Simulation-Based Training for Successful Operations

By ROBERT G. BURTON

When responding to an unconscious subject with questionable breathing or at a possible warehouse fire, how will you and your department members perform when arriving on scene? Too many times, you train on skills and mentor your fellow firefighters and officers the way you were trained. But, ultimately, you cannot predict how someone will perform when placed in critical situations outside of past experiences. Simulation-based training, although not exclusively new, is a better way to predict those outcomes using a newer method of applied training; it will be the virtual reality of future development and training of the 21st century fire and emergency medical services (EMS).

As stated, simulation-based training is nothing new. However, the methods and technology on hand to accomplish quality training have improved immensely throughout the past decade. More and more enterprising companies are realizing this and, through software and product development, have capitalized on this market. Old Dominion University (ODU) has developed the first graduate and undergraduate program in the country on modeling, simulation, and visualization. ODU has determined that the next best thing to actually experiencing a real-life event is to include as many of the responders’ five senses as possible when reproducing an event, with real consequences.

The fire service and EMS have been slow to recognize the value of simulation-based training. I stumbled across this subject while writing my first Executive Fire Officer paper on acting battalion chief training for Norfolk (VA) Fire-Rescue (NFR). I realized that members training for the incident commander position would rarely, if ever, have the opportunity to call second and third alarms during their developmental training. As a result, their first experience with larger events would happen at actual events. I asked myself, Is this the best practice, or was there a better way of preparing for future incidents?

Research has already illustrated the value of simulation-based training in the health care field by using high-fidelity simulation manikins (photo 1), which allows an instructor to leave the room and give various scenarios to which the medical students have to appropriately respond. As a result, the health care field realized that the nursing and medical students experienced the most realistic training possible. More importantly, when mistakes were made (and they were made), no harm came to the patients. Throughout this process, students could build muscle memory for experiences they would later face in the real world.

(1) Norfolk (VA) Fire-Rescue (NFR) responders use high-fidelity simulation manikins.

As I looked for a way to apply this technology to the fire service, I saw many products on the market that would enable NFR members to have valuable experiences. However, I also learned that how the technology was used was far more important than the product itself. One of the first things you must identify before purchasing a product or piece of equipment is its expected outcome. In other words, how would this improve the NFR’s performance and minimize mistakes and deficiencies in the field? Once this question was answered, the remainder of the puzzle fell into place.

In 2012, NFR purchased a computer-based fire simulation program. After months of developing dozens of scenarios using pictures of Norfolk buildings and superimposing onto them evolving smoke and fire, it was time to try it out on the department members (photo 2). NFR dispatchers dispatched and managed the radio traffic as they normally would, and each company officer was represented with his own computer work station. Finally, command was placed in a secluded room with all of the tools and command boards typically carried by the command vehicles. Command members were not privy to see the incident evolve unless they left the command center room and walked to a display screen. This simple act left them vulnerable from managing the command board and tactical worksheets. If they left the command room for too long to focus on the fire or event itself, they lost track of units and companies.

(2) An NFR member trains with the help of the program Digital Combustion Fire Studio 5. (Photos by David Mashaw.)

We quickly discovered that the individuals started to get caught up in the event. Frustration levels rose, radio communication was overwhelmed, and multiple alarms were called until incident command was completely besieged. Many participants described their experience as the same level of stress they felt on the fireground. Without the opportunity to fail and to be overwhelmed on various incidents, it precluded the members from developing the recollection ability needed when those events actually happen. The radio traffic was replayed during the hot wash after each session, and the command boards and tactical worksheets were also reviewed for consistency throughout the department. Each session revealed the building of each member’s experience level above the typical calls on which he would normally respond.

Another critical component that was revealed during these training sessions was the ability to train on specific policies. During the sessions, we applied NFR’s Mayday, high-rise, hazmat, and other policies to reinforce their proper application. The evaluators could quickly identify the individuals who knew the policies and those who did not. The direct chain of command was on hand to participate and see the performances of their subordinates and allow for a follow-up on their part at a later date.

Since this was a new way of training, I was curious to hear the firefighters’ feedback. Indeed, I was not prepared for their responses. Seasoned veterans expressed that this was some of the best training they have had in their careers. Some stated that the takeaway from the training sessions was the exposure and experience on which they could build when large events did occur. All of the same problems experienced on the fireground were reproduced in these training sessions. As a result, the crews worked through communication issues, water supply problems, transitional fires, and hazards of all types.

In late 2013, I looked for a way to apply this same real-life simulation training to EMS. It was already proven in the medical field, but how could it be applied to the NFR? The year prior, NFR received a grant for a high-fidelity SIM MAN that would make this possible. In addition, the training division installed a one-way mirror between the simulation training room and the evaluator’s room. The training room was set up to resemble the back of an ambulance to help give the additional realism effect of workspace confinement. Once again, we used real time from dispatch throughout treatment and transport to evaluate our members on their skills and teamwork. Interestingly, the stress levels of these participants were the same as those in the fire scenarios. Participant feedback was overwhelmingly positive; members offered comments such as, “I have never trained like this before” and “We need more of this type of training.”

As a bonus, the EMS training showed that our members could not hide their deficiencies. The differences between the members who performed well and those who struggled with the equipment and protocols and who looked as if they were “just along for the ride” were very apparent. Since no feedback or intervention was provided throughout the scenarios, the provider skill levels were transparent. I truly believe that our members’ performances in these training sessions were an accurate depiction of how they would perform their medical skills on the streets. This fact alone made this an invaluable tool in evaluating our medical providers, and it also provided them with additional experience.

The final question to consider with simulation-based training-for fire and EMS-is what to do about the identified deficiencies of members. As a department, the training is a good measurement tool, holistically, to observe members’ skill and experience levels. But without follow-up and remediation, all of the training in the world will not correct future behavior and performance. The missing component was the need to bridge the gap between poor performance and improved performance. As hard as any department training division may work toward improvement, ultimately, the company officers will have the greatest impact on bridging this gap.

Department performance standards, once established and instituted, are the gold standards each department member must strive to reach. As supervisors, it is challenging to see your employees perform certain skills in your presence based on frequency of events. The use of simulation training for fire and EMS allows the supervisor to see the employee demonstrate his talents and make an informed opinion of his abilities. The simulation exercise training also provides the employee with the ability to close the performance gap and show his talents.

If you are considering any form of simulation training for your members, ask yourself the following questions:

• What is the best product to purchase?
• How much will the product cost?
• How will the product be used?
• How much time will it take for the product to develop your members?
• How will the training be administered?

All of these questions must be answered before you decide on this form of training. Finally, and most importantly, you will need to consider the next steps to take after the training sessions end. How do you close the performance gap in those who need remediation? The answers to this and many other questions are needed when considering this invaluable form of training.

ROBERT G. BURTON is the battalion chief of training for Norfolk (VA) Fire-Rescue.