Lammers Richard Lee, Byrwa Maria J, Fales William D, Hale Robert A
Department of Emergency Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, USA.
Prehosp Emerg Care. 2009 Jul-Sep;13(3):345-56. doi: 10.1080/10903120802706161.
Emergency medical services (EMS) providers infrequently encounter seriously ill and injured pediatric patients. Clinical simulations are useful for assessing skill level, especially for low-frequency, high-risk problems.
To identify the most common performance deficiencies in paramedics' management of three simulated pediatric emergencies.
Paramedics from five EMS agencies in Michigan were eligible subjects for this prospective, observational study. Three clinical assessment modules (CAMs) were designed and validated using pediatric simulators with varying technologic complexity. Scenarios included an infant cardiopulmonary arrest, sepsis/seizure, and child asthma/respiratory arrest. Each scenario required paramedics to perform an assessment and provide appropriate pediatric patient care within a 12-minute time limit. Trained instructors conducted the simulations by following strict guidelines for sequences of events and responses. Videos of CAMs were reviewed by an independent evaluator to verify scoring accuracy. Percentage of steps completed for each of the three scenarios and specific performance deficiencies were recorded.
Two hundred twelve paramedics completed the CAMs. The average percentages of steps completed were as follows: arrest CAM, 45.3%; asthma CAM, 51.6%; and sepsis CAM, 47.1%. Performance deficiencies included lack of airway support or protection; lack of support of ventilations or cardiac function; inappropriate use of length-based treatment tapes; and inaccurate calculation and administration of medications and fluids.
Multiple deficiencies in paramedics' performance of pediatric resuscitation skills were objectively identified using three manikin-based simulations. EMS educators and EMS medical directors should target these specific skill deficiencies when developing continuing education in prehospital pediatric patient care.
紧急医疗服务（EMS）提供者很少遇到病情严重和受伤的儿科患者。临床模拟有助于评估技能水平，尤其是针对低频、高风险问题。
确定护理人员在处理三种模拟儿科紧急情况时最常见的操作缺陷。
来自密歇根州五个EMS机构的护理人员是这项前瞻性观察性研究的合格受试者。使用技术复杂度不同的儿科模拟器设计并验证了三个临床评估模块（CAMs）。场景包括婴儿心肺骤停、败血症/癫痫发作以及儿童哮喘/呼吸骤停。每个场景要求护理人员在12分钟的时间限制内进行评估并为儿科患者提供适当的护理。训练有素的教员按照严格的事件和反应顺序指南进行模拟。独立评估人员审查了CAMs的视频以验证评分准确性。记录了三种场景中每个场景完成的步骤百分比和具体的操作缺陷。
212名护理人员完成了CAMs。完成步骤的平均百分比如下：骤停CAM，45.3%；哮喘CAM，51.6%；败血症CAM，47.1%。操作缺陷包括缺乏气道支持或保护；缺乏通气或心脏功能支持；不恰当地使用基于身长的治疗胶带；以及药物和液体的计算和给药不准确。
使用三种基于人体模型的模拟客观地确定了护理人员在儿科复苏技能操作方面的多种缺陷。EMS教育工作者和EMS医疗主任在开展院前儿科患者护理继续教育时应针对这些特定的技能缺陷。
