Vision The Joint Emergency Medical Services training Center (JEMSTC) is a multi-use campus and facilities dedicated to the provision of EMS and public safety education in the Ada County-City Emergency Medical Services System. It would serve as a locus of collaboration and effort in EMS education, providing not simply classroom space, but a relevant, dynamic, realistic, and effective learning capacity, ultimately affecting the provision of all EMS services in a positive way. The JEMSTC would provide facilities for 24 /7 EMS education, vehicle operation, skills practice, and credentialing. The facilities would be able to accommodate both EMS and Fire apparatus in all climates for a diverse array of educational activities. This JEMSTC would meet all the EMS (and related operational) training for the ACCESS system.

1. Key considerations in designing an
Emergency Medical Services Training
Center
By
Robert S. Cole, BS, NRP, MEd
Training Captain
Ada County Paramedics

2. Vision
The Joint Emergency Medical Services training Center (JEMSTC) is a multi-use campus
and facilities dedicated to the provision of EMS and public safety education in the Ada
County-City Emergency Medical Services System. It would serve as a locus of collaboration and
effort in EMS education, providing not simply classroom space, but a relevant, dynamic,
realistic, and effective learning capacity, ultimately affecting the provision of all EMS services in
a positive way.
The JEMSTC would provide facilities for 24 /7 EMS education, vehicle operation, skills
practice, and credentialing. The facilities would be able to accommodate both EMS and Fire
apparatus in all climates for a diverse array of educational activities. This JEMSTC would meet
all the EMS (and related operational) training for the ACCESS system.

3. 1.0 Background
Established in 1974, Ada County Paramedics is a 3rd service model Emergency Medical
Service (EMS) serving Ada County, in southwest Idaho. It is the largest EMS agency in Idaho
and services the largest population cluster of patients. Beginning with approximately 30 staff, it
now has over 120 field providers ranging from EMT through paramedic and supports several
specialty functions, including Tactical EMS, Community Paramedicine, Hazardous Materials
Medical Response, and Technical Rescue Teams. It is also an American Heart Association
(AHA) Training Center, providing a wide range of classes both internally and externally.
In the late 2000s, Ada Ada County Paramedics built and established a new
multi-function administrative site, where administration, training, billing, maintenance, and
logistics could all be housed. Prior to this, most of these functions were co-housed in a much
smaller facility, with a 24-hour response unit. Almost immediately, ACP began to outgrow its new
facility. With the addition of additional community paramedics, supervisor functions, use of the
current classrooms beyond traditional EMS education, and general growth of the entire
department, it is likely that an expansion is overdue. Since planning, and implementing such a
new facility is a process that will likely take years, this document should serve as a broad
overview of considerations and best practices in designing an EMS training center.
Today, Ada County Paramedics remains a key member of the ACCESS system
response to calls for medical assistance both on the tactical and strategic levels. Members of
ACP clinical staff participate in most clinical educational activities for the whole system in a wide
range of locations. ACP should take a lead role in future clinical educational activities.
Today, Ada County Paramedics is the lead organization for EMS in the ACCESS
system, and beyond. While the other major ACCESS agencies have purpose-built
educational and training facilities, ACP lags behind. Increasing the educational
capability through the construction of a Joint EMS Training Center (JEMSTC) is
essential for ACP to maintain a leadership role in EMS in the area, as well as to
maintain control of its future in the ACCESS system.
2.0 Rationale for the need for a new center
Ada County Paramedics operates its various administrative functions, including training
and education functions, from its headquarters on Benjamin Lane in Boise. Educational staff
currently enjoy 3 desks/offices, and sporadic availability to the two (adjacent) classrooms, two
meeting spaces (conference rooms), three small breakout rooms (two are used also as
simulation labs ), and a small “library”. These resources are shared with internal and external
1
1
These two simulation labs have limited functionality, consist only of a one way mirror, video recording
and are relatively small. These spaces are not realistic to EMS working environments and do not embody
current best practices in healthcare simulation.

