INTRODUCTION:

The emergency medical personnel's role in the past mainly focused on rapid patients’ transportation to the hospitals and departments of Emergency. It is widely accepted now, nevertheless, that the paramedic performance has developed to involve performing a higher set of skills in enormous diversity of situations (1). Pre-hospital paramedics have a greater responsibility for making clinical decisions and provide a lot of interventions (2).

So, for ensuring medical care personnel is able to handle the growing intricacy that experience by their job, instructors are seeking more creative education methods that help in students’ development for a better medical care system (3). One of the challenges that Paramedic instructors face and need immediate intervention is ensuring a proper practical experience is received by students. This involves an academic knowledge and clinical experience applied into actual situations to make students secured and skilled practitioners (4).

Paramedic teaching is similar to other medical relevant qualifications, where preparing students is affected by short clinical settings. This challenge strives for new methods to create experienced students, while ensuring that institution requirements are met. Thus, as one of enhancing choices, simulation has been confirmed to be a stainless appliance for paramedic students to increase and evolve their skills (5).

Definition of Simulation:

“Simulare” is the original Latin word of simulation, which means emulate and may be described as an alternate way of behaviors for a system by others, similar to representing of actual world issues by the systems of the computer (6). Also, simulation is a set of designed actions to imitate the actual clinical situation of procedures demonstration, making decisions, and thinking critically during some techniques as playing a role with devices such as dummies or interacting videos (7). Furthermore, a simulation manner amplifies and substitutes the actual practices.

Simulations places a students in sensible performance reflective of actual situations taking into consideration social and legal context (8).

Simulation in Medical Education:

In eighteenth century Paris, a childbirth dummy was made by Gregoire father and Gregoire son which consisted of a dead baby and female pelvis. The dummy name was “The Phantom,” which enabled teaching childbirth techniques and resulting in lower death-rates (9). Furthermore, the using of animals for the teaching of surgical proficiencies was documented in historical information from middle eras and recent times (10). Although simulation was documented in old medical texts, its origins nowadays come from the aviation industry (9,10).

The simulation used in medical education, training, and assessment has been prevalently adopted during the last fifteen years. This has been related to many aspects, including faculties’ time restrictions for training, decreased accessibility to patients, significant concerns about the safety of patients and medical mistakes (11).

Simulation in Paramedic Education

Simulation for paramedic and ambulance services personnel has been an essence educational element for teaching, training and ongoing professional improvement for various decades, particularly for life support skills acquisition and performance (12). In the early 1960s, the efficiency of mouth to mouth ventilation in resuscitating of cardio-pulmonary arrested patients was described by P. Safar. Ausmund Laderal, promoted through his job, an industrialist of plastic dummies, an authentic educational simulator designed to practicing ventilation through the mouth to mouth (10). The doll named as Resusci-Anne, which helped managing an obstruction of the airway by head tilt-chin lift techniques by physicians. Safar advised Laderal to add a spring connected internally to the chest wall of dummies hence simulation of cardiac-compression will be enabled. This resulted in the cardio-pulmonary resuscitation (CPR) doll broadly used in the twentieth century (9,10). Abrahamson has developed a simulator of a human body with higher reliability to develop Endotracheal (ET) tubes inserting skills by junior anesthetists (13). Then the development of educational methods increases by using mannequins based on clinical life problems of physicians, so a new aspect was created on education: simulation in medicine (14).

Paramedic Reality

The emergency medical services provider “paramedic” is a critical component of the health care and community-saving foundation in most modern countries (15). Paramedic performance focuses on patient assessment and life-saving interventions. A paramedic must lead the emergency medical team efficiently to provide the preferable patient care, and perform the interventions within ten minutes (16).

Furthermore, Paramedics must perform these practices during various disturbing situations such as bothered family members, intrusive bystanders, and sometimes the first responders. Moreover, the paramedics have to deal with the fact that sometimes the patient could die despite all efforts (16).

These presumed, instant and intense stressors that the paramedic experienced are meaningfully greater levels than other medical care providers (17).

Preparing to Reality by Simulation

Students of different health professions are experiencing a “learning curve” into practice and its subsequent effect on medical mistakes (18). Practical skills training in different health disciplines is progressively utilizing simulation to achieve core practical skills training for students before they get into real hospital environment (19). The quality of simulators used currently is completely high which enables reality-like procedures performing (18). This training might be achieved in different forms, such as:

1. Fidelity of Simulation:

Simulation fidelity is the authenticity level of simulation offered to the trainee (20). Hays and Singer (1989) define simulation fidelity as the similarity level of simulated training to the actual situation. Fidelity specifies the precision of the clinical setting which reflects features emulated by simulation scenarios (21). High-fidelity reflects situations where trainers are capable of “suspend disbelieve” and perform as in the actual clinical situation (22). Simulation fidelity is an essential component for improving the value of learning practice. This can be achieved by different fidelity approaches including psychological fidelity, environmental fidelity and instrumental fidelity (23).

