The 911 call seemed straightforward: A man had fallen off a chair trying to fix something. Three City of Evanston paramedics responded. In the simulation room at Presence St. Francis Hospital, the team worked closely to tend the broken femur, a head injury and elevated blood pressure. Their eyes were on each other and the realistic mannequin, but their ears were trained on Emergency Medical Systems (EMS) Supervisor Adam Greenberg.
Mr. Greenberg is listening to the conversation and videotaping their procedures. From time to time he intensifies the situation, as when the paramedics saw the patient’s blood pressure was steady: “He starts seizing.”
After the patient has been intubated and his vital signs are steady, one firefighter/paramedic pronounces him “good to go,” and a call is placed to alert the nearby hospital of the situation.
“You pretty much hit everything,” Mr. Greenberg tells the group. He presses them slightly. “You got the pupils right away. Is there a reason the leg wasn’t exposed? … Was there a problem with the stethoscope?” All but one person in training that day had had trouble hearing the blood pressure, he said.
Six other communities avail themselves of paramedic simulation training at Presence St. Francis, said Lynda O’Dwyer, director of marketing and public relations.
The emphasis is on standing operating procedure (S.O.P.), Mr. Greenberg told the RoundTable. “The test is ‘How well do they know S.O.P.?’ ‘How do they operate under stressful conditions?’”
Simulation training can be stressful, because so many people are watching, said Fire Chief Greg Klaiber: the supervisor, other hospital personnel and the Chief himself, not to mention that the simulation is videotaped.
And Mr. Greenberg, the puppet-master, can add a wrinkle or two: “If they do something I don’t like [that could be detrimental to a patient], I can ‘kill’ the mannequin,” he said. He adds, though, that in this session of training, “I haven’t killed a patient yet.”
Presence St. Francis has the third-longest-standing paramedic training center in Illinois, where 35-40 paramedics are trained each year, said Ms. O’Dwyer.
“We’re coming up on our 40th anniversary. We’ve had more than 1,500 graduates and of those only one person has not passed the state exam,” Mr. Greenberg said.
The regular simulation training is only one aspect of the continuing education offered to paramedics, said Dawn LeRoy, director of patient-care services at St. Francis. “We also deploy nurses to firehouses – for example if there is a new piece of equipment with which the paramedics should become familiar. We share outcomes with the fire station – if a patient comes in with a heart attack, we will let them know the result. We also invite the paramedics to the MMR sessions, the morbidity and mortality reviews, which “‘closes the loop’ on a call and creates synergies between the hospital and the paramedics,” she said.
Marko Jachtorowycz, M.D., director of medical education at Presence St. Francis, described the importance of simulation training. “Everyone in medical education has been doing simulation for decades [injections, etc.]. … One day we decided to put it all together – to find a room somewhere and stick everything together. … We started with our medical students here, and then expanded as the idea caught on.”
The mannequins in these simulations are “very expensive and pretty lifelike,” said Mr. Greenberg. “They can ‘breathe’; the pupils can dilate, legs twist in fairly accurate simulation of what the human body does.”
“Short of actually training on a live human, this is the next best thing,” said Chief Klaiber. “These high-tech devices and the professional staff are a real benefit to the community and to our department, which fields about 5,800 ambulance calls per year. The practice – the repetition – is important, so it becomes second nature, so when they see it and someone says, ‘What do you see?’ they know how to respond. … They [paramedics] follow S.O.P., but, once in a while things do not go not as planned, and you have to be able to think on your feet.”
“The ultimate outcome [of these simulation trainings] has been quality outcomes, faster dispatch and quality diagnostics,” said Ms. LeRoy. “Time is muscle,” she said. “Time is brain.”
“The challenges to the training are the ability to provide high-quality training in a limited time. … Another challenge is to ensure that the training is going to be meaningful to the paramedics. It is important to ensure that we are providing realistic scenarios, testing their ability to perform procedures and at the same time challenging them. The goal is to put them in situations that are going to make them think and sweat,” said Mr. Greenberg.
The rewards are like those for other teachers, he said. “… [T]he highest reward is in the knowledge that the paramedics gain that enables them to provide excellent patient care with positive patient outcome,” he said.