An in-classroom ambulance simulator takes EMS education to another level.
When Lisa Nickles walked into Sinclair College, a two-year community college in Dayton, Ohio, six years ago, she thought she would find the additional training she needed to fulfill the requirements of a job she recently had taken. She didn't expect to make a discovery that would profoundly change the way she thought about that job and the manner in which she approached it.
Nickles had accepted a position at Rhodes State College — another two-year institution 75 miles due north in Lima, Ohio — as the chair of the emergency medical services department. At the time, she had nearly 25 years of experience as an EMT and a master's degree in education, which she had leveraged to spend 19 years working as a school administrator at the county level. She was looking for a career change, and the job at Rhodes seemed like the perfect opportunity.
However, there was only one problem. Nickles lacked the paramedic certification that would enable her — at least in the minds of the administrators at Rhodes — to effectively lead the paramedic program at the college. They hired her anyway.
“Their rationale was that it is cheaper to train someone as a paramedic than it is to put someone through four years of college to get a master's degree,” she said. “They said, ‘You have the most expensive part, so we'll work with you to get your paramedic's license.’”
Because of the rules associated with the national certification program, Nickles couldn't take the final exam at Rhodes. That's what led her down Interstate 75 to Sinclair College. And that's where Nickles saw it: a working ambulance built inside a classroom. The discovery hit Nickles like a lightning bolt, and she immediately was smitten. “I took pictures. Then I came back and told the administration at the time, ‘I want one of these — we need one of these.’”
First Things First
The timing for such an endeavor couldn't have been better. The college had received a $250,000 grant to renovate its nursing education facility, which abutted the space occupied by the EMS department. The plan was to enlarge the nursing area by moving the EMS department to a new lab that was being built on the campus. Nickles was given a clean sheet of paper to design the new EMS facility. The in-classroom ambulance simulator became part of that design.
That was the easy part. Finding the money to bring the vision to fruition was another matter altogether. It was slow going for quite a while, which forced Nickles to use the section of the classroom she had carved out for the ambulance simulator for storage. Then Dr. Debra McCurdy became president of the college. The project had the champion it needed.
“When we went to the budget meetings, she asked, ‘Why don't you have this,’” Nickles said. “Then she said, ‘We have to do this; we'll find the money.’ It got fast-tracked after that.”
The fund-raising effort was aided greatly by two local hospitals, Lima Memorial and St. Rita's Medical Center, each of which contributed $8,000 toward the nearly $60,000 total project cost.
Once the funding was in place, the next challenge was to find a contractor capable of bringing the dream to reality. That proved more daunting than anticipated. As it turned out, there weren't many companies capable and willing to take on such a project. As a government entity, the college is required to get three bids before it can hire any outside contractor. To get around that, Nickles had to secure letters from two companies stating they had no interest in the project.
Almost unbelievably, the one company willing to bid on the project was located just 33 miles away from Rhodes, in Van Wert, Ohio.
Life Star Rescue manufactures various types of ambulances and fire apparatus. More importantly for this project, the company also does remounts — refurbished boxes that are placed onto new chassis — which fit perfectly into Nickle's strategic vision. She had seen what Sinclair College had done and believed it could be improved on.
“They had contracted with a local construction company, which took apart an old ambulance and put it into the classroom,” Nickles said. “It actually cost them almost as much as what we ended up spending.”
Rhodes got bang for its buck beyond its wildest dreams because of Life Star's generosity, according to Nickles. While their bid called for a refurbished ambulance, the company ultimately decided to go above and beyond. “When the crew came, they got so jived up about it that they said, ‘Let's build one from scratch.’ And they didn't change the cost. So they donated a lot to this.”
What They Did
The motivation behind Life Star's generosity was two-fold. First, the company wanted to give back to the local community. Second, it saw an opportunity, driven by the trend in emergency medical education toward simulators, which provide the opportunity for repetitive training that can't be duplicated in a classroom or working with live patients. Indeed, Life Star is producing a second in-classroom ambulance simulator for a technical high school in Columbus, Ohio.
“I have a medical background, I am a paramedic on the outside when I'm not doing sales,” said Brian Murphy, a Life Star sales representative. “[Simulation] is a key tool for prepping EMTs and paramedics, so they get hands-on, so they have an idea of what they're going to experience.”
The build out of the Rhodes simulator was surprisingly easy, according to Jim Lee, the Life Star engineer tasked with bringing Nickle's vision to reality. “I don't want to jinx our next project, but for the most part, this went smooth,” Lee said.
