Kothari Kathryn, Zuger Chelsea, Desai Neil, Leonard Jan, Alletag Michelle, Balakas Ashley, Binney Mike, Caffrey Sean, Kotas Jason, Mahar Patrick, Roswell Kelley, Adelgais Kathleen M
Department of Pediatrics Section of Pediatric Emergency Medicine University of Colorado School of Medicine Aurora CO USA.
the Denver Health and Hospital Authority Denver CO USA.
AEM Educ Train. 2020 Nov 5;5(3):e10537. doi: 10.1002/aet2.10537. eCollection 2021 Jul.
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.
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 (T), 1-month-old with hypoglycemia (T), and 4-year-old clonidine ingestion (T). 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 T to T.
A total of 135 team-based simulations were conducted over the study period (48, 40, and 47 at T, T, and T, respectively). Inter-rater reliability between reviewers was very good (κ = 0.7). Median simulation score improved from T to T (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).
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.
紧急医疗服务（EMS）专业人员很少运送儿童，这导致对儿童危重病的识别和处理存在困难。模拟为培训EMS专业人员处理儿科急症提供了机会。本研究的目的是探讨为期6个月的系列模拟培训对基于团队护理期间EMS人员心理运动和认知表现的影响。
这是一项纵向前瞻性研究，对一个模拟课程进行研究，该课程在6个月内招募EMS专业人员，在此期间他们每隔3个月进行一次高保真模拟。模拟场景包括一名15个月大的癫痫患儿（T1）、一名1个月大的低血糖患儿（T2）和一名4岁的可乐定摄入患儿（T3）。所有场景均标准化，要求识别和处理呼吸衰竭和失代偿性休克。场景被录像，两名研究人员使用标准化评分工具对模拟过程中EMS团队的干预进行评分。使用kappa分析对30%的视频评估评分者间信度。测量静脉输液（IVF）和药物的使用量，以评估给药错误情况。主要结局是从T1到T3场景评分的变化。
在研究期间共进行了135次基于团队的模拟（T1、T2和T3分别为48次、40次和47次）。评审员之间的评分者间信度非常好（κ = 0.7）。模拟评分中位数从T1提高到T3（24分对31分，p < 0.001，最高可能分数 = 42分）。完成任务的比例在多个类别中有所增加，包括对呼吸失代偿的识别改善（19%对56%）、儿科气道管理（44%对88%）和血管通路的及时性（10%对38%）。正确的IVF给药因场景而异（25%对52%对30%，p = 0.02）。
系列模拟改善了EMS团队在儿科急症识别和处理方面的护理。标准化的儿科模拟课程可用于培训EMS专业人员处理儿科急症并提高其表现。
