A Simulated Scenario to Improve Communication Skills of Residents Providing Online Medical Command of Emergency Medical Service Providers

Abstract

Audience: The primary audience for this simulation exercise is emergency medicine (EM) residents. Additionally, this scenario may be adapted to provide education for any EM provider involved in providing pre-hospital, on-line medical command of emergency medical services (EMS).Introduction: Exposure to pre-hospital medical command and the ability to provide high quality and effective EMS medical direction are essential components of residency training in Emergency Medicine. The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements for Emergency Medicine 1 stipulate that EM residents must have educational experiences in EMS, which should include direct medical oversight of EMS providers. Despite this requirement, there is a paucity of literature to provide clear direction on how residency programs should teach residents how to provide pre-hospital medical command. Prior literature has outlined that the majority of EM residency programs utilize a mix of didactics, structured readings, protocol review, observing EMS crews, and providing care in the field. 2,3 A recent survey revealed that the majority of residency programs meet the EMS requirement through a onemonth rotation involving observation of ground-based pre-hospital care. In addition, 92% of residency programs have residents provide online medical command during their regularly scheduled ED shifts or during dedicated medical command shifts, but only 41% of programs have residents complete medical command certification training, although type of training is not delineated. 2 Additionally, a recent description of a model curriculum for EM resident training in EMS provides education on the principles of providing direct online medical command via didactics, asynchronous activities, and dedicated medical command shifts; however, it does not recognize or utilize simulation as a training modality. 3 To our knowledge, simulation scenarios of on-line medical command have not previously been described as a curricular component in EM SIMULATION 50 residency training. This case provides an opportunity for residents to learn how to communicate with prehospital providers while they are at the scene of a call-effectively teaching them to provide high quality and appropriate medical command, while simulating many of the challenges EM providers face.Educational Objectives: By the end of this simulation, learners will be able to:1. Discuss appropriate medical command instructions for pediatric cardiac arrest.2. Describe alternative methods to obtain weight-based dosing of pediatric critical care medications, if Broselow tape is unavailable. 3. Identify need for a definitive airway in a pulseless patient without interruption of chest compressions. 4. Identify need for rapid intraosseous access in a pulseless pediatric patient. 5. Describe the indications for helicopter transfer in a critically ill child.Educational Methods: This scenario is a simulated medical command phone-call, with details of patient presentation and condition being rel...