4. stakeholders to fill various administrative needs. While a steep upgrade from previous facilities,
it is no understatement to say that ACP was already outgrowing the limited space and
capabilities before the organization took possession of the facility. The current facilities severely
limit the Educational Departments' mission to provide evidence-based, best practice education
for Ada County Paramedics and its allied ACCESS agencies. Major “gaps” in capabilities
include
The Location Of The Current Training Center:
Perhaps the single greatest strength of the current educational facilities is their location.
Being co-housed with other command and administrative functions provides certain advantages
when advocating for the educational mission. Additionally, the central county location offers
access to the interstate and other major thoroughfares that allow decent access to a substantial
portion of the ACP workforce.
Ultimately the advantages of the location are outweighed by the many deficiencies of the
current facilities. Additionally, this location is hampered by heavy traffic during peak hours and
the holiday season, distance from western units, and proximity to other high-traffic activities. A
future training center should be located with a mind for these issues, as well as the capabilities
of other allied departments. For example, with the Boise Fire Training Center in the northwest of
Ada County and the Meridian Public Safety Center in the West of Ada County serving Meridian
and Kuna, an ACP training Center would be best located near the interstate in the Eastern
portion of the county, perhaps near the airport.
Lack Of Dedicated A/V Production Space And Capability:
Healthcare education is delivered across many different methodologies, including live,
pre-recorded videos, and even audio mediums. “Podcasts” , video lectures, and similar methods
of delivery are the new normal in the post-pandemic world of healthcare ord or p. ACP currently
has no “space” to record, produce, or perform post-production editing to produce such content.
This deficit has severely limited the education capacity of the department.
Lack Of High-Quality Simulation Environments:
While again a huge step forward over previous capabilities in the early 2000’s , the
2
“simulation lab” is rudimentary at best. Essentially the simulation mannequin laying on a table,
the lab environment does not represent the actual EMS working environment in any way, either
in the ambulance or the home. A key deficit in EMS training is the lack of a simulated
ambulance environment that serves as both a training environment and a training tool for
credentialing.
2
Previous simulation was held in an open classroom at the Western Idaho Fairgrounds. Equipment was
open, unsecured, and kept in bins.

5. Figure: The Simulation Lab at Kellogg Community College allows EMS students to simulate a call from
start to finish, from the scene to transfer of care in a simulated ED (or responding to a clinic setting) in
addition to traditional simulation environments.
Lack Of Storage Space:
Current storage for EMS education equipment is overstretched, with 1 walk in closet
serving all education functions. A freezer for biological materials for wetlab activities are kept in
3
the common area due to lack of space. Less used educational materials, such as traffic cones,
vomiting airway equipment, and other items must be stored in nooks, crannies, and outside
storage sheds scattered throughout Ada County Paramedic facilities. Ideally, all educational
supplies would be consolidated in a larger, more efficient storage space.
Lack Of Adequate And Dedicated Classroom Space:
Currently, training is provided using two adjacent classroom-type spaces that can be
combined into one larger space. These rooms serve a dual purpose as meeting and conference
spaces, rather than dedicated or primary classroom space. This limits their functionality in
healthcare education. For example, these spaces have a practical capacity of 24 students (12
3
The chest freezer contains frozen swine tracheas, hearts and lungs for airway labs, frozen swine femurs
for intraosseous labs, and other various products.

6. using social distancing). These spaces are also carpeted which renders them unsuitable for
more rigorous EMS training, or training involving liquids and materials that are biological or
staining. There is limited whiteboard space, as well as limited electrical outlets requiring
extensive use of extension cords for training for certain activities .
4
The size of our educational spaces is also lacking. There is substantial evidence for the
role of “space” and its effect on education both in children and adults. While opinions differ as to
HOW MUCH space is needed per student, the negative effect of low space-to-student ratios is
clear. The commonly accepted general “rule” is each student needs a minimum 49 square feet
of classroom space for learning to be effective . While our primary classroom space may be
5
“large enough”, our smaller spaces (i.e. the break-out rooms) are not. Considering that each
breakout room should accommodate a minimum of 6 students (6:1 ratio) for a minimum of 294
6
square feet, the current simulation labs and breakout rooms are barely a third of that size .
7
Lack of Dedicated Clinical Lab Space
Currently, ACP does not have dedicated clinical lab space, a space where clinical equipment is
set up for clinical training around the clock. When clinical training is scheduled, space must be
reserved (if available), equipment set up, classroom arranged, and then taken down and stored
between sessions. This is inefficient and cumbersome given the limited time to conduct classes
and does not allow for FTOs and other staff to conduct short-notice training activities. Having a
dedicated psychomotor lab space would allow a broader range of skills training to be conducted
much more frequently than current resources allow.
Lack of Ambulance Simulation Environment
Ada County Paramedics does not currently have a dedicated space representative of the
work environment of the modern paramedic: the Ambulance. While there are plans to convert a
“retired” ambulance to this use, this approach has pros and cons. Ont the plus side, use of a
retired ambulance is a good pre-purposing of a vehicle already in stock, is a mobile classroom,
and is an actual ambulance similar to the ones in common use. The use of an ambulance,
however, is not designed for education, it is repurposed for this use. There are a number of
static ambulance simulators that are designed for education, allowing for the entire class to
observe the performance, allowing the instructors to observe unobtrusively the performance of
the students, and to do so inside in a climate-controlled classroom environment. An ideal
solution would use both a retired ambulance and the static classroom ambulance simulator as
appropriate for instruction.
7
Current breakout rooms are estimated at 70 square feet.
6
The 6 student to 1 instructor ratio is a common requirement in many courses (AHA, NAEMT, etc)
5
Sommer, R. (1969). Personal Space: The Behavioral Basis of Design. Englewood Cliffs, NJ:
Prentice-Hall.
4
Transport Ventilators, Monitor/defibrillators, and Transport Pumps require a constant power source for
educational use, especially multi-session training.

