Department of Emergency Medicine, Western Michigan University Homer Stryker, Kalamazoo, Michigan (RLL, MJW-B, WDF); Department of Epidemiology and Biostatistics, Western Michigan University Homer Stryker, Kalamazoo, Michigan (DGV).
Prehosp Emerg Care. 2022 Jul-Aug;26(4):463-475. doi: 10.1080/10903127.2021.1916140. Epub 2021 May 7.
Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics' resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4-6 months using methods identical to baseline testing. One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores ( = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments.
有限的资源限制了 EMS 机构在儿科急救继续教育方面的投入时间。对于这些高风险、低频率的事件，EMS 讲师需要有效的、高效的和负担得起的教育策略。为了比较四种培训方法在管理儿科急诊方面对护理人员的效果。使用经过验证的、基于表现的模拟临床评估模块，为护理人员在三个模拟儿科急诊期间的复苏技能提供基线测量。制定了教育模块，针对基线评估确定的缺陷，包括高级儿科生命支持技能、气道管理、使用 Broselow-Luten 带®、儿科药物剂量计算和药物输送、癫痫发作管理和创伤评估。密歇根州五个 EMS 机构的护理人员被随机分配到四个教育干预组。对照组使用现有的在线继续教育课程。三个实验组在 2.5 年内进行了五次 1 小时的课程，接触到相同的内容。根据分组，教学采用高保真、基于模拟的案例培训、低保真模拟培训或讲座加程序技能实验室。培训后，所有组都在 4-6 个月内使用与基线测试相同的方法进行测试。147 名受试者完成了研究。四个组之间的基线技能水平没有差异。只有低保真模拟培训组显示出综合场景评分的提高（=0.0008）。高保真组的一个场景、低保真组的两个场景、讲座/实验室组的一个场景中，目标技能的分数有所提高，对照组中没有一个场景的分数有所提高。尽管在三个组中都发现了培训中包含的技能有所提高，但每年进行两小时的儿科急诊培训不足以全面提高整体水平。昂贵的高保真模拟器对于向护理人员教授儿科复苏技能并不是必需的；使用低保真人体模型和讨论进行有启发性的场景似乎就足够了。在线复习课程提供的内容在基于模拟的案例评估中没有提供任何性能改进。
