Simulations Make for Better EMTs

Anthony S. Mangeri, MPA, EMT-B, is an active emergency responder and professor in the Emergency and Disaster Management Program at American Military University. With 25 years' experience in crisis management and public safety services, Mangeri has become a firm believer in medical simulation technology for educating EMT students. EMSResponder recently spoke with him to get his take on simulation-based EMT education.

What is the current state/level of EMT simulation training?

Mangeri: Whether it is something like the METIman interactive manikin simulator, or a full-sized mock fire exercise with moulaged casualties, smoke and sound effects, simulation has become a sophisticated, integral part of EMS/fire training. It is an effective way to bring students in contact with a realistic training environment without putting anyone at risk.

The best part of simulation learning is that students can evaluate performance and repeat the same exercises over and over again, until they get the procedure right. For example, in the old days, a student might get 10-15 actual intubation cases a week to hone their skills. With a human patient simulator, they can do it hundreds of times, and become comfortable and skilled before they intubate a live human patient.

Clearly, everyone wins when you can impart this level of training to EMTs--including their patients.

How much is possible in terms of skills training and testing?

Mangeri: What isn't possible, given today's technology? It is amazing just how much can be done with today's level of realistic simulation devices and simulation gaming systems. Today's simulations can confront students with complex physiopathology that change based on treatment.

Simulation training is limited only by the creativity of the operator/educator who is employing the technology to supplement training. The technology itself is highly flexible and sophisticated.

Interestingly, there's a real divide between the current generation of educators who are not always as tech-savvy as the students they teach. It won't be until this generation of students becomes the trainers that the full possibilities for applying simulation-based learning will be realized.

How affordable/accessible is simulation technology?

Mangeri: Prices have dropped dramatically since it was first introduced, but it is still out of reach for the smallest departments. Costs start at $50,000 for a basic system, and can go to $200,000 and beyond for the best ones. So unless you can get funding, or have a good-sized training budget, it can be hard to access this technology. As we migrate to the new education standards we may see more simulator labs in the academic institutions.

Where is simulation technology headed?

Mangeri: I am hopeful that emerging systems will not just supply students with symptoms and simulated autonomic responses, but sensory and emotional reactions as well that are inspired by the students' own interaction. For instance, if the simulation is a child-based model and the EMT shows fear, the simulation will display symptoms and responses that a child would when faced with a fearful adult.

This could be particularly important in EMT training. We need our EMTs and firefighters to have the human touch and to be able to connect socially with their patients. This skill may have to be something that is taught--or at least educationally enhanced--for future generations to do their jobs well.

Do you expect simulation-based training to fundamentally change EMT education?

Mangeri: It already has. And I expect it may well change EMT education in general. The reason is this: As simulation training systems become more sophisticated and harvest more response data from students, we will start to get a big picture view of what works and what doesn't, educationally speaking.

When this happens, a debate will unavoidably occur in the medical training community as to what parts of the curriculum need to be reshaped or improved.