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SIM-ND brings real-life training to rural areas

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SIM-ND brings real-life training to rural areas


The 10-member Westhope ambulance squad is responding to two simultaneous emergency calls.
  In one ambulance bay, emergency medical technicians (EMT) stabilize Frank, a 60-year-old who is having trouble breathing. In the other ambulance bay, EMTs care for Andy, a 9-year-old thrown from his bicycle after being hit by a car.
  Frank wheezes, coughs and complains of pain in his leg as EMTs medicate him for the breathing problem and examine his leg for a possible blood clot. Meanwhile, Andy lies unconscious on a gurney, groaning softly as the
EMTs stabilize his neck and back, splint a broken bone and call for a helicopter after determining Andy has a head injury.
  Frank and Andy are incredibly realistic – but they are not real. They are computerized patient simulators that look and respond like real humans. The EMTs are actually working in the back of a custom-built truck parked outside Westhope's ambulance headquarters. Simulation in Motion North Dakota (SIM-ND), which began operating in June 2013, is a statewide, mobile education system using high-fi delity human patient simulators to train ambulance and hospital personnel taking professional education into rural communities.

  Four brightly colored 44-foot trucks, each containing four patient mannequins and a mobile learning lab equipped as a facsimile of an ambulance or hospital emergency room, will be rolling into communities that are home to North Dakota’s 36 critical access hospitals and 140 rural ambulance services. The goal is to provide training for all these entities at least once a year, according to North Dakota Simulation, Teaching and Research Center for Healthcare Education (ND STAR) Director Dr. Jon Allen.
  Simulation training using high-fi delity computerized patient mannequins has become one of the most promising innovations in health care education, according to Dr. Paul Phrampus, immediate past president of the Society for Simulation in Healthcare. This rapidly growing fi eld of medical education enhances professionals’ competency by giving them practice in critically important, but often little-used, skills. The greatest benefi t, Phrampus said, is the improved patient safety that results from practitioners’ increased efficiency and reduction of errors. Many scenarios re-enacted on simulators could not be replicated using a live patient without risking harm to the individual.


  Mannequins in SIM-ND trucks include an adult, child and infant – all with interchangeable anatomy -- and a pregnant woman who delivers a baby through the birth canal. The high fi delity simulators are remarkably lifelike. They breathe, talk and respond to actions taken by emergency medical providers. When given medication, their heart rate and respiration reacts accordingly with how that specifi c drug interacts with the body. They can even die – and be brought back to life with correct medical intervention.
  The simulation’s effectiveness is evident in the immediate feedback that practitioners receive when they realize how their actions might have affected a live human patient, says Tamera Harvey, a Trinity Health paramedic who coordinates the Northwest Region SIM-ND.
  “Everyone is kind of nervous when they fi rst start because this is so new to them, but they really get into the situation once we are under way. We tell our participants that what happens here stays here. This is a learning environment,” she said.
  Participants take a pre-test prior to the simulation and then
a post-test following it. Harvey said they run each scenario twice, which allows training staff to better evaluate and address specifi c performance practices. Many of the more than 50 medical scenarios ND STAR has developed focus on low-frequency, high-mortality types of situations that rural providers are unlikely to encounter frequently enough to feel confi dent about their profi ciency, Allen said. With practice comes improved medical knowledge and response as well as improvements in essential behaviors such as effective communication, teamwork and decision-making.
  “The importance of simulation to health care is just blossoming and we are going to see its practice and educational opportunities continue to dramatically grow,”

Phrampus asserted. “Simulation complements traditional learning. Traditional learning is basedon cognitive knowledge relying on written testing. Simulation enacts performance assessments that test how the individual utilizes that cognitive knowledge.”
  North Dakota critical access hospitals and rural ambulances have requested scenarios related to trauma, labor and delivery, and newborn resuscitation, Allen said.
  “Most small hospitals don’t have labor and delivery services, but EMS squads and hospitals still get pregnant women about to have a baby. Practicing on these simulators helps them be better prepared when it does happen. I think the biggest benefi t of SIM-ND is that these rural areas, which often can’t afford the time or money to send people off to training, can now receive this education free of charge,” he said.
  The Westhope ambulance operates on a tight budget with volunteer members who have full-time jobs. President Ginny Heth, a 22-year veteran and EMT, said it's diffi cult for crew members to leave the community for professional education because they have job responsibilities and are responsible for covering ambulance calls around the clock. The Westhope ambulance responds to 80 to 90 calls a year in a region that also includes Newburg, Maxbass, Antler, Landa and Souris.
  SIM-ND is under the jurisdiction of the University of North Dakota School of Medicine’s ND STAR Center. The N.D. Department of Health provides oversight for the program. SIM-ND’s trucks are situated at Grand Forks, Fargo, Minot and Bismarck. The six hospitals in these cities provide a team of staff members to do rural training using a standardized educational curriculum. The hospitals also contribute fi nancially to SIM-ND. In return, Allen said, these hospitals can use the trucks and equipment for their own staff training.
  To learn more, contact Allen at 701-777-6578 or go to

Candi Helseth is a freelance writer from Minot.