Air medical providers' physiological response to a simulated trauma scenario

We assessed heart rate as a surrogate measure of psychological response to determine whether high-fidelity simulation reproduces a stressful atmosphere for air medical providers.

A prospective simulation study of air-medical providers at a level 1 trauma center randomized to adult or pediatric trauma scenarios in an ambulance. Continuous closed circuit video and wireless heart rate monitoring was conducted from the time of initial patient simulator contact to completion of packaging for transport.

The 19 air-medical providers had the following characteristics: younger than 40 years of age 90%; male 63%; registered nurses (RN) 37%, emergency medical technician-paramedics (EMT-P) 53%; mean time in practice 9 years; mean resting heart rate 71 beats per minute (bpm). Heart rate increased during study intake through start of the scenario, plateaued, and then increased abruptly on scenario completion. "Anticipatory" heart rate (during study intake) and peak heart rate were higher in less versus more experienced providers 106 bpm versus 92 bpm and 132 versus 123 bpm.

Providers demonstrated increased heart rates when exposed to high-fidelity simulation of critically injured trauma patients. Future studies should determine whether simulation continues to provoke this physiological response, and whether this response occurs during live operations.