Research Supports Value of Hyper-Realistic Training for EMTs

EMT personnel take part in a warm zone active shooter drill.

Article written by Whitney Levitz

Over the course of eight days, students and faculty from Rocky Vista University (RVU) and personnel with South Metro Fire and Rescue (SMFR) collaborated on a series of hyper-realistic training sessions designed to assess changes in the physiological response of paramedics in mass-casualty scenarios. The goal of the sessions was to inoculate first responders to the ill effects of stress by inducing a strong reaction that is comparable to a true emergency situation; researchers then assessed the physiological effects produced during the training.

Together, RVU and SMFR created scenarios to measure heart rate and arterial blood pressure, providing information about the stress response and adaptation to the training over time. The data gathered during the scenarios has become part of a research project titled “Training Effectiveness for Point of Injury Medical Care—Vital Sign Monitoring and Demographic Comparisons of Paramedics in Warm Zone Active Shooter Drills.”


“Continuous vital sign monitoring and data collection of paramedics during active shooter drill.” Photo by Tim S. McGough

There were 904 participants involved in the training sessions, including law enforcement, firefighters, paramedics, and staff from three trauma centers. A total of 18 active shooter drills were initiated and six simulated patients with life-threatening injuries were followed for each iteration. Police established a “warm zone” and evaluators assessed interventions and response timing of paramedics. The vitals of seventeen paramedics, including blood pressures and heart rate variability, were followed closely to assess physiologic stress responses during care.

To add authenticity for the training, the “victims” in the simulated scenarios suffered from a variety of traumatic injuries brought to life with the use of Strategic Operations’ surgical Cut Suit® technology, moulage, and artificial blood. These tools provided an accurate representation of wounds and facilitated the performance of true-to-life medical interventions by first responders. The use of surgical simulators allowed for the application of procedures such as cricothyrotomy, needle decompressions, supervised chest tube placement, tourniquet placement, and wound packing.


“Baseline vitals collected through the Caretaker4 device during training videos.” Photo by Tim S. McGough.

The results of the project showed a marked change in blood pressure metrics and heart rate at the start of the simulation, which was maintained throughout its course, proving that the simulation was indeed eliciting a stress response. The collected data was further evaluated to determine possible correlations between demographics, experience level, and associated physiologic response for each paramedic’s individual training. They found that prior experience as a medic or military personnel negatively correlated with increases from baseline physiological metrics.Alternatively, past participation in similar simulated experiences was found to positively correlate with increases from baseline metrics.

Research by Dr. Rebecca Ryznar, Associate Professor of Molecular Biology, and South Metro Fire Rescue has continued under the funding of an intramural grant from RVU, titled “Resilience in the First Responder Population.”  The current research projects are following up from the initial stress inoculation studies to determine biomarkers associated with stress conditioning and resilience. The full research,published in the Journal of Emergency Medical Services, can be read here.

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