Text and video by John M. Cooper III, University of New England, College of Osteopathic Medicine - Class of 2018 and
Samuel C. Broder, University of New England, College of Osteopathic Medicine - Class of 2018
Photos by Josh Shanley, Public Safety Multimedia
Rural healthcare has long faced daunting challenges in the US: fewer resources, more demands on primary care providers, and longer transportation times to definitive care have been daily difficulties. Recent changes in US healthcare have only worsened this situation: fewer physicians are going into primary care, many more are retiring or leaving for specialties, or leaving the profession entirely due to burnout. Although 20% of the US population lives in rural areas, only 9% of US physicians actually serve them. At the same time, rural Americans have become proportionally poorer, older and sicker than their fellow citizens who live in urban and suburban areas.
Vinalhaven EMS crew and Islands Community Medical Services Providers use a Guamard HAL high-fidelity simulation mannequin to enhance communication and improved patient outcomes.
Vinalhaven, an island 12 miles off the coast of Rockland, Maine has had to deal with these problems in the extreme—especially isolation and relative scarcity of resources. The summer population of 4200, with many tourists visiting as well, drops to 1200 in the winter. The only ways on or off the island are by boat or by air. An all-volunteer Fire and EMS service responds to emergencies, and the only medical facility is a clinic that is staffed by a part-time physician, as well as full-time physician assistant, nurse practitioner, and RNs.
Dr. Stuart Damon, the medical director of Island Community Medical Services and faculty at the University of New England College of Osteopathic Medicine, saw a need that needed to be addressed. He partnered with Professor Dawne-Marie Dunbar, the director of the UNE Health Professions Simulation Lab and the Vinalhaven Ambulance Service to develop high quality simulation exercises to build skills and teamwork among EMS and healthcare providers on the island.
Dr. Stuart Damon, Medical Director of Island Community Medical Services and faculty at the University of New England College of Osteopathic Medicine Professor Dawne-Marie Dunbar, Director of the UNE Health Professions Simulation Lab
A major barrier to this kind of training has been time spent off the island: it was not easy for those who needed the training to get time off from their jobs, and there were few people available to replace them if they had to travel to the mainland. The UNE team solved this problem by bringing simulations to Vinalhaven, and pioneered the concept of Simulation in Situ, or On-site Simulation.
Vinalhaven EMS crew and ICMS Providers use the Guamard HAL high-fidelity simulation mannequin to enhance communication and improve patient outcomes.
Dr. Stuart Damon and Samuel Broder supervise the clinical aspects of the scenario as Simulation Specialist Neill Gemmel operates Hal, the high fidely simulator.
John Cooper running a mega-code with the help of Jessi Harnisch and Vinalhaven EMS after their patient in respiratory distress decompensated.
Although call volumes are low, this team has been called upon to respond to critical incidents and manage patients through transport times that may take hours when patients need to be taken off the island. On Vinalhaven, basic and advanced EMTs have responded to calls along with a provider from the clinic, who may accompany the patient who needs to be evacuated to the mainland. In these situations, communication and group dynamics have had an even more important role.
The Vinalhaven EMS crew, EMT Charlie Cross and EMT Richie Carlsen, were dispatched to Booth's Quarry for an unresponsive trauma patient with a head injury. The initial EMS responders performed a primary assessment and found that the patient had a tension pneumothorax and an unstable femur fracture. Samuel Broder, Medical Student and Paramedic, responded in the role of the On-Call Provider from the Islands Community Medical Services (ICMS). A Provider from ICMS is dispatched along with the Vinalhaven EMS to all calls for emergency service on Vinalhaven Island. Sam arrived shortly behind the Vinalhaven EMS crew. The EMS crew gave a report and conveyed their critical findings.
Samuel Broder, Medical Student and Paramedic, performs an chest decompression on HAL, the Gaumard Scientific high fidelity simulator. The Gaumard Scientific high fidelity simulator allows personnel to actually decompress the tension pneumothorax, hear the resulting pressure change and see the immediate improvement in vital signs.
As the patient was being stabilized, transport off the island was being simultaneously arranged by the Vinalhaven EMS Transportation Officer. The patient was loaded into the ambulance and the simulation objectives were completed once the receiving facility was called with a report.
Beyond convenience, Simulation in Situ also provided the ability for EMS and providers from the clinic to practice responding to scenarios together using their teams, on their island, with the equipment that they actually use every day. High fidelity simulation combined with the existing resources delivered much more useful and realistic training. The results were immediate: the team was able to practice important skills that are rarely used, such as trauma assessment or pediatric emergency care, and identify areas for improvement.
Pat Lundholm, Director of Vinalhaven EMS and Chief Marc Candage use the Guamard HAL high-fidelity simulation mannequin at ICMS to enhance communication and improve patient outcomes.
Dr. Damon demonstrating intraosseous technique using the Guamard HAL Patient Simulator
Sam Broder demonstrating intraosseous technique on the Gaumard HAL adult patient simulator Pat Lundholm,Director of Vinalhaven EMS and AEMT assessing lung sounds on the Gaumard HAL patient simulator at ICMS
Simulation in Situ has helped Vinalhaven continue to build their healthcare capacity, and overcome some of the barriers they face as a rural medical system. The project is in its second year, with plans to continue and expand. This model has shown considerable promise for helping other areas in Maine with similar improvements, and could be expanded to other areas across the country.