Dawn Mangine

    Simulation in nursing or EMS education means a lot more than “pretending” to care for a patient. Standardized participants (SP), also called standardized patients, are real people who volunteer or are paid to act in scenarios. SPs are vital to the reality of a simulated scenario, and when effective, can provide learning opportunities in all types of situations.

    Simulation scenarios are used in classrooms or simulation labs, and even at professional conferences. Sometimes, as was the case recently, SPs are recruited from conference attendees for team competitions.

    I was asked to volunteer as an SP for the Emergency Nurse's Association (ENA) Conference, which took place at the David L. Lawrence Convention Center in Pittsburgh. Pocket Nurse had a booth in the Exhibition Hall, and several of our product solutions were going to be used in Sim Wars, run by the iSimulate crew. They just needed bodies. I decided to be one.

    Arrival and Prep

    Once I was fortified with coffee and water, I reported to Todd Vreeland, an EMS professional and consultant to Pocket Nurse, who was running the prep work for the simulations. He quickly introduced me to the personnel who were part of Sim Wars: Matt, the paramedic running the scenario, and Stacy and Sonny, nurses who were both judges.

    Each scenario needed two SPs, a patient and a bystander. I was cast as the patient; my bystander cohort was Terry Pye, a nurse educator from Baptist Hospital in Jacksonville, Florida.

    After the introductions, Todd sat me down behind the scenes, and got me prepared with two task trainers that I would be wearing during the simulated scenarios: the ReaLifeSim IV Task Trainer, a wearable trainer for educating students how to start an IV; and the SA FingerStick trainer, an oversized finger overlay to teach students how to perform blood glucose testing.

    BL-TS-ENA 2018 (3) BL-TS-ENA 2018 (2)
    The combination of task trainers and SPs help make a scenario more realistic.

    The ReaLifeSim IV Arm Task Trainer with IV. The lack of visible flashback means this team probably missed the "vein." 

    Matt shared the scenario scripts with Terry and me. In one scenario, I was brought to the ER suffering from an overdose of Adderall® (scenario A); in the other scenario (B), I was going into septic shock because of an IUD misplacement. Terry was either a family friend or my roommate (we switched it up), and was there to provide distraction, distress, or disruption. Having live role players who behave like real patients and family members adds to realism and evaluates the team member’s patient care skills in the affective domain.

    Regardless of the simulation, at the six-minute mark, I was supposed to report feeling lightheaded, and at the eight-minute mark, I was supposed to “pass out.”

    Sim Wars Participants

    Sim Wars consisted of 16 teams from various schools and hospitals. The teams were comprised of three to six nurse educators and students who would be working together to “treat” me. Teams ran through a 15-minute scenario – it was timed, not a scenario designed to end when the correct outcome was reached. The teams were evaluated by two judges in seven areas:

    • Leadership and scene management
    • Followership and team member assessment/management skills
    • Patient medical history
    • Patient assessment – This was to include appropriate laboratory tests and diagnostic examinations
    • Patient management
    • Interpersonal relations
    • Integration – This was to include diagnosis and transport decisions, specialty consult

    The last bit of the evaluation was to come from the simulated patient (i.e. me) on “Participant's Affective Behavior.”

    Go Time

    For each scenario, I was buckled into a stretcher, which played the part of a hospital bed. Terry stood to one side. Matt gave each team a rundown of expectations, showed them the simulation equipment they had on hand, introduced them to me and showed them the task trainers I was wearing, and then started the scenario.

    BL-TS-ENA 2018 (5)-2
    The author is monitored and given an IV to stabilize heart rate. (It doesn't work.) 


    From my perspective, I worked hard to be in the moment and true to the scenario. I answered questions that were put to me, but didn't offer any extra or additional information. For example, in scenario B, if they didn't ask about menstruation, sexual activity, or birth control, I didn't say a thing about having an IUD. The team leader of one team asked me, “Have you have any syncopal episodes?” and I answered (rather truthfully), “I don't know what that means.”

    This is where the combination of task trainers and SPs reveals the strength of simulation. If one of the team members tried to start an IV without telling me, I jumped and said, “Ouch!” or asked, “Hey! What are you doing?” A couple of team members didn't get a flashback, and realized they had to do it over. Terry and I played that up, with Terry saying, “What are you doing to her? You're hurting her!”

    In Between

    When each scenario ended, I was disconnected from equipment I had been hooked up to (blood pressure cuff, IV, electrodes), and I reported back to Todd. He drained the IV bag attached to my leg, which was collecting fluid running into the ReaLifeSim task trainer, reprimed the SA FingerStick trainer, and reprimed the ReaLifeSim. Over the course of about five hours, I was run through about seven scenarios.


    Obviously, “killing” the patient didn't score team very high points. Coming to incorrect conclusions or treatment plans were also poor outcomes. A couple of teams had excellent bedside manners, but didn't get the relevant information from me (or the simulated diagnostics they were running) before I became “unconscious.” Two teams performed unneeded chest compressions, gently, for which I was grateful. Two teams discussed intubating me, but Matt “prevented” them by telling them the sedation drugs they wanted to use were not available.

    I rated teams on a scale of 1 to 4 – 4 being the best score.

    • I rated one team 1 because they stood around talking about me, but not to me. (Not surprisingly, I "died" in this scenario.)
    • A couple of teams scored 2 or 2.5; these teams never got to the questions they needed to, and did a lot of consulting with each other. They also didn’t address Terry’s frantic questions as my condition deteriorated.
    • I gave one team a 3, even though they “killed” me. They were really nice!
    • One team scored a 4 – they treated me well, asked good questions, were reassuring to me and to Terry, and they saved me!

    Combining the right balance of patient care, diagnostic judgment, and treatment is tricky with a complaining or not forthcoming SP, a troublesome bystander, and a high-pressure time-sensitive scenario! The truer to real life scenarios are, the more they benefit educators, students, and future patients.

    For more information about ENA, see their website.

    Images by Evan Stiger, Pocket Nurse Marketing Coordinator, who was probably pleased to be on that side of the camera.