Simulation training prepares first responders for the possible not just the probable

With violence against paramedics and fire-rescue personnel becoming more frequent, training must include simulations of responding to "everyday" calls gone wrong

By Greg Chapman

In my experience training both military and civilian tactical medics, I grew accustomed to hearing the adage, "train as you fight, fight as you train." Unanticipated violence against first responders requires first responders, and even those responsible for their training, to adopt this training mentality.

For example, a firefighter in California was shot and killed while responding to a call at a retirement facility. In Texas, a man pulled a gun on an EMS crew treating his wife during a domestic dispute, prompting county EMS to finally invest in body armor.

EMTs, paramedics and fire rescue personnel, in particular, should focus as much on preparation for what could happen on the job as they do for what usually does happen.
EMTs, paramedics and fire rescue personnel, in particular, should focus as much on preparation for what could happen on the job as they do for what usually does happen. (Photo/

While researchers work to gain a better understanding of the threats first responders face, headlines across the country suggest dangerous unexpected situations like these can happen anywhere. Paramedics have been held at gunpoint during an overdose call and fire crews have encountered gunshots while responding to a structure fire. That’s why we must shift to a different paradigm in which simulation training programs better reflect these new realities.

Knowing this, EMTs, paramedics and fire rescue personnel, in particular, should focus as much on preparation for what could happen on the job as they do for what usually does happen. That means more emphasis on training in areas that might be a little less obvious to outside observers.

I believe an effective way to achieve better outcomes not only for our patients, but for ourselves and our crews, is to make simulation training a regular part of the curriculum for all first responders.

Making the case for better simulation training

Simulation training exercises combine task training, education and course/classroom training, providing first responders with situations that they could very well encounter in the field, but in a controlled environment.

Effective simulation training programs may have several valuable components, including the use of live actors, an essential emphasis on interagency collaboration and most importantly, appropriate assessment of how professionals use critical thinking to respond:

  1. Critical thinking: To prepare for emergency situations, in which learning on the job isn’t always the best option, simulation training can provide supervisors a better way to observe how personnel respond to situations.
  2. Interagency experience: As medical and fire rescue personnel often respond to scenes together with law enforcement, training together helps improve coordination and reveal points for potential communications breakdowns to refine safety protocols.
  3. Focusing on outcomes: Answers to questions like, "did the simulated patient survive and what were the lessons learned?" are critical. A thorough simulation debrief is important and should take place immediately after each training – look back and see what participants did and assess with guidance from an experienced instructor.

Simulation example: Responding to an atypical cardiac arrest

To illustrate the importance of simulation training, this is an example of a situational awareness simulation module for cardiac arrest response. It helps mimic a situation in which participants respond to a home where a woman is experiencing cardiac arrest.

Cardiac arrests are about one percent of calls first responders receive, but often receive a joint response from police, fire and EMS. In this module, the situation unexpectedly escalates as the woman’s despondent husband points a handgun at officers. The situation unfolds so quickly there is no chance for verbal de-escalation. Protocol goes out the window.

The objectives for participants in this scenario are to:

  • Recognize the dynamic environment of seemingly every day calls
  • Maintain situational awareness by constantly looking at the patient and bystanders
  • Perform patient care while remaining alert to safety changes
  • Underscore the importance of body armor for personal protection

Roles and materials needed for this training include one actor depicting an older patient, one actor depicting a police officer, a high-fidelity simulation mannequin and rhythm simulator if appropriate, along with standard EMS entry bags and equipment.

As participants make decisions on how best to interact with other responders, treat the patients and deescalate, the real benefit, of course, is that they’re not considering all of this for the first time in the real world.

To conduct the training, instructors would brief the participants on the training objectives, then begin setting the stage for the simulation. Following the training, students would then engage in a discussion on key questions including what went well, what could be improved, how crews reacted to the sight of a gun, how crews deescalated the situation, what other tactics could have been used, and whether all participants understood their roles and reacted accordingly.

Simulation training considerations

It should be a priority to ensure trainings and courses are credentialed and provide continuing education credit. This ensures they are useful for the providers, as well as the participants.

Resources to help in development of scenario training curriculums for agencies that currently do not have such a program are available through leading first responder publications, associations, and educational and support efforts, such as Armor NOW, a campaign focused on building awareness around emerging threats faced by first responders through education and advocacy.

It is also important to understand that curriculums could, and often should, be adjusted for variabilities such as agency size, organizational structure and number of field personnel. Every agency is different, and simulations should recognize that.

The bottom line is that resources and scenarios like these are readily accessible and are critical in helping first responders to train for what is possible, not just what is probable. Training to make crews become more aware in the field makes those crews safer.

About the author

Greg Chapman is the director of the Center for Prehospital Medicine, Carolinas Medical Center and an Armor NOW advisory board member. Armor NOW features the Armor NOW Academy which offers a CAPCE accredited course on body armor basics and provides one-hour of free continuing education credits to participants.

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