Simulation-Based Training and Its Use Amongst Practicing Paramedics and Emergency Medical Technicians: An Evidence-Based Systematic Review

Abstract

Objectives: This systematic review (SR) describes how simulation-based training (SBT) is utilized by paramedics and emergency medical technicians (EMTs). Data sources: PubMed, CINAHL, Cochrane CENTRAL, Scopus, Web of Science, and Google Scholar were searched from 2010 to 2021. Review methods: Standard SR methodology was utilized according to PRISMA guidelines. Eligibility criteria included English studies conducted in the United States or Canada published and published between 2010 and 2021. Study designs were somewhat heterogeneous and included quantitative, qualitative, and mixed-methods projects. The specific populations included paramedics and EMTs. Results:  595 articles were initially identified and reviewed, 25 of which met our inclusion criteria. Of them, the most common SBT areas of focus documented in the literature was general assessment and treatment (7 studies) and airway management (7 studies).  The majority of the studies were conducted in a mobile simulation lab (6 studies), simulation centers (5 studies), and ambulances (5 studies). Many of the studies report simulations involving using manikins alone and a combination of manikins and simulated patients. Overall, 21 studies documented the use of high-fidelity simulation. 16 studies involved paramedics only, 8 involved both paramedics and EMTs, and one study involved only EMTs. Most of the impact of SBT appeared to be on objective measures such as performance, procedural success, and ability to identify errors, as well as subjective metrics such as perceived improvement in knowledge and skill. The degree of sustained impact of SBT on skill retention was not frequently reported, and direct enhancement in patient outcomes such as length-of-stay, or mortality were not documented in any of the studies. Conclusions: Paramedics and EMTs provide critically important, often lifesaving, prehospital care.  However, the opportunities to enhance their skills are limited by several factors; most notably their undergraduate and certificate educational requirements, which are much ... (truncated)