title: High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost.
abstract: BACKGROUND
  This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter.
  
  
  METHODS
  Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMantrade mark to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators.
  
  
  RESULTS
  The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of 440 dollars and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234), but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029). Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital.
  
  
  CONCLUSIONS
  It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.
authors.affiliation: University of Cincinnati, Department of Emergency Medicine, Cincinnati, Ohio, USA. stewart.wright@uc.edu
authors.forename: Stewart W
authors.initials: SW
authors.lastname: Wright
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: William R
authors.initials: WR
authors.lastname: Hinckley
authors.forename: Annette
authors.initials: A
authors.lastname: Williams
authors.forename: Carolyn
authors.initials: C
authors.lastname: Holland
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Lewis
authors.forename: Gail
authors.initials: G
authors.lastname: Heimburger
mesh_terms: D000328:Adult; D017732:Air Ambulances; D001307:Auditory Perception; D003198:Computer Simulation / Q000191:economics; D020378:Confined Spaces; D003365:Costs and Cost Analysis; D018961:Educational Technology / Q000191:economics; D004635:Emergency Medicine / Q000191:economics / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000191:economics / Q000379:methods*; D008297:Male; D008348:Manikins; D009622:Noise / Q000009:adverse effects; D015397:Program Evaluation; D020377:Self Efficacy; D013647:Task Performance and Analysis; D014146:Training Support; D014732:Vibration / Q000009:adverse effects