In June 2016 two teams of paramedic students from Coventry University competed in the first Student Paramedic International Rally of Emergency Simulation (SPIRES), hosted and organised by the paramedic team at Oxford Brookes University (OBU). The three-day event consisted of an event registration, a day of emergency simulation, a gala meal and award ceremony, and a conference session with keynote speakers from Queensland University of Technology (QUT) in Australia, Canada and Turkey. The international rally brought together student paramedics and educators with representation from several Higher Education Institutes (HEI) from across the United Kingdom (UK). Coventry University entered two teams each comprising of three students, with pastoral support provided by a member of the teaching team. Students were at differing levels of undergraduate training; each team was composed of two second year and one first year student. The SPIRES event was foreseen as a platform for student paramedics to learn about pre-hospital care, emergency simulation and compare the differences and similarities of student paramedic practice across the world. This article aims to provide insight into the experience of the Coventry University paramedic team at SPIRES 2016.
Registration
Registration for the SPIRES event took place on the first day at Oxford Brookes University, providing an opportunity to meet the paramedic science team and the representatives from HEI's and neighbouring ambulance service trusts. Dr John Black, medical director for South Central Ambulance Service, delivered a formal welcome to the competing teams and promised an exciting weekend for all competitors (South Central Ambulance Service NHS Foundation Trust, 2016). During registration students were encouraged to involve themselves in the social media dialogue and contribute their ‘team selfie’ to the SPIRES2016 online hashtag. This was a brilliant way to communicate with the wider paramedic community and build excitement at the event. After the reception, each team received a SPIRES itinerary and were directed to their accommodation on the OBU campus.
Simulation
Saturday morning found both Coventry teams awake and ready for a day packed with high fidelity simulation.
The simulations were held in the health and life sciences building which was a short walk from the accommodation. After a bacon sandwich breakfast, each team received a short briefing that set out the format of the simulation day to test their assessment, decision-making and clinical skills. Having received our briefing, we were led away to the first scenario and the competition began.
Our first scenario took place outside and we received information about an active shooter incident involving multiple casualties. After being given a few minutes to check our equipment, and work out an initial plan, we were led outside to where a number of casualties were waiting. Our initial plan was for one team member to step back and co-ordinate while another team member triaged the casualties and reported back, then to treat each casualty based on clinical priority. However, we found that aside from the uninjured and minor walking wounded, it was difficult to decide which of the other patients should be treated first, as each was seriously injured, and there were more patients than clinical resources to deal with them. This was an excellent chance to apply the theory of mass casualty triage within a realistic scenario. Competing considerations of treatment priorities and the availability of resources were both factored into clinical decision making. Could the patient with a bullet wound to the thigh wait for treatment now that a tourniquet had stopped the catastrophic bleeding? Does a sucking chest wound take priority over an abdominal wound? All too quickly, the police informed us that the scene was no longer safe, and we had to evacuate. The scenario was over and we now realised how important communication and leadership was in a mass casualty situation.
Our next two scenarios, involving a pregnant lady who was feeling acutely unwell and an older gentleman with acute confusion and reduced mobility tested our clinical investigation, communication and decision-making skills. Following a comprehensive patient history and relevant investigations, we suspected pre-eclampsia in the pregnant lady and an acute infection in the older gentleman, and sent both into hospital for further investigation. After a brief break for lunch, both Coventry teams attended a workshop on difficult airways and were introduced to some eye-opening techniques for improving intubation success.
The fourth scenario of the day added the extra logistical challenge of how best to manage and extract a convulsing child from a simulated carnival atmosphere, involving a very dark room with loud music playing and a journey to the awaiting ambulance. On completion of this incident we completed an assessment and management of a patient with a disrupted thoracic aortic aneurysm in a cardiology scenario.
This station provided an opportunity for students to demonstrate their cardiovascular assessment skills, electrocardiogram (ECG) interpretation ability and knowledge of acute vascular emergencies. Our team was then led outside again for a trauma-based situation.
Arriving at the trauma station teams were met by two builders who had fallen from scaffolding around three metres high. As there were two patients, we initially decided to split our team and two student's went to help the first and most injured casualty, allowing the third assess the patient who was alert and sat up. Much like the mass casualty exercise, this scenario tested our ability to manage conflicting priorities with limited resources. Both patients had sustained serious injuries, with one patient having an open femur fracture with suspected pelvic fracture, and the other a serious head injury with reduced GCS and impaired respiratory drive. As a team, we quickly realised that we needed more resources so requested the attendance of Helicopter Emergency Medical Service (HEMS). Meanwhile, one of our team managed the femur and pelvic fracture patient alone, while the other team members worked on the head injury patient. Although this scenario was challenging, we remembered the importance of structure in trauma assessments and worked through systematically until our patients were stabilised. The picture above shows student paramedics in their initial assessment of this incident.
Our final scenario was based around remote medicine allowing our team to think ‘outside the box’ in an area of practice we had not experienced previously. Our team had been sent to provide medical assistance following an earthquake. Passing a hospital, we were asked to help with a diplomat who had been there with a fever, vomiting and diarrhoea for a few days. In addition to language difficulties we also had to contend with a lack of equipment, missing or out-of-date medication and no backup. After much debate, we suspected an infection and decided to sponge the patient to try to reduce the fever and use our only cannula to deliver out-of-date IV fluids, while arranging for a medical evacuation within six hours. With that scenario completed, it only remained for both teams to meet up again and compare how we went about the scenarios.