7. Figures: Two examples of static, open ambulance simulators allowing instructions and observation both
inside and outside the ambulance. Note the simulation controller in the bottom right of the image.
Lack of a Computer Lab/Facility
Increasingly, EMS education is involving online content and ACP has watched this trend
closely. ACP particularly uses a substantial volume of online content in it’s onboarding and

8. academy. Unfortunately, many new employees and students must rely on their personal phones
or tablets for online access, even when on ACP premises. Currently, ACP has a very limited
supply of “devices” for use during classes and there are no dedicated computer stations for
educational use by students.
Lack Of Appropriate Physical Training Facilities
EMS work is physical work. From lifting and moving patients, to dealing with combative
persons, to simple physical exercise, ACP has often relied on other agencies for the most
rudimentary facilities for physical training.
Ideally, the JEMSTC would provide a workout room for on and off-duty personnel to
maintain a minimum level of physical fitness. It would also provide ample space to conduct
year-long physical aptitude testing for all staff on short notice. It would have an outdoor space
8
for yearly pack testing and similar activities. Finally, it would have a mat room to practice
9
defensive/evasive tactics as well as proper restraint for a combative patient.
Figure: PAT conducted at Wake County EMS, N.C.
Lack Of Secure And Controlled Outdoor Environments:
EMS operations occur in a wide variety of environments, including outdoors, yet Ada
County Paramedics currently has no educational space representative of this reality.
Additionally, many educational activities can only be conducted in either open, outdoor
environments or in well-ventilated, accessible yet tightly controlled indoor environments. Other
activities require the use of a track or small athletic outdoor space. Examples of these activities
include
● Emergency care during simulated or actual auto extrication.
● Auto extrication training
● Emergency care in a steep or vertical environment
9
Pack Testing: 3 miles in 45 minutes with a 45 pound “load”.
8
Physical Aptitude Testing (PAT) as long been a goal for the department.

9. ● Emergency care in a confined space
● Pack tests and Physical Agility Testing (PAT)
10
● Landing Zone Operations (LZO)11
Lack Of Secure And Controlled Emergency Vehicle Operations
Environments:
Current Emergency Vehicle Operations (EVO) training is held on the Ada County
Fairgrounds on a space-available basis using parking lot space. At times, this space is
unavailable due to other activities such as sales, conventions, and of course: The Western
Idaho Fair.
When space is available, it lacks fidelity and realism to our actual environment. There
are no stop signs, traffic signals, road markers, blind curves or changes in elevation.
Additionally, there is no ability to change the environment, such as spraying water, or adding a
fog mist. Finally, the course must be “broken down” between sessions and set up again the
following day, using vital time that could be better used for actual education. This lack of
availability, lack of a faithful simulation to real operations, and lack of suitable preparation time
adversely impact the quality of EVOS training ACP can provide to its providers.
A new facility with space and design for an EVOC course incorporating these elements
would allow for better training, with an eye toward reducing accidents and improving both public
and responder safety in Emergency Vehicle Operations. It would also allow ACP to facilitate our
allied agencies with vehicle familiarization on a much more frequent basis as well. as well.
Lack Of Secure And Controlled Nighttime Environments:
Approximately half of “duty time” occurs during low light and nighttime operations, and
32% of all EMS calls , yet almost universally EMS education ignores this fact. Other public
12
safety professions, most notably law enforcement, address this with indoor simulation with light
control (i.e. “shoot houses”). An excellent local example of this concept is the “Village” at the
Meridian Public Safety Training Center and Forward Movement Training Center (also in
13
Meridian). Unfortunately the availability of the former, and the cost of use of the latter , mean
14
that they are not available on a 24/7 basis.
There is a legal basis for this concern as well. In the case of Popow v. City of Margate ;
15
the City of Margate was found legally and civilly liable for not training its officers for low light
shooting, a circumstance that could be reasonably anticipated that their officers would
encounter. This landmark case changed the way many public safety agencies trains and was
15
Popow v. City of Margate, 476 F. Supp. 1237 (DNJ 1979)
14
Approximately $5,000/week.
13
https://www.forwardmovementtraining.com/
12
Based on an analysis of ACP quarterly reports for hours 8PM through 6 AM in CY 2021.
11
A requirement for Idaho EMS certification
10
A Requirement for TACMED training and Wildland Fire training.

