Utilizing simulation to improve pre-hospital medical care for paediatric seizure

Abstract

Paediatric patients represent 5–15% of emergency medical services (EMS) transports in the US, yet true paediatric emergencies are rare. Management of these cases remains a common area of discomfort for pre-hospital providers. Previous studies have shown that simulation-based medical education is a useful tool to enhance patient safety in paediatrics. Simulation is an ideal modality to evaluate cognitive, technical and behavioural skills in low frequency, high-stakes events for healthcare providers. We hypothesize that using a deliberate practice model with simulation through a 6-month longitudinal curriculum will improve performance among pre-hospital providers treating paediatric seizure patients. A prospective observational education study design of a 6-month longitudinal simulation curriculum was executed. The performance of each two-member fire-based crew was analysed during three separate simulation events. The Thirty-nine pre-hospital providers completed at least some portion of the curriculum. There was an improvement in provider reported self-efficacy scores across all questions, as well as improvement in pre- and post-test knowledge scores. While the total number of critical actions completed did not vary significantly between simulations, there was improvement in several action items including end-tidal carbon dioxide use, application of oxygen, checking of medication dosage and administration of correct benzodiazepine dose. A simulation-based curriculum on the management of paediatric seizure for EMS providers improved self-efficacy, knowledge and performance of various critical actions in simulated settings.