At first glance, the rig parked across from the city ambulance garage looks like the mother of all recreational vehicles.
It's as long as an 18-wheeler, with chrome wheels and brightly painted scenes on the side.
But inside, there is a fully outfitted emergency room bay. At the other end of the truck is a detailed replica of the inside of an ambulance. In between is a small control room.
"They won't even see us when these doors are shut," said Marjie Masten,a registered nurse who works in the emergency room at Essentia Health in Fargo. "It's actually a one-way glass, so they don't even see that we're here."
The truck is part of a new program that aims to improve emergency medical care in rural North Dakota. Its four $500,000 high-tech training facilities roam the state's highways to give ambulance crews a chance test their skills on realistic scenarios.
The project, which began with a $4.98 million grant from the Leona and Harry Helmsley Trust, could become a model for other states, including Minnesota. The trust also funded two trucks in South Dakota which are operated by hospitals.
In North Dakota, the project is run by the University of North Dakota and the State Health Department. All six hospitals in the state agreed to provide training staff. The three-year grant covers part of the salaries of trainers like Masten.
During a recent training session, she played the part of Tommy, a five-year-old boy with serious burns while an ambulance crew on the other end of a video feed tended to the patient, a mannequin.
"Owie, owie, I'm so scared," she said. "Where am I?"
"You were burned. Okay?" replied one of the paramedics."We're going to put some dressing on your chest to help it okay? Is it hard to breathe right now?"
The mannequins, which cost about $100,000 each, are a key part of making the training realistic, Masten said. They allow trainers to modify a training scenario on the fly to challenge inexperienced EMTs or emergency room physicians.
Each truck carries mannequins of an adult, a young child and an infant, with plans to add a pregnant woman to the training scenarios.
"In a classroom a lot of times you'll say pretend you see blood or pretend you're putting in the IV," Masten said. "Here you put in the IV. They bleed. They blink. They talk to you."
The computer responds to how the EMTs treat the victim by adjusting heart rate and blood pressure. Make a serious mistake and Tommy dies. He survives the exercise, ready to be transferred to the hospital.
As the scenario ends the EMTs climb out of the ambulance to take a quiz about what they just did and debrief with a trainer.
"We talk about how it went," said trainer Kyle Janssen, a paramedic at Essentia Health. "What went great, what can go better for next time."
Janssen has done five training sessions with the simulator truck.
"We can go back in and run the same scenario again and see if its improved at all," he said. "And I have not been through any scenario where they have not improved."
This experience is new for Cathy Miller, a new volunteer EMT in Kindred. Tommy the mannequin was her first burn victim. She had no trouble handling the scenario.
"When they get all nervous and worked up then you just go into your natural instinct of calming them and reassuring them and you kind of forget it's somebody with a microphone behind the door," she said.
Miller thinks the training will be much more effective than sitting in a classroom. A "hands-on person," she prefers the simulation to the classroom.
"Experiencing it firsthand versus just reading it out of a book is a whole different experience," she said. "It sticks easier for me."
The training also got a thumbs-up from seasoned veteran Bob Jostad, a retired Fargo paramedic who joined the Kindred volunteer ambulance service.
Jostad said interacting with the victim made training seem real.
"Well you'd be terrified if you were five years old and burned and somebody didn't give you a good answer," he said. "This was really great to hear. ... You got a feedback right now. You didn't have to wait for somebody else to tell you [that] you did a good or a bad job. That's pretty nice, that instant feedback. You learn and you'll remember that."
That's a key goal of this project. Teaching rural emergency responders so they remember how to act when faced with trauma cases they don't often see: a bad burn, an arm severed by farm equipment or a serious head injury.