Whether you're preparing students for their first patient encounter or helping seasoned providers sharpen their skills, one thing remains constant: competence isn't built by lectures alone. It's earned through hands-on, realistic, and data-informed practice — and that's where simulation shines. 
 
Simulation offers a unique opportunity to replicate the complexity, unpredictability, and emotional intensity of real-world prehospital care. It not only builds psychomotor skills, but also develops the judgment, adaptability, and confidence that providers need to perform under pressure.  
 
Even more importantly, it creates a structured environment for assessment: educators can evaluate performance objectively, give targeted feedback, and verify competency over time. 
 
In this article, we explore three high-impact ways to use simulation to build and assess essential competencies — from soft skills to CPR to community births — in your pre-hospital training programme. 

1.Build soft skills by simulating complexity — not just procedures. 

Soft skills — such as communication, teamwork, resilience, adaptability, and clinical reasoning — are among the most difficult competencies to teach, but they are often what separate a good EMS provider from a great one. 

These skills come into play when providers face unexpected challenges: a combative patient, a malfunctioning piece of equipment, or limited resources on scene. They also shape how providers communicate with patients and families, coordinate care with partners, and make decisions under stress. 

How to teach and assess soft skills with simulation: 

• Incorporate stressors and constraints: Go beyond straightforward scenarios. Add elements like delayed backup, missing supplies, or conflicting bystander information to test adaptability and decision-making.
• Focus on teamwork and communication: Include multiple learners in scenarios to assess how they share information, delegate tasks, and collaborate under pressure.
Apply principles of crew resource management (CRM), such as clear communication, situational awareness, and coordinated decision-making, to optimise team performance and safety in high-stress situations.
• Create a realistic environment: Practising where providers actually work — whether in a cluttered living room, cramped bathroom, or chaotic roadside — forces them to communicate clearly, coordinate as a team, and adapt their decision-making under real-world pressures.
• Observe and debrief the affective domain: Use structured observation tools and facilitated debriefing to evaluate emotional intelligence, empathy, and resilience.

2. Build and verify CPR competence with low-dose, high-frequency simulation. 

CPR is one of the most fundamental — and most perishable — EMS skills. While many providers initially master chest compressions and ventilations during certification, competence often declines without regular, deliberate practice. 

Traditional skills refreshers, typically conducted once or twice a year, are not enough to maintain high-quality performance.

• Incorporate CPR refreshers into regular training: Instead of annual skills checks, integrate short, focused practice sessions.
• Use objective performance feedback: Learners need immediate, data-driven feedback on compression depth, rate, recoil, and ventilation quality.
• Monitor performance: Use standardized metrics to assess competence and track improvements over time.

3. Ensure readiness for out-of-hospital births. 

Few situations test a pre-hospital provider’s composure and clinical skills like an unexpected out-of-hospital birth. These calls require rapid assessment, clear communication, and confident execution of skills that many providers don’t get to practice often. 

Simulation offers a safe way to prepare learners for the full spectrum of obstetric emergencies — from uncomplicated deliveries to shoulder dystocia and postpartum haemorrhage. 

How to teach and assess obstetric competence with simulation: 

• Use realistic, high-stakes scenarios: Recreate the urgency and unpredictability of field deliveries, including high-stress elements like panicked family members, imminent births in home settings, or transport delays.
• Focus on communication and teamwork: Assess how learners communicate with patients and their support system, coordinate with partners, and prepare for potential complications.
• Incorporate post-delivery care: Include postpartum haemorrhage management and safe transport considerations to evaluate comprehensive care.