Computer-aided simulations could be your best ally in disaster preparedness
Simulations–What are they exactly?
While attending several emergency management conferences this year, I heard many people talking about “simulations.” It occurred to me that individuals often have a variety of things in mind when using this word, because the term “simulations” describes such a broad range of training.
Simulations are scenario-driven training events or venues designed to give people specific, contextual experience which adheres—as closely as possible—to reality.
Simulations can be used to effectively develop individual, team, and leadership skills. The main advantage of a successful simulation is the ability to build these skills safely and in a realistic context. Another excellent advantage is the ability for the trainer to use the simulation iteratively—to adjust the difficulty of the problem-solving and to give trainees several tries to hone their skills.
Simulations can vary quite a bit in complexity. They can be as simple as an individual role-playing symptoms in a medical triage training or as complex as a computer-aided simulation that helps a hospital incident management team hone their unified decision-making skills.
To be effective, a simulation must be as real as possible. Typically, simulations are used in order to provide a safe training experience. For example, instead of using an actual Ebola patient to train nurses in isolation procedures, one could use an actor-role player who would act out the symptoms. This setting provides a rich training experience that poses little risk to the nurse in training, but is it enough?
The fact that simulations provide context to training is key to understanding this. Context provides nuances and dynamic feedback, which drive the application of skills and decision making while preventing the trainee from suffering from negative consequences.
We want the simulation to provide critical and realistic feedback; but if the simulation does not allow a chance to “fail safely,” it could provide the wrong kind of experience. One example is this story about the blow-back from a hospital active-shooter exercise. The simulation was so realistic, it actually traumatized a nurse who was in the training exercise. She is now suing the hospital for emotional damages.
What is a computer-aided simulation?
A computer-aided simulation (CaS) differs remarkably from the simulations that I just described. A CaS can be an excellent training tool, because it leverages the power of the computer to provide feedback in a controlled environment.
Computing power is the main advantage of a CaS—
Computers can instantly capture, track, and relate together thousands of variables at once. Using various devices and sensors, computers can receive inputs and provide a picture of outcomes. But the most important feature the computer offers is the ability to provide logical analysis, in real-time, and provide feedback to the user.
So how do we leverage computer-aided simulations?
While at the National Healthcare Coalition Conference in Denver Colorado, I saw an example of a 3D virtual reality-based simulation of a hospital incident command post. The simulator was designed to help reduce the complexity of organizing and conducting exercises. By creating a virtual training venue, the authors created a way for people to interact without having to be physically present. The environment also integrated visual data and tracked staff inputs and dialogue, which allowed for analysis of staff functioning in the after-action review. This is a good start towards developing methods to train in the virtual world.
But in truth, the computer can do far more—it can model reality.
Computers have the ability to model complex systems and predict future outcomes.
This is an incredible power that can be leveraged by trainers to drive organizational training such as the command post I just mentioned. Moreover, computer modeling has the power to capture and assess capacities, relationships, and actions at an appropriate scale to assess the adequacy of plans and capabilities.
Let me illustrate the power of a CaS
Let’s say a hospital has an evacuation plan. The plan calls for the ability to evacuate the patients to another care facility. How can a CaS help to validate the plan and train the members of a hospital incident command team?
- First, we model the hospital and health care facilities. We would need to capture all of the adaptive capacities of the facilities. Some examples of these capacities are beds, caregivers, staff, square footage, supplies, equipment, and the facility itself (water, electricity, elevators).
- next we model how these capacities work together to both shelter waiting patients and to move a patient from point “A” to point “B”. This is a series of steps normally defined in a procedure. We identify decision points along the way that trigger certain procedures. We would create patient “agents” who would be identifiable by a unique number. An agent is an actor in the simulation that consumes resources and behaves a certain way based on a set of rules.
- next, we model the local emergency medical service (EMS) capacity. We capture the different types of ambulances available, such as basic life support or advanced life support. We also capture other forms of expedient transport such as school buses, vans, and cars. Ambulances would be modeled as agents too, because as single entities, they would transport patients from point “A” to point “B.” They too are consumers, they can only travel at certain speeds and there are only so many of them.
- then, we would model the environment. We would capture the local population, the roads, transit times between hospitals, and others. These factors all affect the ability of the patient to transport between hospitals and also affects how the population will stress the hospitals as they pour in through the emergency room as a result of the disaster.
- lastly, we create a coordination layer. This layer is where communication and coordination can be input or even input using other systems such as HAvBED data. By creating all the hospitals in the system, some hospitals will be in the “supporting” role, and some in the “supported” role. The supported hospital would be making decisions on how to move patients out. The supporting hospitals would be making decisions on how to both move patients out to create surge capacity, and then receive patients from the supported hospital. These decisions would be put into the simulation in form of dispatches, priorities, and patient tracking.
Missouri Hospital Association Hospital Evacuation Simulation: The development and implementation of this project was supported through a subcontract with the Missouri Department of Health and Senior Services using funds from the United States Health and Human Services Office of the Assistant Secretary for Preparedness and Response, Hospital Preparedness Program, CFDA 93.889, as validated at Phelps County Regional Medical Center, Rolla, MO; Mercy Hospital, Springfield, MO; and Southeast Hospital, Cape Girardeau, MO. The screen shot above is property of the Missouri Hospital Association (MHA).
Since the relationships between the agents and variables described above are habitual and predictable, the performance of the entire system can be accurately assessed. As the model ticks forward in time, logistics are consumed, and patients and ambulances are in-transit consuming vital resilience capacities.
How, exactly, can you time travel using a CaS?
Since the computer calculates on a timeline, it is easy to move faster than the clock. In effect, you can load parameters and play the simulation forward an hour, a day, or a week. The farther out you go in time the more uncertainties are introduced, meaning less accuracy, but simulations enable decision-makers to establish initial historic conditions then play forward along a line of duration to see what outcome is possible.
Validate the plan
When the computer-aided simulation is fully built, it is used to support training. Incident management teams—from the supported and supporting hospitals and the healthcare coalition coordination center along with EMS—would participate in a computer enhanced full-scale “training exercise without troops.” In other words, leaders and their supporting staffs would get together via their normal forms of communication and provide direction to staff, patients and ambulances using the computer-aided simulation.
Since the quantities and use-relationships of these resources are captured in the simulation, the computer provides an adequate scale to assess the capability of the SYSTEM. If the Healthcare Coalition was to do this with physical resources, it would be extremely expensive, disruptive, and very difficult to coordinate. It would also take at least two years to adequately plan. The simulation featured in the screenshot above was developed by Takouba and Simudyne and provides an excellent example of a hospital evacuation decision support simulation. This simulation has been successfully used in a modified table top exercise format to train hospital incident management teams at Mercy Hospital in Springfield, Missouri, Phelps County Regional Medical Center in Rolla, Missouri, and Southeast Hospital in Cape Girardeau, Missouri. This simulation can be easily scaled-up to facilitate a multi-agency communications and coordination exercise.
Computer-aided simulations offer perhaps the best way to test large system capacities.
They offer better training and advantage over traditional full-scale exercises with regard to plan validation, determining the adequacy of adaptive capacities, and supporting the decision-making of unified staffs.
Download a pdf of this article.
This article has been approved by the Missouri Hospital Association (MHA).
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