10. the push for reality-based training. This case can easily be extrapolated to the need for
nighttime driving, nighttime operations, and nighttime training. Unfortunately, training during
nighttime also has a negative effect on learning and retention in terms of the effect of fatigue.
Therefore, creating a nighttime simulation during daytime operations has significant appeal.
Lack of Technical Rescue and Confined Space Training
Apparatus
ACP and the ACCESS system currently has a number of specialty rescue teams.
Training of such teams understandably involves the use of selected areas that enable the
accomplishment of tasks and skills not suitable or practical in a normal classroom environment.
Skills such as room clearing, rappelling, rigging a mechanical advantage in a vertical
environment, pick-offs, pack-outs, tactical patient removal, and other environment-specific
operations. Specialty teams may spend many hours simply transporting to and from off-site
training locations to train appropriately, and bringing such capability to a training center would
provide significant time savings as well as increasing actual time in training.
Lack of Administrative Space
ACP engages 5 “training Captains” to perform a variety of educational and other support
duties. Currently, these 5 Captains (not counting the Deputy Chief) share 3 offices, also shared
with other staff members. Supporting Educational operations are three educational support staff
and an administrative assistant. Pandemic considerations have required that many of these
team members have had to work from home to meet social distancing requirements. Education
staff currently compete for space with the billing department, command staff, human resources,
community paramedics, and other various functions and team members. Education staff also
have limited access to classroom and parking space at the former headquarters , the
16
“fairgrounds”, and occasionally at the Ada County Elections Office .
17
Ideally, a new training center would have individual offices, administrative, storage, and
parking space for each of the current and future team members to allow for a secure
workspace, social distancing, and privacy. It would also be accessible to the oversized vehicles
that on-duty staff would be arriving in (and using) for training. Each space should have
appropriate room, connectivity, and technology support to conduct most routine operations.
Finally, a separate space for storage of training records as well as high-dollar equipment is
required.
At present, no single training center in the ACCESS system, either owned by Ada
17
The Ada County Elections Office is located at 400 N. Benjamin Ln, Boise Idaho 83704. This space
provides a medium sized classroom with basic A/V capability in a building shared with many other Ada
County functions.
16
One medium classroom with basic A/V capability located at Medic 23, located at 5870 North Glenwood
Street, Boise ID 83704.

