Kathryn Kothari1,2, Chelsea Zuger1, Neil Desai3, Jan Leonard1, Michelle Alletag1, Ashley Balakas4, Mike Binney5, Sean Caffrey6, Jason Kotas4, Patrick Mahar1, Kelley Roswell1, Kathleen M Adelgais1. 1. Department of Pediatrics Section of Pediatric Emergency Medicine University of Colorado School of Medicine Aurora CO USA. 2. the Denver Health and Hospital Authority Denver CO USA. 3. the Emergency Department British Columbia Children's Hospital Vancouver British Columbia Canada. 4. the Emergency Medical Services Education and Outreach Program Children's Hospital Colorado Aurora CO USA. 5. the West Metro Fire Protection District Lakewood CO USA. 6. and the EMS Division Crested Butte Fire Protection Authority Crested Butte CO USA.
Abstract
OBJECTIVE: Emergency medical services (EMS) professionals infrequently transport children leading to difficulty in recognition and management of pediatric critical illness. Simulation provides an opportunity to train EMS professionals on pediatric emergencies. The objective of this study was to examine the effect of serial simulation training over 6 months on EMS psychomotor and cognitive performance during team-based care. METHODS: This was a longitudinal prospective study of a simulation curriculum enrolling EMS professionals over a 6-month period during which they performed three high-fidelity simulations at 3-month intervals. The simulation scenarios included a 15-month-old seizure (T0), 1-month-old with hypoglycemia (T1), and 4-year-old clonidine ingestion (T2). All scenarios were standardized and required recognition and management of respiratory failure and decompensated shock. Scenarios were videotaped and two investigators scored EMS team interventions during simulations using a standardized scoring tool. Inter-rater reliability was assessed on 30% of videos using kappa analysis. Volumes of administered intravenous fluid (IVF) and medications were measured to assess for errors in administration. The primary outcome was the change in scenario score from T0 to T2. RESULTS: A total of 135 team-based simulations were conducted over the study period (48, 40, and 47 at T0, T1, and T2, respectively). Inter-rater reliability between reviewers was very good (κ = 0.7). Median simulation score improved from T0 to T2 (24 vs 31, p < 0.001, maximum score possible = 42). The proportion of completed tasks increased across multiple categories including improved recognition of respiratory decompensation (19% vs. 56%), management of the pediatric airway (44% vs. 88%), and timeliness of vascular access (10% vs. 38%). Correct IVF administration varied by scenario (25% vs. 52% vs. 30%, p = 0.02). CONCLUSION: Serial simulation improved EMS team-based care in both recognition and management of pediatric emergencies. A standardized pediatric simulation curriculum can be used to train EMS professionals on pediatric emergencies and improve performance.
OBJECTIVE: Emergency medical services (EMS) professionals infrequently transport children leading to difficulty in recognition and management of pediatric critical illness. Simulation provides an opportunity to train EMS professionals on pediatric emergencies. The objective of this study was to examine the effect of serial simulation training over 6 months on EMS psychomotor and cognitive performance during team-based care. METHODS: This was a longitudinal prospective study of a simulation curriculum enrolling EMS professionals over a 6-month period during which they performed three high-fidelity simulations at 3-month intervals. The simulation scenarios included a 15-month-old seizure (T0), 1-month-old with hypoglycemia (T1), and 4-year-old clonidine ingestion (T2). All scenarios were standardized and required recognition and management of respiratory failure and decompensated shock. Scenarios were videotaped and two investigators scored EMS team interventions during simulations using a standardized scoring tool. Inter-rater reliability was assessed on 30% of videos using kappa analysis. Volumes of administered intravenous fluid (IVF) and medications were measured to assess for errors in administration. The primary outcome was the change in scenario score from T0 to T2. RESULTS: A total of 135 team-based simulations were conducted over the study period (48, 40, and 47 at T0, T1, and T2, respectively). Inter-rater reliability between reviewers was very good (κ = 0.7). Median simulation score improved from T0 to T2 (24 vs 31, p < 0.001, maximum score possible = 42). The proportion of completed tasks increased across multiple categories including improved recognition of respiratory decompensation (19% vs. 56%), management of the pediatric airway (44% vs. 88%), and timeliness of vascular access (10% vs. 38%). Correct IVF administration varied by scenario (25% vs. 52% vs. 30%, p = 0.02). CONCLUSION: Serial simulation improved EMS team-based care in both recognition and management of pediatric emergencies. A standardized pediatric simulation curriculum can be used to train EMS professionals on pediatric emergencies and improve performance.
Authors: Gary M Vilke; Stephen V Tornabene; Barbara Stepanski; Holly E Shipp; Leslie Upledger Ray; Marcelyn A Metz; Dori Vroman; Marilyn Anderson; Patricia A Murrin; Daniel P Davis; Jim Harley Journal: Prehosp Emerg Care Date: 2006 Oct-Dec Impact factor: 3.077
Authors: Lara D Rappaport; Lina Brou; Tim Givens; Maria Mandt; Ashley Balakas; Kelley Roswell; Jason Kotas; Kathleen M Adelgais Journal: Prehosp Emerg Care Date: 2016-02-02 Impact factor: 3.077