2. Improving skills:

Simulation has been adopted accordingly by medical educators as an applicable teaching tool to educate and train a broad domain of technical and non-technical skills. An approach of simulation used in training is using different models to the topic such as anatomical human-body models using high-fidelity simulators pragmatic actuality, and part-time trainers (24). These methods have been particularly used with medical personnel before registration. Trainers can practice through simulation before going to clinical settings and dealing with patients (25). The growing use of simulation has been associated with lower chances to complicated clinical incidents, lack of clinical setting chances, new methods of diagnosis and therapy, increase of competition during instructors clinical period and increase the importance of saving patients (11).

3. Continuous Preparedness:

Simulation give trainers a chance for practicing skills where knowledge and experience can be imparted inside the class room by individuals, their understanding and competence, and participate in an effective thoughtful environment of education (5). An important function that simulation plays is the ability of ensuring continuous preparedness of emergency medical services team personnel for responding to deferent kinds of accidents (26). Simulation can also help ensuring that the efficient integration can be demonstrated by clinicians of both clinical and non-clinical skills which is very critical in providing medical care to patients. Also, simulation provides instructors the chance to reveal rare experiences or high risky medical cases not commonly found in frequent practice (27). Simulation provides the features of potential and frequent observations to recognized etiology events (28).

4. Team Training through Simulation:

Communication and sharing of knowledge as two crucial team attitudes considered important in motivating inventive solution of problems, team-work, and overall performance (28). Team work and team leadership have been important issues in Advanced Cardiac Life Support (ACLS) programs. The team leader must clarify and explain of troubles using a set of skills hence outcomes of resuscitation will be successfully maximized (29). Similar to aviation, medical training is typically not a single person tool but team work. More focus should be on team training rather than individual training and teams must be assessed (30).

One high fidelity-based simulation program was developed as in advanced cardiac life support program. The study used pre/post-test which revealed a significant improvement of leadership, collaboration and communication among team members (31). For a medical care team performance to be deemed efficient, their ability to share knowledge efficiently is assessed (32).

5. Stress Defeating Techniques:

Paramedic training courses should allocate much time in teaching students stress effects. It should teach them how to defeat these influences efficiently (31). One of the favorable techniques for decreasing stress reactions and acting deteriorations during acute stressful situations is stress-vaccination training (33).

The stress-vaccination training:

objective is to prepare people’s response to favorably deal with stressful incidents. Stress-vaccination training includes three stages: 1, perceptual education stage, which aims to enable people to obtain a better recognition of stress nature and impacts; 2, competence obtaining and analyzing stage to evolve and perform adaptation abilities to decrease apprehension and improve the capability of individuals to react efficiently with stressful conditions; 3, is the exercising stage, and it focuses on applying adaptation competencies in progressing stressful situations that imitate the actual life stressor circumstance (34).

The Over-training technique also may defeat stress. This training depends on requiring a continuous practicing by trainers for the competencies recently acquired after the competencies have been gained to a proficiency level (35). Over-training can prepare learners efficiently for practicing under stressful circumstances because of various aspects (36).

For instance, under challenging missions under stressful circumstances, pressure is likely to be even worse than normal simple missions (37). Simplification of complex mission can be contributed by over-training and, accordingly, can make learners less liable to stress (36). Another aspect is that missions can be automated performed through overtraining without an expanded demand for intellectual processes (38). Moreover, this liberates the intellectual resources which can later be utilized for adapting with stress response or to be used with other performance portions. Finally, the third aspect is when missions are over-trained and trained efficiently into learners’ reservoir; this can enhance the learners’ sensitivity of mission practicing control (36,38).

CONCLUSION:

Paramedic profession is one of the most stressful occupations where paramedicine personnel facing several types of stressors like patient condition, scene disturbances, patient family members, bystanders curiosity, complications of patient case, team members communication, decision making and time limitation. These stressors can negatively affect the paramedic performance resulting in threatening patients’ lives. Therefore, simulation offers an effective environment for undergraduate paramedic students for performing the required skills without harming themselves or patients. Furthermore, simulation provides overtraining chance of simple or complicated psychomotor skills, in addition to the capability to provide replication and standardization for required skills and dealing with uncommon cases to the undergraduate paramedic students by overtraining. It can also provide chance to obtain and modify mistakes by debriefing and repeating under the supervision of instructors. Skills repeating and overtraining by paramedic personnel or undergraduate paramedic students through simulated scenarios may help them to overcome stress and decrease their sensitization to the stressors. Furthermore, repeating and overtraining of skills through simulation increase their mechanical performance which can decrease conflicts during management of critical conditions. Moreover, Self confidence is very important for paramedics which enable them to manage scene, team members, development of patients’ conditions and take of decisions correctly. Therefore, simulation is one of the best solutions to improve and encourage paramedic self confidence by imitating several of pre-hospital life threatening conditions like what real paramedic experience in their professional life.

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Received on 28.01.2019 Modified on 02.03.2019

Research J. Pharm. and Tech. 2019; 12(7):3261-3264.

DOI: 10.5958/0974-360X.2019.00550.X