11. County Paramedics or its allied/stakeholder agencies; addresses all of these deficits.
The proposed JEMSTC would provide current and future capacity to meet the needs for
education of all ACCESS clinical staff (regardless of agency) in the entire spectrum of
EMS operations, from cradle to grave of the provider's career.
3.0 Rationale for agency collaborative
Simply put, EMS Training is an expensive proposition. Moving forward, it is irresponsible
not to seek cost-sharing and collaboration opportunities. Fortunately, ACP under the ACCESS
system has truly unique relationships with our partner agencies seldom seen elsewhere. A
well-constructed training center benefits the entire system and should be made appropriately
available to the other members of the ACCESS cooperative.
Additionally, because ACP works so closely with its allied agencies, any EMS
educational facility should at the very least reflect this connectivity in order to provide a faithful
and accurate educational experience.
EMS and Fire agencies would not be the only entity to benefit from such a training
center. Many of the structures and environments would also be useful to our law enforcement
partners, as is already evident by the LE use of the Meridian “Village” at the PSTC and Foward
18
Movement Training Center.
Opportunities for cost-sharing could include the donation of land/acreage or buildings to
house JEMSTC, sharing of office and educational space, conduction of joint classes, and other
collaborative efforts. The “vision” of the JEMSTC lies in its use by all members of ACCESS (and
beyond).
4.0 Scope of operations
What type of educational activities could, and should, occur at a training center of the
scope proposed in this paper? In short: All of it.
Some exampled of training that would be conducted in whole or in part at the conceptual
JEMSTC.
- Initial EMS training: There is some desire to conduct in-house EMS training,
particularly AEMT level training for both ACP and our more rural partners. Beginning in
2025, however, such training must meet standards for accreditation. A key part of those
standards resides in proper educational facilities and resources to include classroom, lab
space, simulation space, and support infrastructure. The properly designed JEMSTC
would help meet those needs.
18
Meridian Public Safety Training Center, a joint endeavor with the City of Meridian, Meridian FD, and
Merdian PD. It is used by fire, law enforcement, and other entities for a wide variety of training activities,
including a police academy.

12. - Initial onboarding/EMS Academy: A properly designed JEMSTC would allow almost
the entirety of the initial EMS academy to be conducted in a single location. This would
also facilitate the movement for a Joint EMS academy for the entire ACCESS system,
taught collaboratively with our ACCES partners, but led by ACP.
- Block Training: A JEMSTC would add another, possibly better-suited facility to conduct
quarterly EMS “block training”. If suitable, it could add another location to reduce the
travel time of units, reducing the time to return to service. Currently, some Fire and EMS
units travel 30 minutes or longer to attend block training. This issue will only get worse
as the population and sprawl of the “valley” continues.
- Staff development: Dedicated classroom space not only enhances clinical education
but provides a means for other staff and leadership development.
- FTEP: The Field Training and Evaluation Program (FTEP) has long been a core part of
EMS training at ACP, and the ACCESS allied agencies also participate to a lesser
degree. By enhancing our simulation facilities, the JEMSTC can provide a more robust
and useful FTEP function available for on-duty staff 24/7/365, particularly with Phase IV
testing.
- Online Education, A/V production: Online education has come a long way in the past
decade, and so have the expectations associated with it. A dedicated facility with A/V
space could produce podcasts, interviews, filmed lectures and skill performances, and
other activities of content creation.
- Immersive Simulation Environments: The use of simulation in healthcare has become
synonymous with education. Simulation can be used for initial education, remedial
training, credentialing, and other educational activities. Simulation is more than simply
purchasing a simulation mannequin. The simulation requires dedicated and trained staff,
dedicated space designed for emersion into the environment, remote and removed
operations and evaluation capability, and the ability to reflect the actual working
environment and situations the paramedic may require. The JEMSTC would have the
dedicated capability to meet all of these activities to replicate the continuum of patient
care.
Geographic Scope
The JEMSTC would focus on providing for the educational needs of ACCESS
system providers in the Treasure Valley, but could easily become the premier training
center in the SW Idaho region, able to host small conferences, training events, and other
activities for outside agencies as well.
5.0 Best Practices in Design
When we contemplate building a training center for Ada County Paramedics and the
larger ACCESS system, specific capabilities should be considered. Just as EMS is more than
an ambulance ride to the hospital, a training center is more than desks and classroom space.

13. Looking at other educational facilities (in public safety, healthcare, and in the academic world)
quite a few capabilities and best practices emerge.
Administrative Space
As a separate stand alone of ACP and the ACCESS system, the JEMSTC should have
adequate administrative space for current and future operations. All training staff from multiple
agencies would be relocated to this central location. This includes separate offices for staff,
flex-space for those on temporary assignments, secure storage for record and high-value
equipment, restrooms, access control points, work rooms, meeting rooms, parking, and of
course a common space to receive visitors.
Figure: Lobby at Eastern Maine
Community College’s Public
Safety Training Center.
Parking and Staging
Another feature particular to the discussion of egress and access is simple apparatus
parking. Any parking should have expanded spaces specifically for fire apparatus, and
shorelines for EMS vehicles that may be parked attending educational activities, as well as
vehicles that “live” at the training center.
Multi-Use classrooms.
The core of any educational facility is its primary education space, the classrooms.
Looking at current and previous classes offered (block training lectures, ACLS, PALS,
academies), a classroom should be able to accommodate 25 -30 seated personnel with tables
for a minimum space of 1,470 square feet . Recent experiences with COVID informed us that
19
these classrooms should also allow for social distancing.
19
30 students x 49 sq feet = 1,470 of square feet in the main classroom.

