How advances in simulation training save real lives

The brisk air betrays the onset of autumn. Recent rains add to the cold and in the early-morning darkness, visibility is virtually nil. About 15m below the edge of the Kingfisher hiking trail, a 19-year German tourist lies with his pelvis splintered, his body temperature plummeting and his level of consciousness slipping. The place where he has fallen is so narrow and difficult to access that there is only space for two people to be lowered into it: a rescue technician and an emergency care practitioner, Robert Westwood.

 

At the time, Robert is 27 years old and has only recently graduated with his Bachelor of Health Sciences degree in Emergency Medical Care (EMC) from the University of Johannesburg (UJ). Throughout his degree, thorough and extensive training, including advanced simulation training, has prepared him for exactly this kind of situation. As he works to locate, treat and rescue the young man who lost his footing while hiking in Wilderness in the Western Cape – a process that takes from 9pm on the day of the accident until 6am the following morning – Robert puts his years of training into practice.

From simulation to success

Simulation training – the process of recreating all the conditions of a rescue or medical scenario so that students can gain first-hand experience – is an integral part of UJ’s educational approach. “Simulation training instils confidence in our students,” says EMC lecturer Andrew Makkink. “The high-fidelity scenarios we create help them to be better prepared.”

In 2016, UJ, together with the Durban University of Technology, the Free State College of Emergency Care and various international schools, organised a weekend of simulation training at Gariep Dam. “The Gariep training excursion, which has grown exponentially ever since, involves a combination of aviation and small boat rescue and is entirely simulated from start to finish,” says Robert, who was part of the first cohort. The South African National Defence Force is on hand, as are helicopter services, and a fully-equipped temporary hospital is set up for the students to run and use.

“The hands-on medical and rescue experience you gain is invaluable,” he adds. “You’re also taught how to work with others and how to use the resources available to you.” It was at Gariep that Robert learnt how to build the high-angle system he used in Wilderness to lower himself and his partner down to the injured hiker. A few years later, he was building it in a real emergency.

But that’s not where UJ’s simulation practices end. As technology improves in the wake of the fourth industrial revolution, so are the devices and training methods available to EMC students. “Drones, GoPros and our high-tech mobile command posts are all part of the day-to-day now, and help us to teach our students to be experts in what they do,” says Connor Hartnady, EMC lecturer and the head of rescue.

Although they have been around for some time, the technology involved in the mannequins the EMC department uses is nothing short of state-of-the-art. The mannequins breathe, bleed, cry and vomit; vibrate if they are experiencing a seizure; and respond immediately to any real medication the students administer intravenously.

“The extensive simulation training we receive limits the risk of human error in real-life situations,” says Robert. “By the time you’re on a mountain the middle of the night dealing with a seriously injured and hypothermic patient, you’ve done the training, you know what to do.”

Simple digitisation informs future developments

One of the defining features of the fourth industrial revolution is the ways in which it is working to address major socio-economic issues and improve research and development. More than the industrial revolutions that have come before, this one has humanity at its core. One of the simpler, digital processes the EMC has put in place is directly in line with this approach.

“UJ has an electronic patient report form system, which involves the digital documentation of every form that students complete,” explains Robert. “This information is collected in a massive database where it is used to identify gaps in research and opportunities for growth and development. This research not only informs what we learn on a daily basis, it also dictates the direction of EMC in South Africa.”

To train the next generation of emergency medical practitioners using the very latest technology, UJ is preparing to launch a new clinical simulation laboratory and rescue simulation centre over the next few years. “These laboratories will help us to further immerse our students in potential scenarios,” says Connor, “with the latter including a wind and rain simulator and the ability to place our students in wet, dark and seemingly uncontrolled environments.”

Robert’s rescue in Wilderness was the culmination of countless simulation training experiences that equipped him with the skills and expertise necessary to rescue his patient and return him to safety. More than that, Robert was able to continue his care after the rescue mission: “Once I took my rescue equipment off, I climbed into the ambulance and carried on looking after him medically,” he says.

In July 2019, Robert started a new position as an operational emergency care practitioner for the Western Cape Provincial Government, where he will be responsible for stabilising patients on scene and transferring them to hospital. As an advanced life support medic, his knowledge and expertise are essential, especially in the public sector, where he is helping to treat and rescue some of South Africa’s most vulnerable people. Through advanced simulated environments, practice sessions on high-tech mannequins and digitally recorded research opportunities, technological advances are saving real lives and improving medical care across the board.

“You’re also taught how to work with others and how to use the resources available to you.” It was at Gariep that Robert learnt how to build the high-angle system he used in Wilderness to lower himself and his partner down to the injured hiker.

“UJ has an electronic patient report form system, which involves the digital documentation of every form that students complete,” explains Robert.

In July 2019, Robert started a new position as an operational emergency care practitioner for the Western Cape Provincial Government, where he will be responsible for stabilising patients on scene and transferring them to hospital.