It was the type of incident a fire/EMS unit dreads. On January 8, 2011, 19 people were shot in a Tuscon, AZ, supermarket parking lot including Congresswoman Gabrielle Giffords. Six people died as a result. The rest were saved due to speedy, knowledgeable assistance from the Northwest Fire/Rescue District (NWFD) response unit. (Giffords herself survived, despite being shot in the head at point-blank range.)
Coincidentally, NWFD’s people were prepared to deal with a mass casualty event. One month before, they had joined with the Arizona Simulation Technology and Education Center (ASTEC) in conducting a mass casualty field exercise. The exercise, which was staged at NWFD Station 31, simulated a two car collision with seven victims.
All of the victims were realistically portrayed by a range of iStan patient simulators. Made by Medical Educational Technologies, iStan manikins look and react like real patients, with reactive eyes, varied breathing and authentic sounds. The iStans are able to deliver pre-recorded human speech reactions, or relay live audio from a human actor nearby. At the same time, the manikins output diagnostic data in real-time to either wired or wireless monitors. During exercises, this data can be used by EMS to monitor the manikins’ reaction to treatments in real-time. After the fact, the iStan data can be reviewed by educators to see how EMS staff performed under pressure, and aid them in making improvements for next time.
During the December 2010 mass casualty exercise, the iStan manikins simulated a 6-year-old boy with an epidural hematoma, a 72-year-old man having a STEMI cardiac event and a 36-year-old female in active labor with a partial abruption.
“The female iStan was so realistic, that it even gave birth,” says Sean Culliney, NWFD’s EMS training coordinator. “The unit has a little pump built in that pushes the fetus out. You can even specify a normal, breech, or prolapsed cord birth.”
The NWFD’s investment in iStan training manikins made the difference in lives saved on January 8, 2011. So did the department’s commitment to other forms of IT-based education, including distance education courses conducted with ASTEC and Web-based training for the department’s 10 stations/30 shifts.
The department’s move to IT-based training didn’t occur overnight. Instead, it took seven years for the NWFD’s institutional culture to change from resistance to acceptance. So what changed people’s minds?
“We realized that we needed to be able to see what we were doing and how we doing,” Culliney says. “Take paper-based EMS medical records: You cannot perform real-time queries on such records to see how many IV setups happen on a daily basis, and what other choices EMS personnel are making on the job. In contrast, electronic records can be queried quickly, and responses/outcomes assessed.”
Electronic data also makes a difference during training. Take the iStan manikin: Using its real-time diagnostics outputs—and patient-like responses—EMS staff can see what’s happening and react as they would during actual incidents.
“Using passive training dummies, the staff would typically ask the trainer, ‘What am I seeing,’ and then respond,” says Culliney. “This is not what happens in the real world: You see the patient and make decisions without the benefit of a trainer standing over your shoulder. The iStans bring this reality to a mass casualty exercise. The person being trained is confronted by the kinds of data they would see in an actual incident, and works with this data without resorting to the trainer.”
From an EMS staffer’s point of view, the iStan’s realism could pose a danger to their career. This is because any mistakes they make during training are on the record for all to see.
“This is why it is so important not to use IT-based training in a disciplinary manner,” Culliney says. “We use the training data to help our staff improve their decisions after the fact, but never to penalize them.”