Simulation-Based Pediatric Resuscitation Curriculum for Prehospital Providers

Doughty, Cara; Pearson, Nadia M.; Mondragon, Juan; Arnold, Jennifer; Ngo, Thuy L.; Shah, Manish I.

doi:10.15766/mep_2374-8265.9949

Cited by 8 publications

(11 citation statements)

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“…Content for simulation cases was chosen based on prior literature ( 2 , 13 ), previously published EMS simulation scenarios ( 14 ), and the results of a statewide needs assessment which identified EMS provider discomfort caring for infants. The cases were all reviewed by the study team and faculty leaders.…”

Section: Methodsmentioning

confidence: 99%

“…In Massachusetts, some communities have BLS-only EMS services while some have a tiered response with BLS responding first and ALS intercepting as needed. For example, the twin field delivery, based on a previously published case ( 14 ), was structured so that the first baby responds to BLS resuscitation measures (high quality CPR and BLS airway management) while the second infant requires additional ALS resuscitation such as IO access, weight-based epinephrine, and intubation. The second scenario, based on a previously published case ( 14 ), adapted and piloted locally ( 15 ), required recognition of status epilepticus and inadequate ventilation requiring hands on practice with infant bag-mask ventilation as well as appropriate use of weight-based anti-epileptic medications.…”

Section: Methodsmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

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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“…Among prehospital providers, there is a growing body of literature to support that simulation is a positive training method [ 22 ], and its use has been shown to improve performance among prehospital providers in pediatric mass casualty triage [ 23 ], pediatric airway management [ 24 , 25 ], and pediatric seizure management [ 26 ]. Doughty et al developed a simulation-based education program for prehospital providers in Texas that included high-fidelity scenarios focused on neonatal resuscitation, respiratory distress, seizures, and non-accidental trauma; posttest results showed significant improvement in medical knowledge over pretest scores, as well as high levels of learner satisfaction [ 27 ].…”

Section: Introductionmentioning

confidence: 99%

Development of a simulation-based curriculum for Pediatric prehospital skills: a mixed-methods needs assessment

et al. 2021

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Background The assessment and treatment of pediatric patients in the out-of-hospital environment often presents unique difficulties and stress for EMS practitioners. Objective Use a mixed-methods approach to assess the current experience of EMS practitioners caring for critically ill and injured children, and the potential role of a simulation-based curriculum to improve pediatric prehospital skills. Methods Data were obtained from three sources in a single, urban EMS system: a retrospective review of local pediatric EMS encounters over one year; survey data of EMS practitioners’ comfort with pediatric skills using a 7-point Likert scale; and qualitative data from focus groups with EMS practitioners assessing their experiences with pediatric patients and their preferred training modalities. Results 2.1% of pediatric prehospital encounters were considered “critical,” the highest acuity level. A total of 136 of approximately 858 prehospital providers responded to the quantitative survey; 34.4% of all respondents either somewhat disagree (16.4%), disagree (10.2%), or strongly disagree (7.8%) with the statement: “I feel comfortable taking care of a critically ill pediatric patient.” Forty-seven providers participated in focus groups that resulted in twelve major themes under three domains. Specific themes included challenges in medication dosing, communication, and airway management. Participants expressed a desire for more repetition and reinforcement of these skills, and they were receptive to the use of high-fidelity simulation as a training modality. Conclusions Critically ill pediatric prehospital encounters are rare. Over one third of EMS practitioners expressed a low comfort level in managing critically ill children. High-fidelity simulation may be an effective means to improve the comfort and skills of prehospital providers.

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“…One curriculum was an introduction to emergency medical skills course that focused on introducing preclinical medical students to the prehospital provider role, 2 and another, older curriculum focused on pediatric resuscitation for prehospital providers. 3 A recent publication included lecture and case-based learning about online medical control for EMS. 4 However, no publications focused on preparing emergency medicine residents for field experiences in EMS with the larger goal of introducing them to managing complex medical and social cases while not having all the resources normally found in the hospital emergency department environment.…”

Section: Introductionmentioning

confidence: 99%

Simulation-Based Orientation for Emergency Medicine Residents Participating in EMS Ride-Alongs

et al. 2021

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Introduction: Emergency medicine resident physicians are required to complete observational ride-alongs with emergency medical services (EMS) units as part of their curriculum as per the ACGME. We created this curriculum to expose emergency medicine residents to the equipment they will encounter in the prehospital setting, discuss basic EMS operations and the challenges of working in the prehospital environment, and review the limitations that restrict care provided by EMS professionals. Methods: We created a series of five simulation cases for resident physicians participating in an EMS ride-along rotation. Each case was implemented with three to four residents at a time. A critical action checklist was used to assess participants during the scenarios. Following each simulation, a debriefing was conducted to discuss EMS operations and the impact on providers. At the conclusion of the session, participants completed a course evaluation survey. Results: Thirteen emergency medicine resident physicians took part in this curriculum from October 2020 through January 2021. Results indicated that the participants gained insight into the prehospital environment, felt more prepared to complete their ride-alongs, and were engaged and satisfied with the introduction to EMS program. Discussion: Simulation allowed emergency medicine residents to be exposed to the complex nature of prehospital care and prepared them for their ride-along sessions. The five cases provided significant breadth and depth of potential prehospital care issues, and the residents were able to discuss the medical, policy, and operational challenges presented as part of each case.

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Simulation-Based Pediatric Resuscitation Curriculum for Prehospital Providers

Cited by 8 publications

References 0 publications

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

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

Development of a simulation-based curriculum for Pediatric prehospital skills: a mixed-methods needs assessment

Simulation-Based Orientation for Emergency Medicine Residents Participating in EMS Ride-Alongs

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