High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost.

BACKGROUND: This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. METHODS: Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMantrade mark to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. RESULTS: The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of 440 dollars and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234), but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029). Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital. CONCLUSION: It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.

Motions and crew responses on an offshore oil production and storage vessel.

The motions of vessels may interfere with crew activities and well-being, but the relationships between motion and the experiences of crew are not well-established. Crew responses to motions of a floating production and storage offshore vessel at a fixed location in the North Sea were studied over a 5-month period to identify any changes in crew difficulties and symptoms associated with changes in vessel motion. Ship motions in all six axes (fore-aft, lateral, vertical, roll, pitch, and yaw) were recorded continuously over the 5-month period while 47 crew completed a total of 1704 daily diary entries, a participation rate of 66-78% of the crew complement. The dominant oscillations had frequencies of around 0.1 Hz, producing magnitudes of translational oscillation in accommodation areas of up to about 0.7 ms(-2)r.m.s., depending on the weather, and magnitudes up to three times greater in some other areas. The daily diaries gave ratings of difficulties with tasks, effort level, motion sickness, health symptoms, fatigue, and sleep. Problems most strongly associated with vessel motions were difficulties with physical tasks (balancing, moving and carrying), and sleep problems. Physical and mental tiredness, cognitive aspects of task performance, and stomach awareness and dizziness were also strongly associated with motion magnitude. There was a vomiting incidence of 3.1%, compared with a predicted mean vomiting incidence of 9.3% for a mixed population of unadapted adults. It is concluded that crew difficulties increase on days when vessel motions increase, with some activities and responses particularly influenced by vessel motions.