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Simulation-based assessment of paramedic pediatric resuscitation skills.

机译：基于模拟的护理人员儿科复苏技能评估。

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BACKGROUND: Emergency medical services (EMS) providers infrequently encounter seriously ill and injured pediatric patients. Clinical simulations are useful for assessing skill level, especially for low-frequency, high-risk problems. OBJECTIVE: To identify the most common performance deficiencies in paramedics' management of three simulated pediatric emergencies. METHODS: Paramedics from five EMS agencies in Michigan were eligible subjects for this prospective, observational study. Three clinical assessment modules (CAMs) were designed and validated using pediatric simulators with varying technologic complexity. Scenarios included an infant cardiopulmonary arrest, sepsis/seizure, and child asthma/respiratory arrest. Each scenario required paramedics to perform an assessment and provide appropriate pediatric patient care within a 12-minute time limit. Trained instructors conducted the simulations by following strict guidelines for sequences of events and responses. Videos of CAMs were reviewed by an independent evaluator to verify scoring accuracy. Percentage of steps completed for each of the three scenarios and specific performance deficiencies were recorded. RESULTS: Two hundred twelve paramedics completed the CAMs. The average percentages of steps completed were as follows: arrest CAM, 45.3%; asthma CAM, 51.6%; and sepsis CAM, 47.1%. Performance deficiencies included lack of airway support or protection; lack of support of ventilations or cardiac function; inappropriate use of length-based treatment tapes; and inaccurate calculation and administration of medications and fluids. CONCLUSION: Multiple deficiencies in paramedics' performance of pediatric resuscitation skills were objectively identified using three manikin-based simulations. EMS educators and EMS medical directors should target these specific skill deficiencies when developing continuing education in prehospital pediatric patient care.
机译：背景：紧急医疗服务（EMS）提供者很少会遇到重病和受伤的小儿患者。临床模拟对于评估技能水平非常有用，尤其是对于低频，高风险问题。目的：确定在护理人员管理的三种模拟小儿急症中最常见的性能缺陷。方法：来自密歇根州五个EMS机构的医护人员是该前瞻性，观察性研究的合格受试者。使用具有不同技术复杂性的儿科模拟器设计并验证了三个临床评估模块（CAM）。场景包括婴儿心肺骤停，败血症/癫痫发作和儿童哮喘/呼吸骤停。每种情况都需要医护人员在12分钟的期限内进行评估并提供适当的儿科患者护理。受过训练的讲师按照事件和响应顺序的严格准则进行了模拟。 CAM的视频由独立评估人员进行审核，以验证评分的准确性。记录了针对三种情况中的每一种情况完成的步骤的百分比以及特定的性能缺陷。结果：212名护理人员完成了CAM。完成步骤的平均百分比如下：逮捕CAM，45.3％;哮喘CAM，51.6％;败血症CAM占47.1％。绩效缺陷包括缺乏气道支持或保护;缺乏通气或心脏功能的支持;不适当使用基于长度的治疗胶带;以及药物和液体的计算和管理不准确。结论：使用基于人体模型的三个模拟，客观地确定了护理人员在儿科复苏技能方面的多种缺陷。在开展院前儿科患者护理的继续教育时，EMS教育者和EMS医疗主管应针对这些特定的技能缺陷。

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