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EMSWORLD.com | MAY 2016 21 he says. "By embracing that tech- nology, you're bridging that gap between knowledge acquisition and knowledge application." Running simulations and sce- narios smoothly requires famil- iarity with the equipment and practice beforehand. Master your technolog y—nothing dispels fidelity and flow like technologi- cal delays and interruptions. Fidelity, or the believability of the experience, is important on a number of levels. It applies to individual items of equipment, the environment in which train- ing occurs and even the psycho- logical realm: Good simulations help suspend disbelief and create a convincing mental "moment" that helps providers learn in what they perceive as credible, convincing situations. "We've all been doing simulation for as long as we've been doing EMS training," notes Heigel. "The question is just how much technology you include and how much realism you try to apply to it. Simula- tion as a technology is great, if it contributes to the flow of the scenario—if you have well- trained people who know how to use the equipment and do it regularly. If you don't have all those things, the technology can get in the way. In that case I'd rather have a non-technical manikin lying on the floor and just describe to the student what they're finding. That may not be as effective, but it's probably more effective than a scenario where the instructor has to stop the student while they try to get the manikin caught up to what was supposed to happen next." Fidelity is holistic. It can be as simple as using a female manikin to represent a female patient, but can also span aspects of the train- ing experience like backgrounds, sounds, smells, even the motion of an ambulance. There's no doubt high-tech manikins that have vital signs and react to treat- ments can improve the fidelit y of the learning experience. At this year's EMS World Expo (Oct. 3–7 in New Orleans), Boyer will describe how simulation can be a disruptive innovation. "Some folks might object to that descrip- tion, because disruptive innovations are typically lower cost, and all the high-fidel- ity simulators, for example, are expensive to purchase," he says. "The efficiency of having students be able to train on a device that actually responds like a patient would is where the disruptive innovation part comes from. Because you're basically uti- lizing the limited time you have in the lab much more effectively. You can get your students to understand and grasp concepts more quickly, and move them into more com- plicated tasks by actually dem- onstrating to them, especially your more hands-on learners: I give Drug A, Drug A takes two minutes to work. Well, instead of doing the magic 'shake the fists' type thing we do in labs sometimes—'OK, two minutes has passed'—they actually have to watch this medication take effect and watch some of the side effects." Some other good ideas for simulation education: • When possible, seek train- ers with EMS experience. Our environments and practices are unique. There's benefit to intra- professional training opportuni- ties too. • Stay abreast of current litera- ture and involved in user groups, profes- sional organizations and the like, where you can exchange insights and lessons learned with colleagues. • Students may appreciate the chance to run through scenarios more than once. "We run them through a scenario where they may miss key things, stumble on something or not be particularly effective," says Hei- gel. "We stop, do a debrief, talk about what was done well or not, and then we reset and let them redo the same scenario, knowing exactly what they're walking into and how Training in an environment that resembles where providers actually work, as opposed to a lab setting, increases fidelity and realism. Photo cour tesy of Nasco The realism and responsiveness of manikins has increased substantially. Photo cour tesy of Casualt y Simulation