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INFORMATION TECHNOLOGY High-Tech Training Preps Agency Simulation assists Northwest Fire/Rescue District with emergency response IT WAS THE type of incident a fi re/ EMS unit dreads. On January 8, 2011, 19 people were shot in a Tuscon, AZ, supermarket parking lot including Congresswoman Gabrielle Giffords. Six people died as a result. The rest were saved due to speedy, knowledge- able assistance from the Northwest Fire/Rescue District (NWFD) response unit. (Giffords herself survived, despite being shot in the head at point-blank range.) Coincidentally, NWFD's people were prepared to deal with a mass-casualty event. One month before, they had joined with the Arizona Simulation Technology and Education Center (ASTEC) in conducting a mass-casualty field exer- cise. The exercise, which was staged at NWFD Station 31, simulated a two-car collision with seven victims. All of the victims were realistically portrayed by a range of iStan patient simulators. Made by Medical Educational Technologies, Inc. (METI), iStan mani- kins look and react like real patients, with reactive eyes, varied breathing and authentic sounds. The iStans are able to deliver pre-recorded human speech reac- tions, or relay live audio from a human actor nearby. At the same time, the mani- kins output diagnostic data in real time to either wired or wireless monitors. During exercises, this data can be used by EMS to monitor the manikins' reaction to treat- ments in real time. After the fact, the iStan data can be reviewed by educators to see how EMS staff performed under pressure, and aid them in making improvements for next time. During the December 2010 mass- casualty exercise, the iStan manikins simulated a 6-year-old boy with an epidural hematoma, a 72-year-old man having a STEMI and a 36-year-old female in active labor with a partial abruption. "The female iStan was so realistic that it even gave birth," says Sean Culliney, NWFD's EMS training coordi- nator. "The unit has a little pump built in that pushes the fetus out. You can even specify a normal, breech or prolapsed cord birth." The NWFD's investment in iStan training manikins made the difference in lives saved on January 8, 2011. So did the department's commitment to other forms of IT-based education, including distance education courses conducted with ASTEC and Web-based training for the department's 10 stations/30 shifts. The department's move to IT-based training didn't occur overnight. Instead, it took seven years for the NWFD's insti- tutional culture to change from resis- tance to acceptance. So what changed people's minds? "We realized that we needed to be able to see what we were doing and how we doing," Culliney says. "Take paper-based EMS medical records: You "Using real-time diagnostic outputs, EMS staff can see what is happening." cannot perform real-time queries on such records to see how many IV setups happen on a daily basis, and what other choices EMS personnel are making on the job. In contrast, electronic records can be queried quickly, and responses/ outcomes assessed." Electronic data also makes a difference during training. Take the iStan manikin: Using its real-time diagnostic outputs— and patient-like responses—EMS staff can see what is happening and react as they would during actual incidents. "Using passive training dummies, the staff would typically ask the trainer, 'What am I seeing?' and then respond," says Culliney. "This is not what happens in the real world: You see the patient and make decisions without the benefi t of a trainer standing over your shoulder. The iStans bring this reality to a mass-casu- alty exercise. The person being trained is confronted by the kinds of data they would see in an actual incident, and works with this data without resorting to the trainer." From an EMS staffer's point of view, the iStan's realism could pose a danger to their career. This is because any mistakes they make during training are on the record for all to see. "This is why it is so important not to use IT-based training in a disciplinary manner," Culliney says. "We use the training data to help our staff improve their decisions after the fact, but never to penalize them." On a larger scale, using IT-based training helps the NWFD make mean- ingful performance improvements. "Historically, people have looked at improving response times as the way to enhance EMS performance," Culliney says. "But getting to the scene quicker means nothing if the treatment you provide isn't effective and lifesaving. This is why the iStan and other forms of IT-based training are so important. Properly analyzed, their data can help our people make better decisions during actual events—and provide better care in the field." The lives saved during the Tucson shootings speak to the effectiveness of the NWFD's IT-based training program. This excellence was recently recog- nized by the Congressional Fire Services Institute and the MedicAlert Foundation, when they presented the NWFD with a Excellence in Fire Service-Based EMS Award for Best Practices by a Career Fire Department. "IT-based training helps our people do their jobs better," Culliney concludes. "It helps us save lives, which is the whole point of what we do." For more information on iStan simu- lators, visit www.meti.com. James Careless is a freelance writer with extensive experience covering computer technologies. EMSWORLD.com | FEBRUARY 2012 33