Simulation-based Assessment of Paramedic Pediatric Resuscitation Skills
Simulation-based Assessment of Paramedic Pediatric Resuscitation Skills
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DOI：
10.1080/10903120802706161
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发表时间：
2009-01-01
影响因子：
2.4
通讯作者：
Hale, Robert A.
中科院分区：
文献类型：
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作者：
Lammers, Richard Lee;Byrwa, Maria J.;Hale, Robert A.
背景资料。紧急医疗服务(EMS)提供者很少遇到重病和受伤的儿科病人。临床模拟对于评估技能水平很有用，特别是对于低频率、高风险的问题。目标。确定护理人员在处理三个模拟儿科紧急情况时最常见的绩效缺陷。方法：研究方法。来自密歇根州五家急救机构的护理人员是这项前瞻性观察性研究的合格受试者。使用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)。情景包括婴儿心肺骤停、败血症/癫痫和儿童哮喘/呼吸骤停。每一种方案都要求护理人员在12分钟的时限内进行评估并提供适当的儿科病人护理。训练有素的教官按照严格的事件顺序和反应顺序进行模拟。一名独立评估者审查了摄像头的视频，以验证评分的准确性。记录了三种情况中每一种情况下完成的步骤百分比和具体的业绩缺陷。结果。212名医护人员完成了摄像头的拍摄。完成步骤的平均百分比如下：心搏骤停，45.3%；哮喘，51.6%；败血症，47.1%。性能缺陷包括缺乏呼吸道支持或保护；缺乏对呼吸机或心脏功能的支持；不适当地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。使用三个基于人体模型的模拟，客观地确定了护理人员在儿科复苏技能方面的多方面的不足。EMS教育工作者和EMS医疗主管在开展院前儿科病人护理的继续教育时，应针对这些特定的技能缺陷。
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.