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.
Simulation with advanced human patient simulators has been discussed as a suitable method for cognitive engineering and patient safety research, with emphasis on its advantage to provide a controlled laboratory environment without placing patients at risk . There are some examples also from the prehospital field. Lammers et al.  used simulation to study patient safety risks in connection to prehospital assessment and treatment of pediatric patients. Simulation has also been used to study stress and the impact of stress on EMS clinicians in a couple of studies [27, 28]. In addition, cognitive processes among EMS clinicians have been investigated in simulation-based studies [9, 29, 30]. Manikins with temperature sensors have been used to determine the effect of wet clothing removal in prehospital care  and the impact of heat stress of chemical protective clothing in connection to prehospital resuscitation . These simulation-based studies are good examples of what simulation can add to the prehospital research in the future.
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.
The results of this study in no way should be interpreted to imply CVS can be successfully deployed in the prehospital clinical environment without structured competency assessments that are customary to the introduction of new techniques and technology into patient care; however, the study suggests limited training is likely required. Times and the first pass success rate with the CVS may have been better if participants had prior experience with the device or a more in-depth training on its use.