14. In addition to classroom capacity, there are a number of other considerations for classroom
design:
Accessible:
The Americans with Disabilities Act (ADA) provides fairly clear guidelines on
accessibility standards in the design of classrooms. For example, All classroom facilities
20
should be, when possible, on the primary floor and handicap accessible. This allows for the
public, guest lecturers, and other parties to attend, speak at, or otherwise participate in activities
in the training center. Additionally, this allows better access for EMS gurneys and other
equipment often used in training.
Figure: Examples of ADA accessibility considerations in classroom design for sight and mobility-impaired
Lighting:
Lighting should be adequate to provide light for student activities (note-taking,
discussions, etc) while allowing for viewing space (screens and projectors) to be dimmed for
adequate viewing. Ideally, a mix of natural, adjustable, and fixed lighting should be used. The
lighting should be separately controlled. For student work areas and teaching space.
20
https://www.ada.gov/regs2010/2010ADAStandards/2010ADAStandards_prt.pdf

15. Image: A good use of both indoor and natural lighting in a multi-purpose classroom at Eastern Maine
Community College’s Public Safety Training Center. Note: Outside lighting can be excluded using curtains.
Indoor/Outdoor access
While not always possible, indoor/’outdoor access to the classroom would allow for the
“training Ambulance” to be parked in the classroom proper for educational putrposes.

16. Image: A training Ambulance is staged in the classroom at Eastern Maine Community College’s Public
Safety Training Center
Concrete floors:
Many healthcare classes require physical activity, moulage, and occasionally
biohazardous specimens. Past practice has shown that moppable concrete floors are more
durable. hygienic, and practical than tile, vinyl, and of course carpet.

17. Image:: Concrete Flooring is available in a wide variety of aesthetic designs and appeal.
Connected Classroom:
Similar to what is currently in use at the Ada County Paramedics “world headquarters” . The
21
capability to combine two adjacent classrooms into one larger classroom has many practical
applications, including larger meeting space, space for practical labs, and other activities.
Multimedia Connectivity:
All multi-use classrooms should have appropriate AV equipment to enable distance
education and telecommunication, as well as ensure that all students have a clear view of any
presented material via multiple screens. This includes adjustable audio equipment,
microphones, dedicated classroom computers, podiums, and other technology. Accommodation
should be made for multiple microphone stations, so students can engage directly with each
other and remote participants equally.
21
One of Chris Ehrman’s favorite turns of phrase.

18. Sound attenuation:
An unfortunate side effect of concrete floors is “echo” in the classroom setting, This
becomes pronounced when lectures are recorded. There should be some accommodation for
audio management via strategically placed soundproofing panels to improve acoustics for both
in-person and remote education.
White-space:
“White Space” in this context is the use of open space as instructional mediums, such as
whiteboards, chalkboards, etc. While relatively low tech, the use of whiteboards and similar
devices (i.e. glass boards, smart boards, etc; collectively called the ”whiteboards”) real estate is
at a premium in a modern classroom. Magnetic Whiteboards with poster keepers should be
prolific in the classroom space to allow ample room for day-to-day and multi-period instruction.
Glass whiteboards are preferred for their durability and aesthetic properties.22
Image: Example of a large glass “whiteboard” with magnetic backing in a classroom. Note the multi-media instructor's
station on the right side, with A/V and Multi-media capability (including ELMO), and the ability to have TWO screens
projecting images simultaneously.
22
https://www.clarus.com/blog/glass-boards-vs-traditional-whiteboards/

