For many years, medical training has consisted of an apprenticeship model where the trainee (doctor, nurse, paramedic, EMT, etc.) followed an experienced mentor around observing and gradually learning the skills to begin practicing on their own. This model worked for many years and produced outstanding practitioners. Medicine has, however, become more complex and the amount to be learned has increased exponentially. In addition, computers have become more sophisticated allowing for new methods of learning. Medicine is now taking lessons from the airline, nuclear power and other industries and beginning to incorporate simulation into the training of medical personnel. Even more important is the use of simulation to maintain critical skills used infrequently.

The first Springfield-area medical helicopter was made possible 25 years ago, thanks to a generous donation by John Q. Hammons. The program has grown to include three helicopters located at bases across southwest Missouri. St. John's Life Line air medical service provides life-saving skills and transport of critically ill patients throughout southwest Missouri and northern Arkansas. In order to maintain the skill levels necessary to do this, Life Line started utilizing a "high fidelity simulator" for training and skill maintenance. Our simulator known as "Leo" or "Leona" depending on the training scenario, is produced by METI corporation (one of several companies that are starting to produce simulators). Leo can exhibit all kinds of medical/surgical problems that the flight crews might encounter in caring for a patient. The ability to do this allows us to practice our skills in a realistic environment without any risk to a real patient. Our crews all provide "care" to Leo or Leona on a quarterly basis with a scenario chosen by the medical director, our program director, and our educational coordinator. In addition we can reproduce almost any "problem" cases we have had and allow all of the crews to benefit from them, not just the crew faced with that particular patient. New Life Line crew members have a chance to practice our protocols and procedures prior to actual patient flights thus assuring the best patient care.

More medical training, both initial and ongoing, will be done using simulation in the future. The advantages are huge because of the controlled environment, the ability to practice "high risk/low volume" procedures over and over without having to "wait" for a patient with those problems. Life Line can assure that all our crew members know what to do in critical situations and have practiced them before they encounter a patient in the field. Medicine has become much more of a "team sport" and simulation allows for teams to practice together in critical situations. A high fidelity simulator allows for situations in which the crew can interact with the "patient" and each other.

St. John's is expanding this type of training into other areas of the hospital as well as including a new OB simulator, pediatric and neonatal simulators. These will allow us to extend the benefits to multiple areas of the hospital and staff members including physicians, nurses, and our health system.
Dr. Charles Sheppard is a board-certified emergency medicine physician at St. John's Hospital's Level 1 Adult and Pediatric Trauma Center. Dr. Sheppard serves as the medical director for St. John's Life Line air medical service.

Dr. Charles Sheppard • February 1, 2010

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