The practice of simulation continues to grow nationally and globally as one aspect of education among a wide variety of health and social care providers, and paramedics are no exception.
Simulation is a teaching tool that allows healthcare workers to offer risk free, safe and effective care, as well as enabling organizations to improve their systems of care and reduce costs. Modelling and simulation has the potential to decrease healthcare error and cost as a result.
There are several variations of simulation and the use of a computer to model real world situations is but one. Simulation can be time-based and considers all the resources and constraints involved, including the way these things interact with each other as time passes.
The interaction also includes the way paramedics interact in the simulation with others. Potentially, with commitment and understanding of simulation, real life actions and omissions can be built into the simulation. Replication can match reality and proficient and competent managers can make changes to the simulation, providing examples of exactly how the system would behave in a real life situation. Importantly, Guba (2004) notes that simulation is a technique, and not a technology—it is used to replace or develop real experiences with guided experiences that encourage or reproduce significant elements of the real world in a fully interactive manner.
Elliott et al (2011) have undertaken a systematic review of the use of simulation with post qualified doctors, nursing and midwifery staff. The review indicated that there is much evidence suggesting that those education programmes that have a simulation-base are consistently effective in enhancing the performance of doctors, nurses and midwives in educational contexts, and particularly so in relation to teamwork and communication. It could be tentatively suggested that the same consistent outcomes would apply to paramedics.
The use of simulation as an approach to learning and teaching is valued by practitioners and those planning educational programmes for healthcare practitioners should be aware of the possible advantages provided by simulation as part of a blended approach to learning.
Donaldson (2009) in his annual Chief Medical Officers report uses an example from the aviation industry when supporting the use of simulation; while it is a rare occurrence, pilots frequently rehearse engine failure in simulators (this could be said about difficult clinical situations paramedics find themselves in). When faced with a real situation, habit takes over. The pilots have developed mental strategies allowing them to prioritize and make critical decisions rapidly and successfully as a result of the frequent simulation training. Habits are developed and then reinforced by continual exposure in the simulator.
While simulation has much potential, it is not the panacea for ills that befall paramedic training. Simulation is costly from a human and material resource perspective—nevertheless, current and prospective paramedics will benefit from a much wider range of training techniques and scenarios than is currently the case.
Simulation appears to be seen in some areas of the country as a useful add-on for paramedic training and education as opposed to a compulsory and core part of training. Using high fidelity advanced technology to artificially reproduce reality offers a unique opportunity to immerse paramedics in an extremely convincing environment.
Simulation-based training must be valued by managers, paramedics and educators as well as being adequately resourced by NHS organizations. Simulation has the potential to offer an important route to safer care and should be more fully integrated into the health service. Simulation is important to paramedic practice and patient safety and NHS organizations should be committed to proving simulation that is fully resourced.
Elliott et al (2011) stress that there is little evidence available to confirm assumptions that improvements in functioning are translated into ‘real life’ settings and ultimately outcomes for those users of services. More research is needed to fully exploit the use of simulation.
Safer paramedic practice is a realistic aspiration all paramedics should aim for. Simulation offers an important route to safer care for patients and this needs to be integrated more fully into all aspects health care education. Simulation can be used for the teaching of basic and advanced skills, motor and interpersonal skills, using low and high fidelity simulation centres and equipment.