19. Breakout Rooms
Breakout rooms are smaller educational spaces that supplement larger multi-use
classrooms. In healthcare, breakout rooms are used for small group discussions, skill stations,
and scenarios. They are also used for scenarios and activities during the hiring exam. Like
larger multi-use classrooms, break-out rooms should have adequate whiteboard space,
concrete floors, adjustable lighting, outlets, and ventilation . Ideally, breakout rooms should
23
also have some cabinet space for supplies, and at least one connected screen to show videos
or other multimedia. Current breakout rooms are inadequate in size.
A best practice is that a break in our room should be at least 294 square feet24
(preferably more) to accommodate a full-sized bed for a scenario or adequate space for 6-9
people to sit in chairs for an informal discussion. By comparison, the absolute minimum size for
a small bedroom is 125 square feet in most building models and our current breakout rooms are
approximately 70 feet. Previous experience shows that many courses need four break out
rooms, preferably separate from simulation space.
Large Auditorium
Large auditoriums are an anomaly in modern education as they routinely disregard the
minimum space per student guidelines for education, but they do allow for a larger number of
students to focus around a small instructional space . Auditoriums are used for all types of
25
formal assemblies: lectures, award ceremonies, press briefings, and more. By contrast,
auditoriums are seldom used for wet labs, psychomotor skills or other activity-based events.
Even so, events place a range of demands on the room.
For all events, it is essential that everyone in the room hear and see, clearly and
enjoyably, everything that is presented. This is the goal of visual and acoustical design for
auditorium spaces. Such a space should be appropriately carpeted, soundl managed, with
multiple screens and white space, as well as a good sightline to the primary presentation space.
The auditorium should also be equipped to allow a wide variety of presentations such as
ELMO-style cameras, microphones, lighting, speakers, etc. Like other parts of the center, it must
also be ADA compliant. An Auditorium should be able to seat 100-150 attendees, with some
small desk space and power source available for each student.
26
26
Power sources are used for charging tablets, laptops, and other mobile devices. These are a mainstay
of modern education.
25
Generally 10-12 square feet per student is the minimum recommended space. Fiona. (2020, March 31).
Auditorium seating layout guide. Leadcom Seating.
https://www.leadcomseating.com/blog/auditorium-seating-layout-guide/
24
6 students x 49 square feet per student = 249 square feet
23
Ventilation is often overlooked, yet previous experience shows this to be a major detractor to classes
held in the summer. Some break out rooms began to smell like teenage boy bedrooms at the end of the
day

20. Computer Lab
A new training center should have 6 or more specific computer learning stations with
connectivity to access and conduct online learning and testing. This would enable proctoring of
computer-based testing if required, access to complete online education for employees without
stable connectivity or computer access, and also allows for use of simulated computer-based
response (i.e. MDT use, charting) as a class. In a similar vein, a computer lab could be used to
schedule online testing of candidates for employment as well.
Image: Example of a small computer lab that can also serve as a traditional classroom.

21. The Simulation Stage: Purpose-built simulation environments
Much of this proposal has focused on the use of simulation. This is large because to
maximize the impact of simulation in education, it requires specialized facilities with limited
application outside of the simulation role, unlike multi-purpose classrooms, outdoor spaces, and
the like.
Ideally, the simulation “stage” would be able to replicate commonly encountered environments.
Examples include
● The Ambulance
● The Bedroom
● Bathroom
● Garage
● Retail
● Bar/Club
● Playground/recreational/outside
● Automobile
Figure: The infamous Toilet triangle of Death, a location where many patients have been found in the

22. peri-arrest state. Any proper simulation facility should have a bathroom simulator.
Image: An ACCESS team removes a simulated victim from a bathroom prior to beginning in care.
Simulation is more than simply a “stage”, it is an immersive experience. Contemporary
simulation labs rival the production values of “escape rooms”. Therefore, a well-constructed
simulation room would include:
● A/V monitoring capability
● A simulation “control Room” and support infrastructure
● Furniture, props
● Audio effects for background
● Olfactory capability
● Adjustable lighting (to darkness).

23. ● Ability to be observed (directly or remotely) by the larger classroom for instructional
purposes.
Image: ACCESS providers “work a code” in a realistic simulation environment, overcoming commonly
found challenges such as furniture, spaces, and fostering inter-agency teamwork.
Image: An Instructor controls the simulation from “above”, outside the simulation environment and
unobtrusively. This adds to the quality of the simulation.

