Day 3 of our Train-the-Trainer workshop began with creating and running a “CPR” case scenario. The case was facilitated by the GEMS instructors to demonstrate learning by simulation and reflection by debriefing.

In situs CPR case simulation

We then restarted the process to create the next protocol, “Shortness of Breath”. This process begins with brainstorming about needs and priorities, then determining learning objectives and assigning competency levels, followed by developing the treatment protocols according to the objectives.  The next step is creating case simulations and testing questions.  After a productive morning, the afternoon had its challenges.  The energetic and motivating morning turned into frustration of not meeting our goals for the day, which was made more difficult by the KN95 masks hindering clear communication.  We aspired to finish the protocol but quickly realized that we needed finish for the day. Dr. Unger stated, “We should end here. We are creating the protocols that will change how prehospital medicine is practiced for the next 10 years, we should do them with a clear and fresh mind.”  We all went home and planned for the next days and how we could improve.  

SLFS instructors facilitating the Chest Pain case scenario

The next day, we began by setting a clear timeline and goals for the day.  We decided on doing the cognitive work in the morning and interactive simulation and skills training in the afternoon. The SLFS EMS instructors suggested splitting into breakout groups to improve the process for creating the simulation cases. We completed the protocols on “Shortness of Breath” and “Chest Pain”, achieving our goals and more.  The simulation was facilitated by the SLFS EMS instructors and the GEMS instructors acting as patients. It was an eye-opening experience for everyone, showing the many nuances of how difficult facilitating simulation can be. We all felt excitement and immediately saw the merit of this learning modality. The day ended on a positive note. 


Day 5 started where we had left off the day before. Our partners from Saint Lucia gained more confidence in themselves and took ownership of the process. They created the next protocol on “Loss of consciousness” themselves and gave brilliant suggestions.  This day also came with an important group decision to implement information about intravenous medications in the protocols as an option to consider if trained and the resource is available.  This was decided by the Saint Lucians as a way of building toward the future and taking the opportunity of this policy window to change practice capacity of the Emergency Medical Service.   

Ms. St Rose and Mr. Alexander creating the protocols

The afternoon was filled with case scenarios.  They again facilitated and practiced the simulation scenarios with the GEMS instructors as patients.  The result was encouraging.  Mr. Henry, the EMS manager for the south of Saint Lucia, participated as the trainee for this scenario. He accepted his role with humility, whilst demonstrating leadership skills and grace. He thanked his colleagues for the feedback and at the same time provided knowledge and constructive criticism.  We are very grateful to have Mr. Henry as a keen supporter and facilitator of this workshop. We feel inspired by Mr. Henry and his spirit. We know this process will be successful and is in the best hands with him and the rest of the Saint Lucian team.   

Mr Henry taking part at the Train the Trainer workshop as trainee, instructor and over-all facilitator

Before we concluded the week, we discussed our achievements together. The conversation was positive and gave us an insight into what they believed the process would be versus what it was.  They expressed relief that the GEMS instructors where not dictating protocols, but it was rather an interactive conversation between colleagues. The process is seen as a steppingstone for the future of EMS in Saint Lucia, with hopes of establishing higher quality of care. 

To be continued…

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