Challenges to the implementation of in situ simulation at HEMS bases: a qualitative study of facilitators’ expectations and strategies (original) (raw)
Related papers
2020
IntroductionMedical simulation is used in helicopter emergency services as a tool for training the crew. Using in situ simulation we aimed to evaluate the degree of implementation, factors for successful simulation and the crew’s attitude towards this form for training.MethodsA one year prospective study on simulation at all Norwegian helicopter emergency services bases and one search and rescue base. Local facilitators were educated and conducted simulations at their own discretion.ResultsAll bases participated, but the number of simulations attempted at each base varied from 1 to 46. Busier bases had a significantly higher number of aborted simulations. Regardless of base and number of attempted simulations, participating crews scored self-evaluated satisfaction with this form of training highly. The number of local facilitators and their travel distance to work seemed to make no difference to the number of attempted simulations.DiscussionOur study reveals large differences in the...
In situ simulation training in helicopter emergency medical services: feasible for on-call crews?
Advances in Simulation, 2020
Simulation-based training of emergency teams offers a safe learning environment in which training in the management of the critically ill patient can be planned and practiced without harming the patient. We developed a concept for in situ simulation that can be carried out during on-call time. The aim of this study is to investigate the feasibility of introducing in situ, simulation-based training for the on-call team on a busy helicopter emergency medical service (HEMS) base. We carried out a one-year prospective study on simulation training during active duty at a busy Norwegian HEMS base, which has two helicopter crews on call 24/7. Training was conducted as low fidelity in situ simulation while the teams were on call. The training took place on or near the HEMS base. Eight scenarios were developed with learning objectives related to the mission profile of the base which includes primary missions for both medical and trauma patients of all ages, and interhospital transport of adults, children, and neonates. All scenarios included learning objectives for non-technical skills. A total of 44 simulations were carried out. Total median (quartiles) time consumption for on-call HEMS crew was 65 (59-73) min. Time for preparation of scenarios was 10 (5-11) min, time for simulations was 20 (19-26) min, cleaning up 7 (6-10) min, and debrief 35 (30-40) min. For all items on the questionnaire, the majority of respondents replied with the two most positive categories on the Likert scale. Our results demonstrate that in situ simulation training for on-call crews on a busy HEMS base is feasible with judicious investment of time and money. The participants were very positive about their experience and the impact of this type of training.
The Facilitator's Role in London's Air Ambulance's Simulation “Moulage” Training
Air Medical Journal, 2015
Objective: This research focused on the facilitator's role in the simulated patient training "moulages" used by London's Air Ambulance (LAA) for their team training. Facilitators are chosen based on their experience and expertise in the field. The aim of this research was to gain insight into the role of moulage facilitator. Methods: An ethnographic approach was employed, using the notion of "progressive focusing." Overt observational fieldwork was performed, with the resulting field notes evaluated by content analysis. Semistructured interviews were then conducted with 8 facilitators selected by convenience sampling in order to gain an understanding of the role according to their perspective. Results: The research revealed the role of the facilitator to be challenging and multifaceted. The moulage process appeared appropriate to its function, and the facilitation methods were largely in accordance with recommended practice outlined in educational literature. Conclusions: The London's Air Ambulance moulage facilitators have to prepare trainees for an intense and emotionally demanding job. Their methods are derived from experience, often with a subconscious application of sound educational practice. This research may help the team identify certain areas with scope for further refinement including feedback methods, fidelity, and reducing the burden of multitasking. This ethnographic research reveals how the London' s Air Ambulance (LAA) moulage facilitator could be compared with that of a movie director. The facilitator has to write the script, set the scene, cast the participants, and heighten the realism. The facilitator is also required to act, whether mimicking the sounds of a sick child gasping for breath or the accident and emergency doctor at a busy district hospital. This is done in an emotionally charged, multiprofessional environment while showing a high level of applied medical knowledge. The LAA is manned by highly trained professionals capable of providing critical and emergency care out of hospital. They are based at the Royal London Hospital, Whitechapel, UK, and are able to reach the scene of any medical emergency in the Greater London area rapidly by their well-equipped helicopters. In the United Kingdom, the term "moulage" in this context represents simulated scenarios that are based on real-life situations, involving "patients" as mannequins (Fig. 1). Their purpose is to replicate the real-life scenarios that the participants are likely to encounter during their work. The facilitator can be any team doctor or paramedic who oversees the moulage process and is responsible for adjusting "patient" outcomes based on the interventional decisions made by the learners. LAA moulage facilitators are experienced professionals who have dealt with a wide range of medical and surgical emergencies over the years. Hence, they are well-placed to oversee these simulated training sessions. Bredmose et al 1 described LAA facilitators as senior physicians or paramedics whose role is to "brief the training team and guide the scenario." The authors received informal explanations from crewmembers who found the moulage process useful for team building, decision making, and motor skill development, concluding with the hope that other researchers would further investigate the effectiveness of the moulage process. The aim of this research is to gain an in-depth insight into the workings and rationale behind moulage facilitation methods. It was hoped that this knowledge could enrich understanding of the challenges faced by those who teach in such an intense environment, consequently helping organisations learn how best to prepare future facilitators for their role. Methods Study Design The LAA is a highly specialized and understudied group of professionals. An ethnographic study approach was used, including the notion of "progressive focusing," 2 in which the process of inquiry involves a gradual clarification of the research question. To achieve this, observational field work was followed by in-depth interviews.
