Date Published: February 13, 2019
Publisher: BioMed Central
Author(s): Hanna Maurin Söderholm, Henrik Andersson, Magnus Andersson Hagiwara, Per Backlund, Johanna Bergman, Lars Lundberg, Bengt Arne Sjöqvist.
There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.
This commentary article discusses the challenges of conducting research in the prehospital field and how prehospital simulation, currently underused for research purposes, has great potential to address these.
Already in 2004, Gaba  discussed the future role of simulation as a research method, in particular for addressing central research areas such as organizational practices and human factors. He also highlighted the role of simulation in the development and evaluation of new equipment and methods in healthcare. The future is here, and with advances in healthcare simulation, there is now a potential for simulation in a number of research areas. To date, simulation-based research projects are relatively sparse in the prehospital research literature (excl. training). Furthermore, similar to the practices in how simulation traditionally is used for training purposes, they often focus on specific tasks or skills and/or are designed in a way that does not take the full complexity of the prehospital process and different contexts into account.
Due to the characteristics of the prehospital context, it is not optimal to use the same types of simulation-based facilities, such as the ones often used in hospitals or for training purposes where only one or two locations and/or rooms are represented, and many of the prehospital activities, tasks, and dimensions are excluded. We argue that to be able to conduct advanced prehospital simulation research, it is critical that simulations include the full context, phases, and details of the entire prehospital work process, e.g., different types of fidelity as proposed by Lioce et al.  and further discussed by Engström et al. , as well as advanced technology and equipment for high-quality data collection and analysis. A recent research interdisciplinary (serious games, information science, prehospital care) project (SAREK)  developed a simulation platform for prehospital training and research . The simulation platform was created to support patient care provision in live role-playing scenarios using simulated patients (actors or patient simulators). The platform integrated physical spaces and rooms, components such as a real ambulance and EMS equipment, and equipment for visualization. It also included software support, such as wall projections, sounds, and images, for creating different types of scenario environments.
Prehospital care differs a lot from hospital care in terms of physical environments, mobility, work processes, and range of patients. There are phases and tasks not present in hospital care such as driving and radio communication, and changing and unstable environments provide challenges to performing patient care. While there is a need for more research in the prehospital context, the context itself presents obstacles and difficulties to this, e.g., as lack of control and an insufficient EMS clinician involvement. Hence, we argue for the development of advanced simulation laboratories dedicated to the prehospital context. This can be compared to the use of living labs approaches  in disciplines such as human-computer interaction, interaction design, and computer-supported collaborative work where emphasis on context, work processes, and practices is increasingly considered important [47, 48]. To be able to create immersive prehospital scenarios, it is important that a simulation laboratory offers the means for close tailoring between required competence, methods and equipment/facilities, and the research problems and context presented.  Hence, it needs to provide both the width and depth of real prehospital scenarios. This can be attained through serious game-inspired techniques and methods, including sound and image projections, role-playing, and inclusion of all phases in an ambulance mission, along with data collection equipment and people with experience and competence in simulation development and design. An advanced prehospital simulation-based laboratory presents great promises to increase the scientific knowledge of prehospital care.