Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study

Brown, Seth A.; Hayden, Theresa; Randell, Kimberly A.; Rappaport, Lara; Stevenson, Michelle D.; Kim, In K.

doi:10.1017/s1049023x16001230

Cited by 15 publications

(10 citation statements)

References 28 publications

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“…A general discomfort in treating children, especially critically-ill children, was a recurring theme in the IDIs. That discomfort and the need for pediatric-specific EMS education have been reported over the past thirty years [18][19][20][21][22]. The IDIs revealed that despite those repeated calls for prehospital pediatric education, current educational practices are still not alleviating EMS clinicians' widespread discomfort in caring for children.…”

Section: Discussionmentioning

confidence: 99%

“…EMS clinicians have historically reported discomfort with treating pediatric patients [18][19][20][21]. Previous studies have found infrequent exposure to pediatric patients and limited pediatric-specific formal education lie at the heart of that discomfort [18][19][20]22,23]. Additionally, there is even less exposure to critically ill children and in performing advanced life support (ALS) skills and procedures [19].…”

Section: Introductionmentioning

confidence: 99%

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Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Fratta¹,

Fishe²,

Schenk³

et al. 2021

Cureus

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Objective This study sought to identify factors that influence emergency medical services (EMS) clinicians’ destination decision-making for pediatric patients. We also sought EMS clinicians’ opinions on potential systems improvements, such as protocol changes and the use of evidence-based transport guidelines. Methods Thirty-six in-depth phone interviews were conducted using a semi-structured format. We utilized a modified Grounded Theory approach to understand the complicated decision-making processes of EMS personnel. Memo writing was used throughout the data collection and analysis processes in order to identify emerging themes. The research team utilized hierarchical coding of interview transcripts to organize data into sub-categories for final analysis. Results EMS clinicians cited the perceived need for specialty care, the presence of a medical home, a desire for improved continuity of care, and the availability of aeromedical transport as factors that promoted transport to a pediatric specialty center. They voiced that children with emergent stabilization needs should be transported to the closest facility, however, they did not identify any specific medical conditions suitable for transport to non-specialty centers. EMS clinicians recommended improvements in pediatric-specific education, improved clarity of hospitals’ pediatric capabilities, and the creation of a pediatric-specific destination decision-making tool. Conclusion This study describes specific factors that influence EMS clinicians’ transport destination decision-making for pediatric patients. It also describes potential systems and educational improvements that may increase pediatric transport directly to definitive care. EMS clinicians are in support of specific designations for hospitals’ pediatric capabilities and were in favor of the creation of a formal destination decision-making tool.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Fratta¹,

Fishe²,

Schenk³

et al. 2021

Cureus

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“…( 2 ) Yet EMS providers are an essential link in the chain of survival, and when needed, these pediatric skills must be executed effectively. Given limited clinical exposure, EMS providers cannot rely on experience alone to maintain proficiency in pediatric assessment and resuscitation skills and need access to effective continuing education opportunities ( 3 , 4 ). Simulation has been demonstrated as an effective tool within medical education, including training for low frequency, high stakes events ( 5 – 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…However, simulation education can be resource intensive and costly. EMS providers face additional challenges when accessing pediatric simulation including lack of standardization in pediatric continuing education requirements, and limited access to subject matter experts and simulation resources ( 3 ). Research on the most effective means of pediatric continuing education for EMS providers is limited ( 3 , 8 – 10 ).…”