24. Vehicle extrication/egress ability
A high desirable feature of an EMS simulation facility os the baility to “drive through” the
environment with EMS and fire apparatus. This enhances the simulation immersion of the
activity, and allows providers to train with the equipment they actually use in a manner
consistent with actual practice, to include actual staging, radio traffic, approach and egress.
Ideally, a future training center would include a large, oversized warehouse-type
structure enabling an indoor “village” with drive-through capability. Being completely enclosed,
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lightings can also be manipulated to simulate a wide range of experiences. Such capability
already exists in other similar public safety training centers, such as the Forward Movement
Training Center in Meridian. Such a facility, if properly constructed, would be useful across the
public safety spectrum and could also be utilized by local law enforcement under a cost-sharing
agreement.
Figure: An EMS crew responds in a simulated nighttime environment at the Forward Movement Training
Center(Left) as well as a simulated nighttime response with variable lighting from emergency lights
(Right). This training occurred during normal business hours but EMS crews were able to simulate
nighttime operations in the large indoor simulation area.
Designated Skills lab area
Having a dedicated psychomotor lab space would allow a broader range of skills training
to be conducted much more frequently than current resources allow. Such a space should eb
sufficient to allow at least 4 teaching stations with skill trainers set up on tables or floor, and uyp
to 6 students per station. Accommodation should be makde to charge equipment, provide
adjustable lighting, and storage as well. Like most of the facility, concrete floors should be the
norm.
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Suitable for EMS vehicles and Fire Apparatus.

25. Figure: Dedicated Skills lab at a hospital for airway management using the AirSim Airway Trainer and
Video Laryngoscopy.
Figure: An example of a combined simulation and skills lab space at the Oregon Institute of Technology
Designated wet lab facility/area
A “wet lab” is a room or facility specifically designed for the handling of biological matter.
This could include anatomy labs, airway labs with lungs and tracheas, or cadaver labs. This

26. room requires accommodation for storage of materials (including a walk in Cooler or floor
freezer), ventilation, secure access, non-porous walls, work stations/tables, and a floor drain.
FIgure: (Left) Students prepare for a cardiac anatomy “wet lab” . (Right) actual wet lab at ACCESS Block
Training.
Designated dry lot/outdoor area
Many activities are best conducted outside, such as auto extrication. A section
partitioned off for such activities would bring the ability to pre-stage accident simulation or
vechiles for extrication classes in advance makes logistical sense. ACP would have a
designated “space” where a vehicle or other “props” could be staged and used to accurately
and safely conduct training, yet be protected and secured against theft, accidental damage or
inappropriate use.
One would envision a “lot” inside or outside, secured with fencing or other barriers as
needed. Such a space should be accessible by EMS and Fire vehicles both for educational and
operational purposes, and large enough for LZ/HEMS operations/simulation as well.
Figure: Boise Firefighters practice auto extrication in the gravel lot at the Joplin Training Center.

27. EVOC facility/Highway simulation
Every response ACP undertakes involves operating a motor vehicle, either in emergency
or non-emergency mode. ACP providers are expected to be proficient, regardless of the
circumstances. The potential cost in lives and litigation for filing to train adiwuately in this skill
set cannot be overstated. Unfortunately, such training requires space and resources. In the past,
scheduling EVOC is almost as difficult as getting clinical timein the OR. The JEMSTC should
have space not only to conduct EVOC/EVOS courses, but also simulate actual driving
enviroment. This means simulated stretch of highway, intersections, etc; as well as a simple
“cone course”.
Image: An ambulance negotiates an EVOC/EVOS cone course in a parking lot.
SERT/Tech Rescue capability
A well designed training center would be able to host multi-disciplinary training, such as
confined space and technical rescue ability. A repel tower, steep slope, skid repeland confined
space props would be available for training on site, saving time and efort traveling hours to train
on simple skills.

28. Image: An ACP SOT team member trains in technical rescue

29. 6.0 Financial Implications
The construction of a purpose build training center is not cheap. Exact costs are, at best, rough
estimates and variables based on the economic and market conditions at the time. These
estimates are based on publicly available market estimates, but may not reflect actual costs of
construction through bid processes.
Costs may include:
Design and Architecture 500,000
Land (10 Acres x 400,000 per commercial acre )
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4,000,000
Structure29
5,000,000
Additional Furnishings, A/V equipment, training equipment 500,000
Total costs 10,000,000
Ultimately, this is a capital expenditure and will likely require a multi-year planning
period, over which time prices may fluctuate.
29
Estimated new construction of combination of 50% commercial office space and 50% warehouse
space. for simulation space. Conversion/expansion of an existing structure may result in lesser
expenditures.
28
Includes parking space, 5 Acres room for outdoor educational activities such as EVOC, etc.
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