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- [00:01]
A
Welcome to Advancing Health. Being your best at anything usually boils down to practice, practice and practice. All across rural Iowa, first responders and other healthcare professionals are getting in that critical practice to improve patient outcomes, and the training that makes it possible is delivered right to their doorstep.
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B
You.
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A
I'm Tom Peterle, senior communications specialist with the American Hospital association, and I'm delighted today to welcome two healthcare professionals to introduce us to Simulation in Motion Iowa. That's a mobile clinical education initiative that delivers on site simulation training to EMS providers and others who provide care to the about 43% of Iowans who live in rural areas. Joining me today to talk about this are Dr. Jacinda Bunch, an assistant professor at the Iowa College of Nursing and senior advisor to the Sim in Motion Iowa program, and Tina Eden, who is CEO of Virginia Gay Hospital in Vinton, Iowa. Tina and Jacinda, thank you so much for joining me on Advancing Health today.
- [01:12]
C
Thank you for having us.
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B
Thank you.
- [01:14]
A
Well, let me start with you, Jacinda. Maybe you could take a whack at this. First, I'm sure that my introduction did not do full justice to this wonderful program. So what needs was it designed to meet and what kinds of medical scenarios do the care teams get to practice?
- [01:27]
C
So Simulation in Motion Iowa, or SIM Iowa, is a mobile simulation program where we have three trucks that we take across the entire state. We allow healthcare providers to practice to take care of our simulated patients. They can provide care for patients they don't see very often. They can take care of patients in new settings. And it's a way to test new protocols and really just refine the care that they're providing across the state to really improve patient outcomes. And we really designed this because in rural Iowa, access to simulation education is a challenge. It's expensive, it requires special training to really do it well. And we all know that resources are somewhat limited in our rural areas. So this provides both EMS providers and hospitals with the opportunity to have their staff go through simulation education to really enhance the care that they're providing across the entire state, regardless of where they live.
- [02:34]
A
How realistic are the scenarios?
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C
So we work together with both the hospitals and the EMS providers to really design the scenarios to best fit their location, what they're seeing and the things that they feel that they need to work on the most. We can do medical scenarios. We can do trauma scenarios. We have simulators that are adult pediatric infant and then a neonate, a 25 week premature baby. We can really do almost any type of medical or trauma scenario. Then we also work to make sure that the scenarios match the local protocols, we're going to ask you to use the same medications that you have access to, the same equipment, and really follow your protocols, rather than having you do something if you traveled to a mobile sim center that might not match what you do locally.
- [03:25]
A
And I guess in some cases, the EMS teams or the people that are getting the training are working on. I don't want to call them crash test dummies because I know they're not, but they're human bodies in a sense, right, that they get to do some of these things on?
- [03:36]
C
Yes. So our simulators are basically mini computers. They're little robots. They have heart sounds, they have lung sounds. You can take pulses, you can give them medications. We can amputate an arm and have arterial bleeding that they need to control. We can change heart rhythms based on medications that are given. So we really can create almost any medical or trauma scenario. We try to make it as realistic as possible. Again, we want to put the learner in that environment that they would be caring for a live patient and really try to recreate as much of that as we can.
- [04:15]
A
Wow, that's really impressive. Tina, if I could get your thoughts as the CEO of a hospital and boss of some of the care teams that have received this training, how did.
- [04:24]
B
It work out for your folks, really, with any simulation? Muscle memory is so important to build confidence in our staff. Some of the experiences they have with the simulation mannequins are those that it would take a year in their training to receive that same experience. And so it's really invaluable. It does provide a lot of confidence and just creates more of a teamwork environment. They do work with a group of other individuals when they go through their.
- [04:55]
A
Simulations, sort of circling back to some of the most valuable services that the program offers. I understand that 32 of Iowa's counties are considered maternal care deserts, meaning they lack adequate labor delivery, postpartum care services. How has a SIM Iowa helped in that particular sphere?
- [05:14]
B
At Virginia Gay Hospital, we did actually have a maternal child simulation lab come as well as sim Iowa and working with those pediatric patients, it's really important. Our staff just don't have the pediatric experience in working in a critical access er. You can see anything on any given day. So it's really important to have that in lab experience to handle those situations, everything from a burn to a crush injury.
