feature story

Simulation in Motion

Driving emergency care training into rural areas

Brad Stiefvater Jr.’s family has been operating a small ambulance service across several communities in a rural county, or as Medicare describes it, “ultra” rural South Dakota since 1977. Hands-on paramedic and Emergency Medicine Technician (EMT) training in the area was limited to say the least. That all changed when the Simulation in Motion – South Dakota (SIM-SD) emergency patient care program literally rolled into Salem, a small South Dakotan community with some 1,350 residents.

Made possible through a grant from The Leona M. and Harry B. Helmsley Charitable Trust, SIM-SD is an innovative and sustainable statewide outreach training program launched in 2010 by the South Dakota Office of Rural Health (ORH). Qualified SIM-SD instructors travel the countryside providing advanced emergency care training to pre-hospital and hospital personnel in rural communities. SIM-SD’s ‘fleet’ consists of three fully equipped mobile learning labs featuring CAE’s high-fidelity patient simulators.

The mobile sim

The fully equipped SIM-SD mobile learning labs enable emergency medical personnel to sharpen and maintain their first-responder skills. All vehicles are equipped with an iStan™ adult, PediaSim™ child, BabySim™ and Lucina™ maternal fetal patient simulator.

Filling the training gap in rural areas

Heidi A. Schultz, Program Officer at The Leona M. and Harry B. Helmsley Charitable Trust, explains the impetus for the Rural Healthcare Program: “In cities, there are 235 to 300 physicians for every 100,000 residents. In rural areas, this number drops to as few as 55 physicians for every 100,000 residents. In South Dakota, 86% of ambulance personnel are volunteers. What’s more, time and distance from a speciality trauma centre are as much problem as a patient’s specific injuries in a rural landscape. That’s why maintaining the overall capability of the responding team is of the utmost importance.”

Paramedics and EMTs in rural areas have less exposure and individual experience in managing major trauma and critically ill patients than their colleagues in larger urban centres. Hands-on practice is essential to keeping up his team’s skills. SIM-SD is great because it lets them repeatedly rehearse real-life scenarios in a risk-free environment.

The mobile sim Team

Selecting the right training partner

The Leona M. and Harry B. Helmsley Charitable Trust teamed up with the South Dakota Department of Health, Office of Rural Health to select the right training partner for this crucial project. After thoroughly assessing several vendors, CAE ultimately came out on top.

“CAE’s credentials and track record were very strong,” underscores Heidi. “The relationship between our simulation partners and CAE has been seamless. We appreciate how they generously share their library of scenarios. They truly want to help.”

“We are very proud to be part of this important healthcare initiative,” says Robert Amyot, President of CAE Healthcare. “The 44-foot customized mobile learning labs have the ambulance in the rear and the emergency department in the front. A computerized simulation command centre located in the middle is where the trainings are filmed and teams can review and discuss them together to enrich the learning.”

Enhancing patient outcomes

Having a competent and confident first-responder team improves patient outcomes and saves lives. Every year, SIM-SD instructors give hundreds of Emergency Medical Services (EMS) and nursing personnel as well as physicians and their assistants the opportunity to practice complex, time-critical emergency scenarios.

Instructors run dozens of different scenarios, from car wrecks and heart attacks to births and playground accidents. CAE’s patient simulators each have their own features, which may include breathing, crying, talking, sweating, reacting to medication and, in some cases, ‘dying.’ They also come back to life, allowing medical personnel to repeatedly practise their skills. Participants get to encounter the same ‘patient’ many times and receive focused feedback in a managed-stress environment.

Barely 30 minutes after an SIM-SD training session on needle chest decompression and intubation, McCook County EMS were called to an emergency that, uncannily, required them to perform this procedure on an elderly woman in severe respiratory distress. Given that Brad and his staff only perform this procedure five to 10 times a year, the timing and content of hands-on training couldn’t have been better.

The mobile sim Team

Between September 1, 2010 and December 31, 2014, SIM-SD instructors delivered 1,160 training events to over 15,600 participants in South Dakota. North Dakota launched its program in early 2014 and, by the end of 2015, had delivered more than 310 training events to more than 4,050 participants.

Growing the program

Since SIM-SD was launched, three other states have come on board: North Dakota, Montana and Nebraska. All have received substantial equipment grants from The Leona M. and Harry B. Helmsley Charitable Trust to start up their programs. The Trust’s goal is to have seven Simulation in Motion programs in seven states. The American College of Surgeons has also expressed an interest in the mobile learning labs.

Hospitals and their first responders see tremendous benefits in the cost-effective mobile outreach program. Among the benefits cited by participants are greater confidence in a variety of situations, more rapid patient assessments and improved team communication and collaboration. Some communities have been able to attract more EMS volunteers and even physicians thanks to the program.

Thanks to SIM-SD, Brad and his team are learning how to work better together in emergency situations, some of which rural EMS staff and volunteers rarely see. They are not only honing their skills and staying current, they are improving their team spirit and efficacy. They are also helping enhance patient outcomes, the most important benefit of all.