Leading the Way in EMS Education: Sussex County's Trailblazing Journey to SSH Accreditation

Sussex County EMS is embracing cutting-edge simulation technologies and methodologies to achieve an extraordinary milestone—becoming the first EMS agency in the world to obtain accreditation from the Society for Simulation in Healthcare (SSH). This groundbreaking achievement has not only transformed its quality of education but has also sparked inspiration for other agencies to follow their lead.

Sussex County EMS

Sussex County EMS (SCEMS) is a third government service, providing fly-car advanced life support (ALS) care. Founded on January 15, 1991, they work closely with fire department-based basic life support (BLS) services, non-fire department-based BLS services, state, and local police, and are a part of the Delaware State-Wide Paramedic Program. Responding to a staggering 34,000 incidents annually, the department boasts a dynamic team of over 100 paramedics.

Simulation: The Road to Excellence

SCEMS's journey to SSH accreditation began in 2002 when the department introduced the "Air Man," a high-fidelity simulation mannequin that allowed paramedics to practice airway management skills in a realistic environment. In the years since SCEMS has continued to invest in simulation technology and training. Collaborating with fire departments, local colleges, hospitals, and beach patrols, the department offers a comprehensive simulation program that includes bi-monthly road shows, customized mannequins, and live role players.

A Journey towards Accreditation

Three years in the making, the journey toward becoming the first EMS agency worldwide to attain SSH accreditation was a feat that demanded immense dedication and perseverance. The process became a catalyst for introspection and provided invaluable feedback to the department. By adopting an accredited framework into their internal promotion process, the department neutralized the specter of favoritism, reinforcing transparency and fairness in decision-making processes that involved skill proficiency.

Elevating the Art of Education

The department's commitment to simulation has had a profound impact on the quality of education and training provided to its paramedics. Intensive hands-on training, customized mannequins designed for challenging airways, and video laryngoscopy practice have driven success rates to unprecedented heights.

This simulation training has been firmly institutionalized. Recently, simulation training has been used for farm rescue, water rescue, beach rescue, care in helicopters, and managing critical patients with aviation. Shift by shift, the paramedics of SCEMS engage in simulation skill practice for folks the day before they start their tours.

“Our people don’t have to pay for their recertifications and CEUs, we have in-house instructors,” shared Murray. “As a result of the leadership of SCEMS, the state of Delaware now has state-wide best practices guidelines when it comes to the use of simulation for training.”

Innovative Teaching Yield Results and a Culture Shift

SCEMS's commitment to education has made it a leader in the EMS field. The department's customized mannequins, targeted cardioversion training, and presentations by skilled personnel serve as examples of their forward-thinking approach.

Over this three-year period of accreditation, one of the most notable areas of success was the airway program.

“As an agency, we drop very few ‘rescue airways’ shared Matthew Troutman, Education Coordinator. Our agency's goal is to have over 90% first-pass success when it comes to endotracheal intubation. At one point a few years ago, we dropped to the 70% first pass success rate.”

Troutman noted that virtual training wasn’t helping as it wasn’t providing the hands-on practice needed to bolster skills. SCEMS shifted to a hands-on simulation approach, subsequently increasing the agencies’ airway skills. More recently, SCEMS has been looking at cardioversion as a “disposable skill” where paramedics lose their skills and speed when they don’t use a skill regularly. Simulation practice has allowed the speed of usage to shorten the window to effective cardioversion.

Inspiring the Future of EMS Education

Having achieved the SSH accreditation, Sussex County's vision extends beyond its own boundaries. With regional outreach, they are beginning to engage ER personnel by running ER clinical simulations and practicing the EMS interface. They also plan on engaging in national media collaboration and presenting their work at national conferences. They have personnel participate in clinical competitions, such as JEMS games, showcasing their commitment to what Glenn Marshall calls training done right.

“We also want to elevate EMS as a profession by sharing best practices with other agencies.” shared Troutman.

Securing Excellence for the Long Haul

Sussex County's journey to accreditation is not the end. It marks the beginning of a new phase of continuous growth. The department's commitment to staying on the cutting edge is evident in its innovative programs, such as whole blood utilization and gear bag optimization through simulation. Its focus on improving ventilators and implementing Point of Care Ultrasound (POCUS) further solidifies its place as a pioneer in EMS education.

"We want to ensure that the program remains strong even if personnel changes occur in the department," said Marshall.

Navigating Resource Challenges with Foresight

In overcoming resource challenges, SCMES leadership offers practical advice. They recommend adhering to established processes, focusing on consistency, and promoting a goal-oriented mindset. They emphasize that innovation does not always require the latest technology, but can come from a commitment to continuous improvement. Other practical suggestions include:

• Start with a goal and know what you want to accomplish with simulation. What is your objective? Then create a strategic plan with timelines and responsibilities.
• Look at your funding sources. “While we are very fortunate that our county gives us $100,000 a year for simulation and training, you may not have that. Do the best with what you have and grow it into your plan.” shared Robbie Murray.
• Create a protocol for briefings and debriefings. “The feedback that you give your people in a non-judgmental way will be the success of your program,” said Troutman.
• Find people who are passionate about running it. “Use folks who are active field providers, not folks who are full-time office people who haven’t been on a truck in years.” offered Murray. 
• Have consistency and stick with the program over time.
• Try to change the culture of training from complicated unrealistic scenarios that providers will rarely see. Instead change to goal-oriented agency improvement related to protocol, equipment, and clinical success. Murray shared, “Not everything has to be curve balls. Keep it realistic. Your goal is building clinical confidence and competence.”
• It is a team effort; be sure your end users have input.

Conclusion: A Beacon of Excellence

Sussex County EMS's journey to SSH accreditation is a testament to its commitment to innovation in EMS education. Their dedication to excellence has not only redefined training methodologies but has also set an inspiring example for paramedic agencies nationwide. SCEMS has shown itself to be a true trailblazer in the world of EMS education.

Robbie Murray is the EMS Director for SCEMS.

Matthew Troutman is the  Education Coordinator for SCEMS.

Glenn Marshall is the Special Operations Manager and Public Information Officer for SCEMS.

Barry Bachenheimer, Ed.D, NREMT/FF is a frequent contributor to EMS World and has been a practicing EMS Provider and Instructor for 37 years.