For the final session of the day Lynda Sibson, consultant editor for the Journal of Paramedic Practice, delivered an interesting writing for publication workshop. During this session, Lynda promoted the benefits of contributing to paramedic literature, and provided inspiration for this article (Sibson, 2016).
Awards ceremony
After a day of challenging clinical scenarios, the SPIRES team hosted a black tie dinner event with the awards ceremony where teams were recognised for their performance during the day. It was a fantastic opportunity for students to network and meet with students from Turkey and Australia, and Canada. The awards from each scenario were announced over the course of the night; each scenario had a gold, silver and bronze, which were scored on the ability for team to manage their clinical scenario, work together to provide care and communicate with each other. Additionally, three trophies were presented at the end of the evening for teams that clearly demonstrated attributes that are desirable within the paramedic profession. A summary of Coventry University's performance at SPIRES is presented in Figure 1.
Both teams from Coventry University were recognised for their performance in simulation, and we are proud of our achievements over the course of the weekend. As mentioned earlier, both teams were made up both first and second year undergraduate students and to achieve such strong results is a reward for the hard work, dedication and passion of the entire paramedic team. Although we were effectively two competing teams, we were all extremely proud that Coventry B team was awarded the ‘Spirit of the Profession’ trophy; a great team effort. Receiving this trophy emphasised the importance of care and compassion within paramedic practice, and value of listening to understand the specific needs of each patient so they can feel valued, respected and dignified. In addition to a trophy, both teams managed to achieve awards in five out of the seven scenarios, including two in the trauma category. Plymouth University were awarded the best overall performance of the SPIRES event; a great achievement for the team and a credit to their university.
Conference
The final day of SPIRES 2016 enabled the participants the opportunity to learn of the opportunities and challenges in paramedic practice across the world. Peter McKie provided the first session, providing an overview of paramedic education in Australia, encouraging the audience to engage in international paramedic practice to enhance their development and awareness (McKie, 2016). Speakers from Turkey and Canada each expounded on the infrastructure of the ambulance service within their community, and it was interesting to see how each service was uniquely tailored to meet the needs of the population with differing geographical challenges. JD Heffern further described the successful implementation of community paramedics in Canada that had effectively reduced the number of emergency calls to the ambulance service within his district by pre-empting episodes of crisis (Heffern, 2016). The audience was captivated by the comparison between paramedic practice within the United Kingdom, and the paramedic role in Canada, Australia and Turkey. Surprisingly, there were many comparisons to be made, with speakers discussing issues related to 24-hour rostering, the protection of the paramedic title and professional registration within each country.
Aylesha Philips then spoke about the role of paramedic practice within primary care in the United Kingdom, and encouraged students to venture beyond the lights and siren into general practices. Aylesha spoke passionately about the opportunities available to the paramedic profession in primary care, and considered the education, training and challenges that paramedics face in this area of practice (Phillip, 2016). This was parallel to Professor Mary Lovegrove who delivered a fascinating talk on the need for well-educated and highly trained paramedic workforce, exploring the shift in service delivery from transport service to a clinically focused service. Professor Lovegrove spoke about areas of paramedic practice that could improve, considering mental health awareness, dementia care, clinical decision making, end of life care and the effectiveness of the paramedic in these cases (Lovegrove, 2016). Bob Fellows then discussed the need for people-centric leadership to help the growth of the individual professional and also the profession as a whole. He promoted the need for leadership within paramedicine allowing students to push boundaries, create a paramedic culture that is unopposed to progress and who are unafraid to challenge current paradigms of clinical practice (Fellows, 2016). There were also clinical sessions considering pain management, resuscitation and spinal immobilisation.
SPIRES 2017
The SPIRES competition was a fantastic opportunity for student paramedics to participate in realistic clinical simulation, meet potential employers and network with colleagues from ambulance services across the UK. There is opportunity to expand the SPIRES event and going forward it would be fantastic to see more teams competing. Furthermore, our team suggested that more debrief time at the end of each scenario would be a useful in future events so that in-depth feedback could be given to enhance the process of reflection. We would also welcome spreading the event over two days, to provide even more diverse, dynamic and more complex incidents. Nevertheless, SPIRES 2017 promises to be an exciting weekend of pre-hospital simulation and we are looking forward to building on our success at next year's event.
Conclusion
Both teams from Coventry University thoroughly enjoyed their experience at SPIRES, and students valued the opportunity to participate in such a well-organised event. Throughout the weekend students were able to develop their decision-making skills, enhance their ability to manage complex trauma cases and test their mass casualty management during high-fidelity simulation. Furthermore, students maximised the opportunity to reflect on their performance across all seven stations, to ensure they maximise their ability to learn from this experience. Coventry University won several awards at SPIRES and we are proud of our team's performance. Moreover, we are proud of the relationships we have formed with neighbouring HEIS and paramedics from across the world that we hope to explore over the coming months. With SPIRES 2017 promising to be an even bigger weekend of emergency simulation, we excitedly await registration for next year.