Improving Prehospital Pediatric Emergency Readiness with Telemedicine

项目摘要 博士波义耳提出了一个5年的指导研究培训计划，成为一个独立的临床医生 负责院前儿科急救护理研究的研究员。她有很强的基础知识背景 科学研究，是一个委员会认证的儿科急诊医生和儿科助理教授 在波士顿大学。她目前的研究重点是测试系统级干预措施，以改善患者的生活质量。 重症和受伤儿童的导向结果。该提案侧重于远程咨询， 创新的干预措施，以改善急性呼吸道急症儿童的院前治疗， 促进护理向急症护理医院的过渡。波义耳博士的职业发展计划包括系统的 干预优化的教育和指导;使用模拟作为早期阶段的研究工具 干预试验;临床试验设计和分析;院前急救护理伦理培训 研究，包括知情同意的紧急例外情况和保护儿童作为人类受试者。 她组建了一个多学科专家团队来支持她的这个项目，由主要导师领导， 詹姆斯·费尔德曼，医学博士，公共卫生硕士，FACEP和共同导师，卡洛斯卡马戈，医学博士，公共卫生博士，FACEP。她的训练计划 包括正式的课程和研讨会，科学研讨会和会议的组合，以及一个重点 研究伦理实习这些将与指导研究配对，她将测试中央 假设紧急医疗服务（EMS）提供者的儿科远程会诊（干预）将 与通常的护理相比，对患有危及生命的呼吸道疾病的儿童的护理明显更安全。 博士波义耳已经与当地的马萨诸塞州EMS系统和附属儿科专业运输合作 系统，以完善和试点测试在模拟和真实的儿科呼吸紧急情况的干预。的 本职业发展建议的具体目标是：（1）确定利益攸关方接受 采用混合方法研究儿童院前远程会诊;（2）评估干预的可接受性， 模拟儿科呼吸系统中院前团队复苏性能的可行性和效应量 紧急情况下使用试点随机对照试验;和（3）现场测试的可接受性和可行性，使用 移动的视频会议平台，用于对救护车运送的儿童进行远程评估， 呼吸窘迫这一提议具有双重目的，即支持波义耳博士过渡到 独立作为临床研究人员在以病人为导向的研究，以及产生重要的试点数据 估计临床效果，提供样本量依据，并确定可接受性和可行性 使用为院前提供者优化的远程咨询平台，指导未来的疗效确定性试验。如果 资助，这项研究将确定是否远程咨询，一个有前途的干预措施，以增加获得 在农村和服务不足的环境中提供高质量的护理，可以改善儿童的院前急救护理。

PROJECT SUMMARY Dr. Boyle proposes a 5-year mentored research training program to become an independent clinician investigator leading prehospital pediatric emergency care research. She has a strong background in basic science research and is a board-certified Pediatric Emergency Physician and Assistant Professor of Pediatrics at Boston University. Her current research focuses on testing system-level interventions to improve patient- oriented outcomes of critically ill and injured children. This proposal focuses on teleconsultation as an innovative intervention to improve prehospital treatment of children with acute respiratory emergencies and to facilitate transitions of care to acute care hospitals. Dr. Boyle’s career development plan includes systematic education and mentoring in intervention optimization; the use of simulation as a research tool for early phase intervention testing; clinical trial design and analysis; and training in the ethics of prehospital emergency care research, including emergency exceptions to informed consent and protection of children as human subjects. She has assembled a multidisciplinary expert team to support her on this project, led by primary mentor, James Feldman, MD, MPH, FACEP and co-mentor, Carlos Camargo, MD, DrPH, FACEP. Her training plan includes a combination of formal coursework and workshops, scientific seminars and meetings, and a focused research ethics internship. These will be paired with mentored research studies where she will test the central hypothesis that pediatric teleconsultation (intervention) by Emergency Medical Service (EMS) providers will result in measurably safer care for children with life-threatening respiratory illness as compared to usual care. Dr. Boyle has partnered with local Massachusetts EMS systems and an affiliated pediatric specialty transport system to refine and pilot test the intervention in simulated and real pediatric respiratory emergencies. The specific aims of this career development proposal are to: (1) Identify predictors of stakeholder acceptance of prehospital teleconsultation for children with a mixed methods study; (2) Estimate intervention acceptability, feasibility, and effect size for prehospital team resuscitation performance in simulated pediatric respiratory emergencies using a pilot randomized controlled trial; and (3) Field test acceptability and feasibility of using a mobile video-conferencing platform for remote assessment of children transported by ambulance for respiratory distress. This proposal serves the dual purpose of supporting Dr. Boyle’s transition to independence as a clinician investigator in patient-oriented research, as well as generating important pilot data to estimate clinical effect, provide sample size justification, and establish the acceptability and feasibility of using a teleconsultation platform optimized for prehospital providers to guide future definitive trials of efficacy. If funded, this research will determine whether teleconsultation, a promising intervention to increase access to high quality care in rural and underserved settings, can improve prehospital emergency care for children.