Tagging some rural, wilderness & prehospital people who may be interested in VEMS. Would love to hear your thoughts. @canadianwildmed @snewbery1 @broomedocs @TheSGEM @lespsar @EMManchester @CanadianKayMD @stemlyns See toolkit here:

@cjmdenny @precordialthump

Inspired to share this after seeing all the #ICEM2025 posts, and hoping to contribute some MedEd from the southern hemisphere. @CAEP_Docs @HumanFact0rz @petrosoniak @EmICUcanada @davidcarr333 @ICEM2025

I learned a lot from the experience, and have included some 'top tips' in the folder linked above. Please check it out - I've taken a 'done is better than perfect' approach and so lots of room to improve, and would love to hear any and all feedback.

The teams loved it, it was highly engaging as a facilitator and debriefer, set up/clean up took <5min, everything fit in one letter sized folder and the whole thing cost less than $60! To quote one of the participants: ‘Every rural hospital should have this!’

I am particularly interested in how this could apply to rural or lower resource settings, places that may lack the space and money for more traditional simulators. We tried this out at a couple of hospitals in the rural Far North of New Zealand, and was thrilled at how it went!

... and spend 10-15 minutes doing the sim, and clean up is as simple as swiping it all back into the folder. Could the same be done with the days trauma team? Code blue team?

I envision being able to have one of these kits in the ED, and doing a low stakes sim every day, or even every shift. For instance, at the hospital I work at now every shift has a team assigned to resus. With VEMS they can pull out the kit, set up a sim on an empty stretcher...

Here is our VEMS setup for use at our HEMS base - paper cutouts of patients and gear, stowed in portable and small folders.

As a fairly new sim modality, there is some great stuff out there but nothing that suited our needs. So I used elements from the Optimus BONUS team, added some of our own, made and modified cases, and found a free online vital sign simulator to add to the mix.

If you're interested in why, check out a paper and presentation I did for some recent post-grad work here:

Enter visually enhanced mental simulation - VEMS combines elements of sim, with mental rehearsal as a team. This is not my idea, but it is a great one and I personally think VEMS will form a major part of simulation outside (and inside!) large well resourced academic centres.

TLDR: if you want to try VEMS here is the kit we used, along with instructions and some thoughts, tips and tricks. It’s a bit janky but works great with plans to continue updating:

...not feasible, as it requires time, resources, and technology that is not available outside of most sim centres. So what we need is something cheap (ideally free), easy to set up and store, but that keeps as much of the goodness of ‘traditional’ sim as possible. So what to do?

To do this with swarm teams however needs a different approach to traditional simulation. If the team changes every day, or every shift, how can we train together? I think an answer could be more frequent simulation training. Conducting a traditional simulation is likely...

So how to develop culture in these ad hoc swarm and smash teams? I got thinking about @purdy_eve leaky model of sim, and how we could influence culture and therefore team performance through training.

Another new concept for me was smash teams, where two or more teams come together to form a new team to deal with a situation. We do this a lot in HEMS, where we come together with road EMS, fire and rescue, and other teams on scene to care for a patient.

However, most of these teams are ‘fixed’, that is they don’t change much day to day. In acute medicine we more often operate in swarm teams, where individuals from different teams come together to form one new one. Think of a trauma team with people from multiple specialties.

I had the chance to present to and learn from high performers from medicine, police, military and sport at the Mission Critical Team Institute summit a few months ago. We talked a lot about the importance of culture, and how to develop a learning culture within a team.

This year with @Aucklandhems I have spent a lot of time thinking about human performance, in particular how create and sustain high levels of performance in teams.