Section: Introductionmentioning

confidence: 99%

A Statewide Collaboration to Deliver and Evaluate a Pediatric Critical Care Simulation Curriculum for Emergency Medical Services

et al. 2022

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ObjectiveCare of the critically ill child is a rare but stressful event for emergency medical services (EMS) providers. Simulation training can improve resuscitation care and prehospital outcomes but limited access to experts, simulation equipment, and cost have limited adoption by EMS systems. Our objective was to form a statewide collaboration to develop, deliver, and evaluate a pediatric critical care simulation curriculum for EMS providers.MethodsWe describe a statewide collaboration between five academic centers to develop a simulation curriculum and deliver it to EMS providers. Cases were developed by the collaborating PEM faculty, reviewed by EMS regional directors, and based on previously published EMS curricula, a statewide needs assessment, and updated state EMS protocols. The simulation curriculum was comprised of 3 scenarios requiring recognition and acute management of critically ill infants and children. The curriculum was implemented through 5 separate education sessions, led by a faculty lead at each site, over a 6 month time period. We evaluated curriculum effectiveness with a prospective, interventional, single-arm educational study using pre-post assessment design to assess the impact on EMS provider knowledge and confidence. To assess the intervention effect on knowledge scores while accounting for nested data, we estimated a mixed effects generalized regression model with random effects for region and participant. We assessed for knowledge retention and self-reported practice change at 6 months post-curriculum. Qualitative analysis of participants' written responses immediately following the curriculum and at 6 month follow-up was performed using the framework method.ResultsOverall, 78 emergency medical technicians (EMTs) and 109 paramedics participated in the curriculum over five separate sessions. Most participants were male (69%) and paramedics (58%). One third had over 15 years of clinical experience. In the regression analysis, mean pediatric knowledge scores increased by 9.8% (95% CI: 7.2%, 12.4%). Most (93% [95% CI: 87.2%, 96.5%]) participants reported improved confidence caring for pediatric patients. Though follow-up responses were limited, participants who completed follow up surveys reported they had used skills acquired during the curriculum in clinical practice.ConclusionThrough statewide collaboration, we delivered a pediatric critical care simulation curriculum for EMS providers that impacted participant knowledge and confidence caring for pediatric patients. Follow-up data suggest that knowledge and skills obtained as part of the curriculum was translated into practice. This strategy could be used in future efforts to integrate simulation into EMS practice.

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“…24 Qualitative studies of EMS providers reveal education, training, and practical barriers (e.g., low frequency of encounters compared to adults, difficulty obtaining IV access, drawing up weight-based medication doses, communicating with parents, emotional difficulty in treating ill children) to pediatric EMS care. [25][26][27] Therefore, in addition to evaluating clinical outcomes, EMS studies (particularly pediatric EMS studies), must systematically evaluate how best to implement evidence-based practices in the unique prehospital setting. This trial employs a hybrid effectiveness-implementation design to determine if EMS-administered OCS improves clinical outcomes for pediatric asthma, the cost of EMS OCS administration, how EMS transport time affects clinical and economic outcomes, and implementation considerations.…”

Section: Introductionmentioning

confidence: 99%

Early administration of steroids in the ambulance setting: Protocol for a type I hybrid effectiveness-implementation trial with a stepped wedge design

Fishe¹,

Hendry²,

Brailsford³

et al. 2020

Contemporary Clinical Trials

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Background: Pediatric asthma exacerbations are a frequent reason for emergency care. Early administration of oral systemic corticosteroids (OCS) in the emergency department (ED) decreases hospitalization rates and ED length-of-stay (LOS). However, it is unknown whether even earlier OCS administration by emergency medical services (EMS) in the prehospital setting further improves outcomes.Purpose: To describe the background and methods of a type 1 hybrid effectivenessimplementation trial of EMS-administered OCS for pediatric asthma patients incorporating a stepped wedge design and the RE-AIM framework.

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Improving Pediatric Education for Emergency Medical Services Providers: A Qualitative Study

Cited by 15 publications

References 28 publications

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

Emergency Medical Services Clinicians’ Pediatric Destination Decision-Making: A Qualitative Study

A Statewide Collaboration to Deliver and Evaluate a Pediatric Critical Care Simulation Curriculum for Emergency Medical Services

Early administration of steroids in the ambulance setting: Protocol for a type I hybrid effectiveness-implementation trial with a stepped wedge design

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