel Brimm, head nurse with the SIM-SD project out of Rapid City Regional Hospital. "Basically they can do everything you and I can do except sing and dance."

Through a wireless computer connection to inside the trailer, the training mannequins can sweat, bleed, move their eyes, vary blood pressure and talk directly to the EMT. They generate heart sounds, lung sounds and even bowel sounds. The entire practice sessions are video recorded for playback during a debriefing. There is no testing, just training.

The SIMS-SD program is a partnership for emergency patient care. It is funded, free of charge to trainees, by the Leona M. and Harry B. Helmsley Charitable Trust Foundaton. The program includes three 44-foot long, fully-equipped mobile learning labs and two smaller outreach vehicles in the state. These trailers are fully equipped for training. All five have human patient simulators and their crews use a uniform educational curriculum. The advanced human patient simulators realistically replicate many health problems, and actually react to a provider's actions during true-to-life training scenarios. The infant mannequin cries constantly, like a real infant patient, and the others can talk, ask what is going on, answer questions and whine.

One of the trailers is based out of Rapid City for western South Dakota. It has a mock ambulance box, a slide-out mock emergency room and a computer work cubicle. The other four bases are Mobridge, Pierre, and two hospitals in Sioux Falls.

Governor Dennis Daugaard has showcased the rural community medical training program. In a press release, he said. "South Dakota is unique in using human patient simulators with a standardized, statewide training curriculum and is the first state to take such training directly to providers in rural areas with its fleet of mobile units."

"SIM-SD is making it easier for rural EMTs and hospital staff to get the critical-care, continuing education they need to keep their skills up, without ever having to leave their own community," said Daugaard. "But the real beneficiaries will be South Dakotans in need of emergency healthcare services, regardless of where they live."

Brimm, along with paramedic Ben Leonard, showed trainees how to treat the mannequins as if they were real patients. Then, life-like scenarios were played through, with Brimm just observing and Leonard running the computer interface and operating the patient's voice. "We aren't going to answer you or your questions; you check your patient," said Brimms. As for the observers waiting their turn, "Watch. You can make your comments during the debrief, but during the scenarios let them do their thing," said Brimm.

One of the pre-hospital scenarios for the ambulance crew was a vehicle crash victem who was somewhat responsive. One of the emergency room scenarios was an awake infant with head trama and a mother who could not answer any of the trainees' questions. The mock ER even included IV bags and an x-ray and CAT scan monitor.

"I think it's a really good tool," said Brimm. "The object is to bring training to people who may not treat patients like this all the time. Not that they don't do a great job now, but they see them only on a limited exposure."

The ambulance crew broke up into however many people they run on a crew (three), and the hospital staff broke up into emergency room crews - doctors included.

"There is no test," said Brimm. "There is no right or wrong. You aren't going to pass or fail. There is no stress here."

Leonard said, "We are going to try to simulate the high and low tensity calls. The hardest thing is to simulate, to realistically and logistically recreate what you could experience."

Brimm said, "We want to be life-wise and time-wise as real as possible. We are going to learn."

Leonard said, "And there will be times when you do everything right, and he still dies."

The program works around trainees' schedules, not requiring volunteers to take time off from work nor requiring hospital personnel to get overtime. "These people are volunteers," said Brimm. "The already give of their time. We try to make it convenient, so they don't have to miss work. We are available evenings and weekends."

The program also visited Kadoka, which included the Midland Ambulance Crew.