One challenge was that Life Star had to construct the simulator to fit within a pre-defined space. Another was presented by the building itself — which has narrow stairways, narrow doorways and no freight elevator — and the fact that the EMS department is located on the second floor.
“We had to build the truck here in pieces, make sure everything fit in place and met all of the external dimensions, so that it would fit in the hole, and then we had to rebuild it in the classroom,” said Brandon Fruechte, Life Star's engineering manager. “That means there was a lot of finish work that had to be done.”
Perhaps the biggest challenge was that the use of oxygen tanks in the simulator was deemed too dangerous — given their explosion risk — and too expensive. Fortunately, the dental-education department, housed on the floor directly below where the ambulance simulator was being built, had an air compressor that the EMS program was able to tap.
Why it Matters
In the end, Rhodes received a simulator that is capable of doing just about everything an ambulance is capable of doing. Into that simulator was placed a programmable medical mannequin that lets Nickles replicate a wide range of situations that EMTs and paramedics face in the field. Once in the ambulance, the students are on their own after the doors close. Because the simulator is equipped with video cameras and the students are miked, Nickles can monitor their every movement, conversation and decision.
However, communication in this scenario is a one-way street, as Nickles provides no feedback or instruction until the students re-emerge. Students are forced to make decisions based on what they encounter, a frightening proposition that in the end results in better-prepared EMTs and paramedics. Clearly, Nickles operates according to the adage of “what doesn't kill you makes you stronger.”
“The scariest thing to me about being a paramedic was being in the back of an ambulance, by myself with a patient, with no one to lean on, and having to make that decision — and trusting that my training, knowledge and confidence were enough for me to say that this is the right drug at the right time for the right patient,” Nickles said. “When you put them in the back of that [in-classroom] ambulance and close those doors, that's the closest to simulating that feeling that we can get.”
The ability to repeat scenarios over and over is the key to developing confidence in the students, according to Rick Woodfield, dean of Rhodes' division of allied health, who likened the experience to that of a football team continuously practicing its two-minute drill so that it can perform instinctively at the most critical, stressful juncture of the game.
“We're finding that by putting students through the paces, it not only gives them the ability to respond appropriately and efficiently, but it also gives them confidence and helps them to critically think, because they've seen this before, and they've been in this environment before,” Woodfield said. “The whole idea behind the repetitiveness is that, when the real deal comes along, they know what to do without hesitation.”
To that end, Nickles plans to go so far as to have students set up the simulator. “In the fall, I'll strip the simulator, take everything out of it, and one of their first projects will be to set the ambulance up,” Nickles said. “As a paramedic, you're responsible for your ambulance … and you make decisions as to how it's set up, especially if you're working for a volunteer department.”
The realism afforded by Rhodes' ambulance simulator is invaluable, said Joe Kitchen, chief of the Bath Township (Ohio) Fire Department and the chair of the college's EMS advisory committee. “It helps these paramedics to hit the ground running,” Kitchen said. “They're ready to go out on the street. You'd hate to hire a paramedic who's never worked in the back of an ambulance significantly. This puts them in that environment, so they can make better decisions and feel more comfortable.”
The simulator has been up and running for about a year, and roughly 40 students have shared the experience. One of those is Jeff Jones, a 33-year-old career firefighter/EMT for the Shawnee Township (Ohio) Fire Department, who went to Rhodes to earn a paramedic certification. Jones agreed with Woodfield that practice makes perfect.
“We can practice codes for hours on end, and get ourselves to the point where it becomes so much second nature,” Jones said. “That's what you want. When you go to a code out here in the real world, you want it to be something that's smooth.”
Jones added that just because students are working in a simulator — which means they know their mistakes won't kill anybody — doesn't mean that the experience isn't stressful. He agreed that it is analogous to walking a tightrope knowing that a safety net is below — even with the net in place, the fall is still scary.
“When you have someone's life in your hands, regardless of whether it is on the street or in a simulator, it's still stressful, because you know that whatever you are doing in the simulator, you're going to be doing it down the road on an actual person. … You know that once you're out in the real world, that safety net is gone.”
That's the whole idea, Nickles said.
“Working without a net, when someone's life is dependent on it — not your own, someone else's — I think is the scariest thing in the world. And that's what medics do every day,” Nickles said. “They don't have a doctor standing over them, telling them what medication to give. Nurses have that — we don't. We have our protocols, but some of that is really gray. You have to make judgments, and that's scary.”