Transitioning From a BLS to ALS Ambulance, With the Use of Simulation

Transcription

1 Transitioning From a BLS to ALS Ambulance, With the Use of Simulation Travis Spier RN, NR-Paramedic, CCEMT-P Director of Simulation and Pre-hospital Care Sanford Health Sioux Falls, SD

2 Disclosures! Spier none

3 Greetings from Sioux Falls, SD

4 Today's Objectives! Review the assessment strategy of transitioning volunteer EMT providers into Paramedics! Review the activities and scenarios that incorporated simulation into the learning plan! Review comments captured from the participants

5 Request! Assist a volunteer EMS service with their transition from BLS to ALS licensure! Utilize simulation to assist new paramedics in clinical judgment and skill development! Provide lifelike experiences and mentoring to help develop clinical competency in new paramedics

6 Partners! Hospital owned volunteer BLS ambulance Less than 15 total members/volunteers 911 call volume: 400 responses per year Interfacility transfers: 450 requests per year

7 Partners! Tertiary Receiving and Teaching Hospital Established simulation program Regional EMS education facility

8 Planning: Agency Assessment! Desire to provide a higher level of care in a rural community! Incorporate a business model to capture lost revenue from interfacility transfers! Need for ALS competency and experience within a low volume market! Build clinical confidence in participants through the use of simulation

9 Planning: Overcoming Challenges! All of the participants were volunteer EMTs advancing to the paramedic level! Clinical and field experience varied! Learning disparity within the group! Financial commitment to fund the project! Sustaining the program post grant

10 Planning: Intended Goals for the Project! Provide realistic simulated patient experiences for various age groups with a sampling of illnesses and injuries! Build confidence and competence of the new ALS providers! Provide a structured learning plan that improves clinical judgment! Increase the level of care provided in the community

11 Planning: Starting Point! Design a 12 month program that guides new paramedics through their advancement from BLS to ALS licensure! Implement protocols that guide paramedics in a rural setting! Evaluate clinical skills and critical thinking! Develop scenarios for various age groups with medical and traumatic disease processes

12 Planning: Agency Transition! Six volunteer EMT-B advancing into six FT paid paramedics! Completing a paramedic program in 14 months! Interim period from paramedic course completion to ALS licensure! Convert a hospital owned volunteer BLS service into a paid ALS service! Address the challenges encounter pertaining to scope of practice and the nurses union

13 Design: Engaging the Learners! Simulation was a new learning methodology for most of the participants The learning environment needed to be safe for the learners non-judgmental and non-punitive learning The sessions needed to be fun FUN = RETURNING PARTICIPANTS The sessions needed to be realistic not just a doll with moulage but deliver a heart pounding experience The sessions needed to provide optimal learning opportunities experiential, self discovery, education, questions, guided practice, debriefing, The sessions needed to be purposeful with productive outcomes for the institution closing the gap

14 Design: Operational Considerations! Conduct a needs assessment! Utilize a performance checklists! Review their equipment, resources and capabilities! Promote the education, opportunity and technology incorporated with simulation! Design simplicity over complexity! Script the event and establish expectations! Set goals and a timelines to measure success

15 Design: 12 Month Grant Funded Program! Deliver a two day immersive experience! Provide three 4 hour didactic and hands on sessions! Offer a three day classroom refresher! Conduct a one day multi-sim experience! Clinical and educational mentoring! Incorporate educational and evaluative simulation opportunities! Consultation throughout the grant

16 Design: Two Day Immersive Event! Two Day Immersive Event Information on the education plan Orientation into simulation Introduction to ALS equipment and protocols Individual Learner Assessment Refresh of clinical skills and judgment Multi sim and situational experience Dedicated ALS focus Adult, Child, Infant

17 Design: Core Content Refresher! Three day classroom core content refresher Content review since paramedic course completion Adult, Child, Infant topics Assessment, Judgment and Management Review disease processes, physiology, pharmacology and treatment plans Protocol Review

18 Design: Three - 4hr Sim Sessions! Age Specific Focus Adult, Child, Infant! Medical and Trauma! Didactic information pertaining to age specific assessment! Multiple age specific scenarios! Task training opportunities! Clinical mentoring and guidance! Combined ALS and BLS experience

19 Design: One Day Immersive Lab! Conduct a multi-station immersive event! Eight 1hr simulation stations! Focus on Communication, Assessment, Management, Treatment, Clinical Judgment, Team Work! Evaluate protocol implementation in scenarios! Combined ALS and BLS experience

20 Scenarios: Foundation! Focus on key educational components Objectives Assessment Clinical Judgment Treatment plan and use of protocols Clinical Skills! Simulation Scenarios Educational, Teach a new skills and Evaluative! Operations mapped scenario outcome

21 Scenarios: Infant (Baby ECS)! Medical Normal Non-Medical Crying Respiratory Hypovolemic Fever with Seizure FBAO Cardiac Arrest Complex Resuscitation

22 Scenarios: Infant (Baby ECS)! Trauma Normal Non-Trauma Crying Non-accidental Trauma Vehicular Trauma restrained Drowning Burns Shock Complex Resuscitation

23 Scenarios: Child (Peds ECS)! Medical Respiratory Distress Respiratory Failure Seizure Diabetic Cardiac Arrest Allergic Reaction Complex Resuscitation

24 Scenarios: Child (Peds ECS)! Trauma Vehicular Trauma Bicycle Trauma Fall Burns Internal Bleeding Drowning Complex Resuscitation

25 Scenarios: Adult (ISTAN)! Medical Cardiac Respiratory Diabetic Seizure Allergic Reaction Cardiac Arrest Complex Resuscitation

26 Scenarios: Adult (ISTAN)! Trauma Vehicular Trauma Electrocution Burns Penetrating Injury Crushing Injury TBI Complex Resuscitation

27 Delivery: Implementation! Identify the strengths and weaknesses of each learner! Team of educators throughout the project Provide explanation Providing recommendations Providing guidance Providing reassurance! Promoting ongoing self awareness and personal growth

28 Delivery: Operational Considerations! Incorporate reality and practicality into the scenarios Suspend their disbelief making it real Had them find and use their own equipment Provide the participants with real life situations that they can interact in, learn from and increase their knowledge base with Identified high frequency/low risk vs. low frequency/ high risk scenarios

29 Delivery: Clinical Skill Expectations! Assessment! Communication! Airway Management! Needle Decompression! Cardiac Monitor! Equipment Selection! Medication Administration/Calculations

30 Results: Subjective vs. Quantitative! Personal Assessment Knowledge Finesse Comfort Competency Problem Solving Retention

31 Results: Quantitative vs. Subjective! Performance Evaluations Standardized Checklists Scenario Objectives Agency Skills Checklists Medical Director Approval Written Exam by the Agency

32 Results: Sustainability! The overwhelming message from the participants was to continue simulation training into the future! Commitment of ongoing financial support! Simulation days off-site! Simulation days on-site! Internal Task Training! Ongoing mentoring and collaboration

33 Who Said You Can t Have Fun at Work J

34 SIM-SD Simulation in Motion South Dakota