Wolf Dogs, Chocolate Pudding and Crazy Glue: Realistic EMS Training

Seamlessly integrating high fidelity simulation with a cutting edge blue tooth enabled real-time feedback platform, you can optimize your training paradigm with advanced innovative methods and complex HFMBS algorithms.

Or you can just buy some pudding at Walmart.

jello
$66,250 dollars buys a lot of Jello, or one SimMan 3g.

I don’t even know what high fidelity means. I mean, I kind of think I do, as long as no one really questions me on it.

We don’t train like we practice, we don’t train for real life, we don’t train for failures, and we don’t train for the curve balls that are thrown at us. We train in a nice clean environment with everything neatly organized. There is no chaos in the training room.

Here are some ideas I have come up with to add an element of realism to scenarios, all of these are based on real situations.


“You are paged to an RV. The patient has been living it in for several weeks and has been using the toilet in spite of it not being hooked up. There is a mountain of feces and toilet paper in the toilet and a literal shit avalanche covers the floor. It is everywhere. It is on the bed, it is on the dresser, it is on the patient. You cannot set anything down or it will be covered in feces.” [The proctor has a bowl of chocolate pudding and any time something is set down the proctor smears pudding on it. Chunky peanut butter can also be substituted. Yes, cleaning up after a call is part of EMS, so why not incorporate it in the scenario]


“You are paged to a residence for a 66 year old male that is in cardiac arrest. He is on the floor when you arrive, pulseless and apneic. A 1/8 inch thick  piece of glass, the sliding patio door, is the only thing keeping the two wolf-dogs , (which are way more wolf than they are dog), from killing you. The dogs think you are hurting their master. It seems unlikely they would break through the door. Unlikely, but not impossible. It is 2am, you are in out in the rural part of the county, and no one else is coming for at least 15 minutes.” [The proctor releases two pissed off wolf dogs behind glass partition, this might be hard to simulate if you do not have access to wolf dogs, I am open to ideas here]


You are in the back of a trailer with a patient in status seizure. The patient’s mother just knocked over all your medications that you had carefully placed on the dresser. Several of them have rolled under the bed. She is still seizing. [The proctor proceeds to dump out the medications and scatter them]


You are rendezvousing with a crew where things are going very, very bad. The patient is on a backboard and has a head injury and altered mental status. They attempted a nasal intubation and it went poorly. You get in their ambulance to help out.  The airway is full of blood. They are bad at restocking and there is only a pediatric LMA and a size 8.0 ET tube. [The proctor dumps several hundred cc’s of fake blood in airway, ideally uses a neb or oxygen tubing attached to a tank to intermittently to simulate bloody coughing and spray]


You just intubated your patient, congratulations on getting the tube. Unfortunately they had  aspirated a ton of vomit before you got there. Think pulmonary edema except the edema is slurry of pizza and beer instead of fluid. The end tidal Co2 detector was working but now vomit has clogged the line and you need to switch it out. The end tidal Co2 sensor is stuck on the top of the tube adapter; it will never come off no matter what you do.  You do know not all tubes have the same size male end  adapter, right? The apnea alarm continues to sound…. [the procotor has crazy-glued adapter in to end tidal Co2 adapter in advance]


If you are running the scenario here are some prompts and ideas to add an element of realism.

Cover everyone’s gloves in liquid soap or water based lube for that lifelike “everything is slimy feel.” I was going to tell you to use brown gravy but that is much harder to clean up.

“The tube ET is in and you think you hear good lung sounds…maybe…but the monitor is reading 0 etco2…I don’t know why, but it just won’t read.”

Does your ambulance have an air ride suspension system? Put everyone in the back and drive around for a scenario. Let the air out of the suspension and find some bumps.

Dump out the jump bag and stir it up a bit. Choose three items to kick under the bed.

Have the fire department start the IV and let them get fake blood all over everything.

Cover everything in D50, let everything get real sticky and then proceed with the scenario.

“You can’t get an IV nor can you get an IO. I don’t know why, but you can’t. Sorry, it sucks. Hope you have a plan C, or is it D?”

“The BP is 196/130…wait, it is 88/62….actually you can’t get one at all.”

Lotion: the patient is a firm believer in deep moisturizing; no electrodes will stick to the patient, ever.

Two words: Air Horn! Tell the participants you will be throwing them some curve balls to add a bit of “excitement” to the scenario. This can be a car horn that refuses to go off at an MVA or it can just be a random element to induce some excitement.


What other things have you experienced that would add an element of realism to scenario based training?

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