Lammers Richard L, Willoughby-Byrwa Maria, Fales William D
From the Department of Emergency Medicine, Western Michigan University School of Medicine, Kalamazoo, Michigan.
Simul Healthc. 2014 Jun;9(3):174-83. doi: 10.1097/SIH.0000000000000013.
Management of pediatric cardiac arrest challenges the skills of prehospital care providers. Errors and error-producing conditions are difficult to identify from retrospective records. The objective of this study was to identify errors committed by prehospital care providers and the underlying causes of those errors during a simulated pediatric cardiopulmonary arrest followed by a structured debriefing.
Performance criteria were defined prospectively by an advisory panel. Prehospital care providers from 6 emergency medical service agencies in Michigan participated in a simulation of an infant cardiopulmonary arrest using their own drugs, equipment, and protocols in a mobile trailer. Simulations were video recorded and played back during debriefings that were conducted immediately after the event to facilitate error analysis. Observed errors and subjects' explanations were analyzed by thematic qualitative assessment methods and descriptive statistics.
One hundred ninety-four subjects, including paramedics, emergency medical technicians, and emergency medical responders in various crew configurations, participated in 60 simulation sessions during a 5-month period (April to August of 2010). Error types were classified into 4 clinically important themes as follows: failure to provide adequate ventilation, failure to provide effective circulation, failure to achieve vascular access rapidly, and medication errors. Multiple underlying causes of medication dosing and other errors were identified, including cognitive, procedural, communication, teamwork, and systems factors.
We systematically observed many types of errors and identified some of the underlying causes during a simulated, prehospital, pediatric cardiopulmonary arrest. There were numerous, multifactorial, and sometimes, synergistic causes of medication dosing errors. Emergency medical service officials can use these findings to prevent future errors.
小儿心脏骤停的管理对院前急救人员的技能构成挑战。从回顾性记录中很难识别错误及产生错误的情况。本研究的目的是在模拟小儿心肺骤停及随后的结构化汇报过程中，识别院前急救人员所犯的错误及其潜在原因。
由一个咨询小组前瞻性地定义绩效标准。来自密歇根州6个紧急医疗服务机构的院前急救人员在一辆移动拖车内，使用他们自己的药物、设备和方案参与了一次婴儿心肺骤停模拟。模拟过程进行了录像，并在事件发生后立即进行的汇报过程中播放，以促进错误分析。通过主题定性评估方法和描述性统计分析观察到的错误及受试者的解释。
在5个月期间（2010年4月至8月），194名受试者参与了60次模拟，包括护理人员、急救医疗技术员和处于各种人员配置的急救医疗响应者。错误类型被分为4个具有临床重要性的主题，如下：未能提供充分通气、未能提供有效循环、未能迅速建立血管通路以及用药错误。确定了用药剂量及其他错误的多种潜在原因，包括认知、程序、沟通、团队合作和系统因素。
在模拟的院前小儿心肺骤停期间，我们系统地观察到了多种类型的错误，并确定了一些潜在原因。用药剂量错误存在众多、多因素且有时协同的原因。紧急医疗服务官员可利用这些发现预防未来的错误。
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