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18 MAY 2016 | EMSWORLD.com some recommendations for improving the use of simulation in EMS education. 2 First some barriers. The NAEMSE sin- gled out: • Faculty training—Less than half of SUPER respondents reported their faculty training was appropriate, the vision paper noted. Users of advanced manikins were primarily trained by manufacturers' rep- resentatives, but nearly one-fifth said their faculty had no training specific to the mani- kins they owned. • Psychological fidelity—How realistic is the training experience? Beyond indi- vidual tools, developing skills and integrat- ing knowledge in complex scenario-based simulations requires a "whole experience" fidelity that encompasses the environment and mind-set of the practitioner. Most para- medic program simulation happens in a skills lab, classroom or simulation lab, not a realistic, dynamic field setting. • Insufficient personnel resources—More than half of respondents to the SUPER sur - vey said they had no staffing resources to support simulation beyond regular faculty hours, and 19% blamed inadequate person - nel for their equipment's disuse. • Shared resources—Having, or having access to, simulation equipment clearly doesn't mean it'll be used, and that's espe- cially true of shared resources: "Programs that reported 'having access to' a given simulation resource use that resource less frequently than programs that reported 'having' the same resource." • Inadequate funding—The money dedi- cated to simulation education often just isn't enough. Fewer than half of those answer- ing the SUPER survey said their simulation budget funding was adequate. The portrait that emerges here is that across much of EMS, simulation is handled in a cursory kind of way: Give the program head a tool or two and pay no more mind— they'll work out the rest. "It speaks to the problem we have with our general approach to simulation in EMS education," says Elliot Carhart, EdD, NRP, EMS performance and research coordina- tor for Florida's Pinellas County EMS & Fire Administration and a coauthor of the SUPER study. "That is, we take an educa- tor, and we give them complex equipment and expect them to develop learning objec - tives, program a simulation and operate the manikin, all while observing the students and facilitating a debriefing, and all while achieving the desired educational outcome. When we look at the use of simulation in other healthcare disciplines, we see a much greater depth of resources." To instructors in the field, that rings authentic. "My experience is that folks will buy, for example, something like a high-fidelity sim- ulator through a grant," says Chris Boyer, MPA, NRP, FP-C, simulation coordinator at Delaware Technical Community College in Dover. "But when they buy the simulator, they never actually incorporate a cost for somebody to come in and train people how to use it. So they're trying to learn how to use it on the f ly, on top of trying to write the scenarios and run the simulations, and they never get comfortable with it." "Even when schools find grant funding or some other way to get this expensive stuff, very few of those grants provide any funding to pay or train the staff or pay for extra personnel," says Gary Heigel, chair of the Emergency Services Department at Oregon's Rogue Community College. "To use that kind of technology, you really have to have multiple instructors involved—one who's running the scenario overall, another who's just running the manikin, and prefer- ably a third who can be sort of a participant observer. It gets very difficult on most of our budgets to figure out ways to do that." Still, many paramedic education pro- grams—both well-funded ones with whiz- bang toys and modestly appointed ones using more basic tools—make effective use of simulation in EMS education. What are the finer points of that? Secrets of Success The first thing to know is that you don't have to spend a lot of money to get some benefit from simulation. Even simpler tools and approaches can have value. "When people think about doing simu- lation, they often think of these expensive high-fidelity simulators," says Boyer. "Simu- lation is more of a concept than an actual purchase. You can use student role players with some of these fairly low-cost devices that are out now. It doesn't have to be super- expensive. The focus should be less on the equipment and more on the process." "As much as we want to focus on the technologies, we can't lose the importance of the simplified approach—the simple tabletop-type stuff as well," says Carhart. Technology in simulation can be valuable if it contributes to the flow of a scenario, but without well-trained people who know how to use the equipment, it can get in the way. Photo cour tesy of Gaumard