A 'mixed reality' simulator concept for future Medical Emergency Response Team training
Journal of the Royal Army Medical Corps, 2017
The UK Defence Medical Service's Pre-Hospital Emergency Care (PHEC) capability includes rapid-deployment Medical Emergency Response Teams (MERTs) comprising tri-service trauma consultants, paramedics and specialised nurses, all of whom are qualified to administer emergency care under extreme conditions to improve the survival prospects of combat casualties. The pre-deployment training of MERT personnel is designed to foster individual knowledge, skills and abilities in PHEC and in small team performance and cohesion in 'mission-specific' contexts. Until now, the provision of airborne pre-deployment MERT training had been dependent on either the availability of an operational aircraft (eg, the CH-47 Chinook helicopter) or access to one of only two ground-based facsimiles of the Chinook's rear cargo/passenger cabin. Although MERT training has high priority, there will always be competition with other military taskings for access to helicopter assets (and for other plat...
BMC Medical Education, 2006
Background: This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. Methods: Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMan™ to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre-and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. Results: The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of $440 and a time cost of 22 hours of skilled instructor time. The simulation and nonsimulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234), but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029). Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital. Conclusion: It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.
Advances in Simulation
Background Anesthesia personnel was among the first to implement simulation and team training including non-technical skills (NTS) in the field of healthcare. Within anesthesia practice, NTS are critically important in preventing harmful undesirable events. To our best knowledge, there has been little documentation of the extent to which anesthesia personnel uses recommended frameworks like the Standards of Best Practice: SimulationSM to guide simulation and thereby optimize learning. The aim of our study was to explore how anesthesia personnel in Norway conduct simulation-based team training (SBTT) with respect to outcomes and objectives, facilitation, debriefing, and participant evaluation. Methods Individual qualitative interviews with healthcare professionals, with experience and responsible for SBTT in anesthesia, from 51 Norwegian public hospitals were conducted from August 2016 to October 2017. A qualitative deductive content analysis was performed. Results The use of objecti...
Using Simulation to Train Medical Units for Deployment
Military Medicine, 2019
Introduction Recent downsizing and budgeting issues have led to challenges when attempting to train military health care reserve forces. A specific military unit collaborated with a university simulation center in order to provide more meaningful training experiences that mirrored the deployment operational experience. Methods The article discusses the processes used to initiate and build a simulation-based military health care training curriculum. The team consisted of an educator specializing in the use of simulation and military content experts. Rubrics for all skills were developed or found in nursing or emergency medical technician/Paramedic textbooks. Skills station training was completed using deliberate practice, where students practiced until they reached mastery level. Simulation scenarios were completed that included a primary and secondary survey improvised explosive device event. Simulation curriculum has expanded to include psychiatric scenarios using standardized patients (actors). Results Documentation of the training yielded greater insight into the unit's abilities, strengths and weaknesses. After the initial 1-year time period, 87% of medical technicians and 92% of registered nurses completed training. In total, 12 out of 38 participants needed additional support. The participants reported through the Debriefing Assessment for Simulation in Healthcare tool that they enjoyed and valued the meaningful training. Conclusion Training using simulation has been invaluable to improving team cohesiveness. Building a training curriculum has generated a new perspective on ways in which military units may train and assess the strengths and opportunities of the unit. The ability to see participants in action allowed for a clearer understanding of the knowledge and skill each participant actually possessed versus what was assumed. The information obtained was invaluable to leadership in determining the true readiness of the unit for deployment. The authors offer the scenarios, lesson plans, and curriculum that they developed to other units that are interested in the training.
How Modeling and Simulation Can Support MEDEVAC Training
Proceedings of the First …, 2002
Airborne medical evacuation (MEDEVAC) is vital for maintaining a safe lifeline for military personnel in tactical operations. Medical evacuation must be reliable and efficient, independent of the threat level of the operation. Not only must the medical personnel be proficient in trauma surgery, they also must be able to work as a team in the confined environment of a helicopter. The various stages of MEDEVAC training reviewed in this paper, from individual skill training to full-scale, applied tactical training, lend themselves to a variety of simulation tools and devices. Promising modeling and simulation methods and tools for training individuals, teams, and taskforces are identified. Finally, we discuss how present and future means of modeling and simulation can support and enable MEDEVAC training to meet today's changing and challenging missions.
BMC Medical Education, 2021
Background Continuous medical education is essential in Helicopter Emergency Medical Services (HEMS). In-situ simulation training makes it possible to train in a familiar environment. The use of a dedicated facilitator is essential; however, when an in-situ simulation training session is interrupted by a live mission, the efforts invested in the training are left unfulfilled. This study aims to evaluate if HEMS mission observation and debriefing by the simulation facilitator is a feasible alternative to mission-interrupted simulation training, and how this alternative to simulation training is perceived by both facilitators and HEMS crew members. Methods Facilitator observation during live missions and post-mission debriefing was offered as an alternative to mission-interrupted simulation training over a one-year period at three HEMS bases. Immediate feedback was requested from crews and facilitators after each observed live mission on a predefined questionnaire. At the end of the s...