The previous blog post covered a recent session that I ran for some Australian Rally Championship competitors which covered First On Scene Response training. The aim of the session was to give the competitors some basic skills so that should they be the first to arrive at a rally accident where someone has been seriously injured they have a framework to get help and provide some potentially life or limb saving assistance, buying time for the medical team. The session was deliberately practical with hands-on activities, practicing the different components on eachother or on a mannequin.


This post got me thinking about the work on education, training and skill maintenance that has been going on in critical care circles. We all need to learn our trade and once learnt, we need to maintain those skills, especially skills that are infrequently called upon but may be critical when they are. These may be technical, cognitive, communication or integrative skills.

Simulation training has been around for a while and is used in a variety of industries. Commercial pilots use simulators to learn how to fly a passenger jet and have to regularly attend simulator sessions to revalidate core skills. The military uses simulation to train techniques and prepare for mission scenarios. Simulation training has grown popular in medicine and surgery too and it has led to the development of large and often expensive simulation centre with individuals carving niche careers as simulation educationalists. Simulation is used to train ATLS, APLS, EMST and a bunch of other acronymed acute care courses.


Motorsport is no stranger to simulation either. Drivers attend high-end simulator sessions to practice track layouts and technique to find hundredths of seconds of advantage. Teams use simulators to develop and test design concepts.

High fidelity sim centres are expensive to set up and run and an effect of this is that the courses that they host are often pricey as well, to cover the cost. An emerging simulation model over the past number of years is in-situ simulation, the concept being that most of us do not work in ideal environments with resus teams so big that each task can be assigned to a different individual, so we should train the way we intend to work, in the environment that we work in and with the people and equipment that we work with.

In-situ simulation usually makes use of relatively inexpensive equipment with tricks to modulate the training pressure as required. The sessions are designed to be rapidly set up to make use of quiet or protected periods in the department and disbanded just as quickly should there be a sudden surge in department workload that overrides a training priority.


For more on in-situ simulation, read these sites and articles:

Emergency departments, ICUs, prehospital groups and others have taken up this model of simulation for its relative ease of application to their environments. Groups like Sydney HEMS have incorporated in-situ sim to their highly regarded induction weeks and run sessions regularly throughout the year to keep their crews' skills fresh and shiney. Emergency and critical care conferences have adopted the in-situ sim model and in the run up to this year's SMACC conference, the EMS Gathering ran a whole series of in-situ training sessions.


This is a model that should work well for motorsport response teams as well. I'm sure there are teams out there that already run regular simulated response scenarios and it is something that is being worked on for a number of different Australian events and race categories. Both the FIA Institute and the ICMS run medical conferences which often incorporate a demonstration of a race track rescue procedure. These could be ideal opportunities to integrate some delegate sim training, whether as individual workshops or using a model similar to SimWars and SonoGames.


If your team is not already doing in-situ sim, here are some pointers and resources to get you going.

Why run in-situ simulation training?

Initially sim sessions can be run in a classroom set up and subsequently move out to a trackside, pit lane or rally route location. The aim is to be able to quickly set up a realistic scenario, targeting either 2 or 3 learning points or practicing a whole process in a representative environment. As the skill and experience of the group increases, elements such as pressure can be modulated by adding auditory cues such as beeping alarms and recordings of racecars zipping by. To further add pressure, confederates can be used to simulate interfering spectators, media personnel trying to get "the shot" or race control bellowing through the radio to "clear the scene". All of this should help to build team skill, cohesion and resilience leading to a robust and adaptable team and thereby achieve better outcomes.


One additional element that has arisen lately is the role of 3D printing. When you run simulation sessions that involve procedures you need models that you can do things to. This allows some technical practice and also gives a more realistic tone to the timeline. The intraosseus nail doesn't just go in, you have to actually carry out the procedure. The models available are of variable quality, they often don't feel right, they don't bleed and they are usually isolated. For example, cricothyroidotomy trainers are often dry plastic and foam and are not attached to a head and neck so that there is a lesser need to get into the right position. They are often based on the ideal specimen rather than the anatomical variants that can cause us problems. And with repeated use, these task trainer models need to be replaced which can add up.


So a few of us, including people like Andy Buck (ED physician in Victoria) and Ciaran McKenna (Intensivist in Northern Ireland) are exploring the potential uses of 3D printing to produce low cost, improved tactile and more representative anatomy models for various tasks such as difficult airways, lateral canthotomy and thoracostomy amongst others. It is an exciting area and something I hope to write more about in time. To hear more about this area, listen to this podcast:

If you or your team has a sim training program, please leave your comments below. It could be how you went about setting up your sim program, scenarios that you have developed, task trainer models that you have built or resources that you have found useful.