Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

Abstract

Introduction: We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers.

Methods: A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic).Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predominantly senior physicians. Their role is to brief the training team and guide the scenario, results of patient assessment and the simulated responses to interventions and treatment. Pilots, fire-fighters and medical students are utilised in scenarios to enhance realism by taking up roles as bystanders, additional ambulance staff and police. These scenario participants are briefed and introduced to the scene in a realistic manner. After completion of the scenario, the training team would usually be invited to prepare and deliver a hospital handover as they would in a real mission. A formal structured debrief then takes place.

Results: This training method technique has been used for the training of all London Helicopter Emergency Medical Service (London HEMS) doctors and paramedics over the last 24 months. Informal participant feedback suggests that this is a very useful teaching method, both for improving motor skills, critical decision-making, scene management and team interaction. Although formal assessment of this technique has not yet taken place we describe how this type of training is conducted in a busy operational pre-hospital trauma service.

Discussion: The teaching and maintenance of pre-hospital care skills is essential to an effective pre-hospital trauma care system. Simple mannequin based scenario training is feasible on a day-to-day basis and has the advantages of low cost, rapid set up and turn around. The scope of scenarios is limited only by the imagination of the trainers. Significant effort is made to put the participants into "the Zone"--the psychological mindset, where they believe they are in a realistic setting and treating a real patient, so that they gain the most from each teaching session. The method can be used for learning new skills, communication and leadership as well as maintaining existing skills.

Conclusion: The method described is a low technology, low cost alternative to high technology simulation which may provide a useful adjunct to delivering effective training when properly prepared and delivered. We find this useful for both induction and regular training of pre-hospital trauma care providers.

Figure 1

Local and nearby obstructions are used to create a simulation-scene for i.e. entrapment or road traffic collisions with entrapment. Using closeby (on the helipad) obstructions makes it feasible to train with the on-call crew. The imagination and creativity of the facilitator and other staff is important for creating a scene that takes the participant into "the zone".

Figure 2

All members of the team are expected to engage in the scenario training. It is of importance to participate and act in a realistic manner, use gloves, use stretchers in the same was as in a real-patient situation. Involving other members of staff and using real equipment in the scenario is important for keeping participants in the zone as well as for maintaining a high degree of realism in the scenarios.