- [05:43]
A
SIM Iowa, as I understand it, has now visited, I believe, all 99 counties in Iowa. I think some of the most important lessons learned in the field have not necessarily been hands on operations and emergency response, but more having to do with emergency protocols and things like that. Can you both speak to that aspect of the training and maybe not, you know, if it's not treating a patient who is on a stretcher. What are some of the other big lessons and takeaways that the care teams have benefited from as the program goes around the state?
- [06:15]
C
I know a couple of things that we have experienced with our educators is when we go into either an EMS agency or a hospital and we're working with scenarios that they don't see very often, they may have read those protocols multiple times, but to really pull them out and go through the steps. Do we really have this medication in stock? Does everyone know where it is? How do we access it? What about this piece of equipment that we don't pull out very often? Have we really had the chance to use it hands on? Does everyone know how to work it? Well, Tina mentioned that muscle memory to actually get your hands on it and do the tasks and provide the care and use the equipment, especially when it's something that we may not see as often. So that has been a huge piece. Our EMS folks bring their bags in so they are going through their own jump bags and finding their equipment and pulling out those things that maybe they don't see very often. And we also are able to take our mannequins inside the hospital so that they are also providing care in the same location that they will be with a live patient.
- [07:20]
B
We were able to do an on site airway training with Sam, Iowa, where they actually came into our emergency department and worked on difficult innovations with our ER staff, including our physicians and physician assistants as well as our nursing staff. We were also able to do emergency crike procedures in their unit. And that's something that we would only use in an extreme emergency. And our staff weren't comfortable.
- [07:51]
A
The program was recently gifted with, I think more than $5 million in investment by the Wellmark foundation to expand the reach and frequency of the training. I wonder if you both could speak to what the plans are for this funding. How do you see it helping and benefiting patients around the state?
- [08:07]
C
Well, the focus of this particular gift from the Walmart foundation, it really has a focus on our rural hospitals and EMS providers. So what this gift is able to provide is two trainings every year for our rural and mixed urban rural counties. So those are emergency departments primary focus. So it may be a medical scenario in the er, like sepsis, it might be a trauma, like a motor vehicle accident. But they will receive two of these trainings and those costs are covered by the gift from the Wellmark Foundation. And then in addition, the maternal care desert counties are also provided one obstetric emergency training, and that is delivered in partnership with the ipqcc, which is the Iowa Perinatal Quality Care Collaborative. And so our educators are working together. We go out jointly and provide this education in the maternal care deserts. And the Walmart foundation is paying for these trainings to occur over five years.
- [09:11]
A
That's fantastic. Is it your sense that there's a great appetite for this? Maybe, Tina, you can speak to that because you're one of the hospitals who have benefited from the training. Do you have this sense from your own folks that, wow, this was fantastic, great use of our time and we'd love to see them come back and do more of this kind of work?
- [09:27]
B
Absolutely. It's very engaging for the staff. They get to do those hands on skills that they may not necessarily do. And a lot of the apprehension that new staff will have working in the emergency department is they just haven't seen something before. So it really provides that access to think through, talk through and work through an emergency situation.
- [09:49]
A
I don't know this for sure, but this is the only program that I'm aware of in Iowa that is set up to do what it does and organized like this. If another state is considering doing something similar, what advice would both of you have in terms of what you've learned so far and what you know works?
- [10:05]
C
I would say from launching this program, some of the things that we learned and actually did were to partner with a state that was already doing something similar. The Helmsley Foundation, Helmsley Charitable Trust provided the initial startup funding for this program and they have done so in four other states. Each of us run our programs just a little bit differently. But we collaborated with them and we learned from them. We learned the mistakes they made and also the things that they did well. And then really just getting out and talking to providers across the state, to hospitals, to EMS agencies and finding out what their needs specifically are. We don't want to come in and say you need A, B and C. We want to know what you need and then we can provide that for you.
- [10:54]
A
Got it. Tina, any final thoughts?
- [10:57]
B
If there are other facilities that haven't used them, Iowa, I would recommend it. It's been very time valuable and well worth the cost of training your staff.
- [11:08]
A
It sounds like a marvelous program and really impressive. Thank you so much for spending some time with me on advancing Health Today to talk about this and share your insights and your knowledge.
- [11:18]
B
Thank you. Thank you.
- [11:20]
A
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.