Scenario-based education is one of the most cutting edge topics in EMS these days. You’ve heard the reasons why scenarios are great for students, but where should you start? How do you stage a scenario?
I reached out to paramedic educator and scenario master Dave Ussatis of Inver Hills Community College to ask. He replied with a few of his favorite scenarios from his years of teaching Ambulance Operations. Here are the gory details:
“I love a good OB scenario. We took an infant manikin, a blood soaked, ribbed nylon rope, and used a Tegaderm to attach the rope to the baby's umbilicus. We then ran the cord to the mom who was wearing flesh-colored pantyhose with a slit cut in them. The infant was greased up and the toilet was filled with Sim Blood. It looked real. For this scenario, the mother was in and out of consciousness, still sitting upright on the toilet. The baby was being held by Grandma or other convenient family/ friend based on volunteer availability. In our scenario, baby was breathing and doing fine, but for ALS, there could be complications. The shock value of this scenario was profound, given that it cost so little to produce with drugstore items. The challenge for the students was how to prioritize, should the cord be cut, and how to be effective in the confined space of a bathroom stall, given that access was very limited.” (N: Does this sound familiar? I once ran this scene as a volunteer, and I can attest to its shock value.)
“Traumatic injuries are also fun. The best we’ve done so far are a chainsaw injury and an impalement. For the impalement, I took a chunk of rebar, welded up a U-shaped band that would encompass a chest and made it so the rebar looks to be running through someone. Think Steve Martin with the arrow through the head, but on steroids. The challenge here is how do we move and position this patient, given that we have to manage his airway as he spits up blood, and we can't lay him flat. The chainsaw injury required the use of high tech appliances: using adhesives, modeling clay/wax, and fake blood, we created a blood spurting injury that panicked half the students that saw it. They all seemed to forget where their tourniquet was.”
“In the more psycho/social realm, we like to do a domestic abuse scene. One partner has knocked the tar out of the other. Sometimes we make it a same sex couple, as that adds a level of discomfort for some students. The worst of it is that the patient refuses transport, for fear that their partner will kill them when they return, or will hunt them down. A great scenario. The one thing that I'll say about this is that in order to sell it, you need real actors.”
4. Scene Safety
“Finally, we like to do at least one "scene safety" scenario each semester. You take your volunteer, filthy them up a little bit and give them a knife wound to the abdomen. An evisceration is nice if you've got the time. If the students ask for the background story, the shifty patient finally reveals that he was making a drug deal. A little white powder in a baggy and a couple of TB syringes are on their person. The fun part comes when--if the students fail to do a full physical exam--the patient pulls a gun (cap gun) and lays waste to the attendants. Cap guns are very loud in the back of a rig. My students all seem to remember the day they died in EMS Operations.”
Another proponent of simulations, Dennis Edgerly from Denver HealthONE EMS, recommends a concept from Ken Murray’s book, Training at the Speed of Life. Edgerly suggests planning time to repeat a scenario so that students can make corrections and build confidence. Especially if the students “die” during the simulation, giving them an opportunity to run the same scenario and adjust so that they “save” themselves is a good resolution after a traumatic event.
Feel free to adapt and use these scenarios in your class! And keep an eye out for upcoming Fisdap workshops where you can collaborate with other educators to build realistic and challenging scenarios for your class.