In an EMS training program that combines his concerns for pediatric EMS delivery and rural EMS education, Felix Marquez, CEO of the Orlando Medical Institute (OMI), has traveled with his team throughout Florida using the latest technology for education delivery: virtual reality (VR).
OMI teamed up with Health Scholars, which provides VR medical training, and created a pediatric emergency assessment training solution used by OMI.
Using funding from a Florida rural EMS grant, OMI purchased 10 Oculus headsets through Health Scholars.
“[Health Scholars] created all the technology with scenarios they vetted through the American Academy of Pediatrics,” Marquez says of the AI-assisted, voice-directed clinical training for pediatric emergencies.
Pediatric patients are in a low-volume, high-risk category with accompanying quality assurance concerns, he notes.
“We wanted to look at it from a hospital’s perspective,” says Marquez. “When we deliver these pediatric patients, what are we missing that becomes critical?
“I can sit there with my students with no stress, run them through a scenario, and they’ll tell me everything they should do,” he says. “Once we add the element of stress that comes with it being a kid, that takes it to another level. They struggle to find the data in their head to process it and implement it and save this kid.”
Bridging a Gap
Marquez says VR is the answer to bridging the gap between didactic classroom information and real-life scenarios that are still controlled and add a level of stress to ascertain EMS performance. Rural areas often lack the resources found in suburban and urban areas, so Marquez identified them as a priority for such education.
The program, expected to be completed by the end of June, has entailed visits with 300 first responders at North Florida College in Madison County, DeSoto County Fire Rescue, and the Monroe County Fire Department in the Florida Keys, where only one road leads in and out and from which many critical patients must be airlifted to Miami for treatment.
“We’re trying to better educate their first responders to better stabilize these patients for transport,” Marquez notes.
Marquez and his team have already developed online education for prehospitaltraining.com. They’ve created videos and podcasts highlighting the skills needed to address five key topics for EMS providers: pediatric assessment, airway management, neurological emergencies, psychosocial concerns, and unique medical topics.
Simulations were added for VR education.
The child simulation station addresses diabetic ketoacidosis and asthma. A high-fidelity infant station simulates bronchiolitis and seizures. Another addresses how to truly draw a pediatric medication without creating medical error, based on pediatric pharmacology and simplified for providers.
“There’s the stress of being a pediatric patient and then the stress of how to give medication according to kilos—the patient’s weight adds a different stress,” Marquez points out.
The program has been well-received. In Madison County Marquez discovered the area’s small community hospital was staffed with nurse practitioners, physician assistants, and one doctor. He learned it often takes an hour in one of the county’s four ambulances to transport a critical patient to more definitive help in Tallahassee.
In one case one of his instructor’s sons, a Madison County paramedic, told Marquez he learned from the training that a child who was initially presumed to have asthma was really presenting with bronchiolitis.
He told his preceptor—who hadn’t attended the class—that the medication thought appropriate would be detrimental based on what he learned in OMI’s VR class. After the child was transported to the hospital, the doctor confirmed the actions of the young paramedic would have been exactly how he would have handled it.
“It validated what we are doing,” Marquez says.
Students learn better through podcasts, videos, and hands-on simulation. “Our learning management system on the online platform has short videos and podcasts at 30 minutes long,” Marquez says. “They get all of this education first. Then we wanted to bring them high-fidelity technology to really enhance the student’s or provider’s ability to learn.”
The current generation of young paramedics thrives on this type of technology, Marquez notes. VR also offers the advantage of simulations for first responders who may not yet have children, he adds.
“It really takes having a sick child to develop that reference experience, to know what to do and to have lived through the real-life signs and symptoms so the next time you see it, you know how to manage it,” says Brian Gillett, MD, president and chief medical officer of Health Scholars. “Recognizing signs and symptoms of severe illness in infants and young children is extremely difficult. Virtual reality provides that reference experience to do so.”
Paramedics and EMTs are often challenged to make decisions based on signs and symptoms they may never have seen before, Gillett notes.
“They can go an entire career only seeing 2–3 critically ill children. Virtual reality provides the ability to step into a real-life environment and practice identifying these critical and subtle manifestations of severe illness in infants and children.”
Through VR, Health Scholars has recreated all the nuanced physical findings and the framework by which users have to exercise cognitive processing and decision-making in a real-life environment so that when they step into a real situation, they’ve already been there and are confident and competent, says Gillett.
“Our mission is to scale experience-based training by taking the evidence-based educational paradigm of manikin simulation and putting that into software,” he adds.
Other areas in which Health Scholars is applying VR training include high-risk obstetrics. In the meantime, OMI is applying for more grants to expand its VR program beyond rural areas throughout the state, Marquez says.
Carol Brzozowski is a freelance journalist and former daily newspaper reporter based in South Florida. Her work has been published in more than 200 media outlets.