Emergency medical services (EMS) clinicians rarely perform pediatric critical procedures, necessitating continued education for skill maintenance, which presents unique challenges. This study transitioned a previously reported, traditional, simulation-based training (SBT) curriculum delivered by on-site pediatric simulation experts (On-Site Phase 1), into a program delivered by agency Pediatric Emergency Care Coordinators (PECCs) supported by remote pediatric experts (Remote Phase 2). Primary outcome was non-inferiority of Remote Phase 2 compared to On-Site Phase 1 as analyzed using bag-valve-mask (BVM) ventilation, supraglottic device (SGD) placement, and intraosseous (IO) catheterization assessment tool scores. This was a non-randomized, prospective study of simulated procedural outcomes by emergency medical technicians and paramedics recruited from the same three EMS agencies that participated in On-Site Phase 1, along with their PECCs. Without additional on-site simulation staff, PECCs incorporated the program into their regular training schedule over the one-year study period and submitted participants’ first-person-view videos for remote expert assessment across two sessions. Assessment data were analyzed longitudinally across both phases for non-inferiority testing, and between agencies. Qualitative comments from participants and PECCs were solicited via e-mail. Remote Phase 2 was found to be non-inferior to On-Site Phase 1 for each procedure (p = 1.0). Procedural performance during Remote Phase 2 Session 1 was similar to the end of On-Site Phase 1 (BVM p = 0.62; SGD p = 0.87; IO p = 0.60); by Remote Phase 2 Session 2, BVM (p = 0.01) and SGD (p = 0.01) performance improved, but IO (p = 0.19) performance remained the same. Performance across sites was similar at all time points, except for higher BVM scores at the rural site during Session 2 (p = 0.00). Qualitatively, PECCs reported scheduling difficulties due to competing educational and administrative tasks. In this prospective study of EMS clinicians, we found non-inferiority between a traditional on-site approach and a remotely-supported approach in simulation-based pediatric procedural training. Skill overall was high and BVM and SGD performance improved. This demonstrates a viable method for PECCs to deliver recurring evidence-based education while receiving curricular and assessment support from remote pediatric experts. While still effort-intensive, this methodology may help to address several barriers of time, cost, and accessibility for pediatric prehospital education.

Emergency medical services (EMS) clinicians rarely perform pediatric critical procedures, necessitating continued education for skill maintenance, which presents unique challenges. This study transitioned a previously reported, traditional, simulation-based training (SBT) curriculum delivered by on-site pediatric simulation experts (On-Site Phase 1), into a program delivered by agency Pediatric Emergency Care Coordinators (PECCs) supported by remote pediatric experts (Remote Phase 2). Primary outcome was non-inferiority of Remote Phase 2 compared to On-Site Phase 1 as analyzed using bag-valve-mask (BVM) ventilation, supraglottic device (SGD) placement, and intraosseous (IO) catheterization assessment tool scores. This was a non-randomized, prospective study of simulated procedural outcomes by emergency medical technicians and paramedics recruited from the same three EMS agencies that participated in On-Site Phase 1, along with their PECCs. Without additional on-site simulation staff, PECCs incorporated the program into their regular training schedule over the one-year study period and submitted participants’ first-person-view videos for remote expert assessment across two sessions. Assessment data were analyzed longitudinally across both phases for non-inferiority testing, and between agencies. Qualitative comments from participants and PECCs were solicited via e-mail. Remote Phase 2 was found to be non-inferior to On-Site Phase 1 for each procedure (p = 1.0). Procedural performance during Remote Phase 2 Session 1 was similar to the end of On-Site Phase 1 (BVM p = 0.62; SGD p = 0.87; IO p = 0.60); by Remote Phase 2 Session 2, BVM (p = 0.01) and SGD (p = 0.01) performance improved, but IO (p = 0.19) performance remained the same. Performance across sites was similar at all time points, except for higher BVM scores at the rural site during Session 2 (p = 0.00). Qualitatively, PECCs reported scheduling difficulties due to competing educational and administrative tasks. In this prospective study of EMS clinicians, we found non-inferiority between a traditional on-site approach and a remotely-supported approach in simulation-based pediatric procedural training. Skill overall was high and BVM and SGD performance improved. This demonstrates a viable method for PECCs to deliver recurring evidence-based education while receiving curricular and assessment support from remote pediatric experts. While still effort-intensive, this methodology may help to address several barriers of time, cost, and accessibility for pediatric prehospital education.

Emergency medical services (EMS) clinicians are expected to provide expert care to all patients, but face obstacles in maintaining skillsets required in the care of critically ill or injured children. The objectives of this study were to describe and assess the effectiveness of a pediatric-focused, simulation-based, procedural training program for EMS clinicians, delivered on-site by a pediatric simulation education team. We also describe a novel, remote, asynchronous performance outcome measurement system using first-person-view video review. This was a prospective study of simulation-based training and procedural outcomes. The study population involved EMS clinicians at three fire-based EMS agencies stratified as urban, suburban, and rural sites. The primary outcome was performance of intraosseous catheterization (IO), bag-valve-mask ventilation (BVM), and supraglottic device placement (SGD), measured across three time points. Secondary outcomes were identification of differences across EMS agencies and participant survey responses. We obtained video data from 122 clinicians, totaling 561 videos, with survey response rates of 89.0–91.3%. Pre-intervention scores were high: least-square means (95% confident-intervals) 9.5 (8.9, 10.2) for IO; 9.6 (9.3, 9.9) for BVM; and 11.6 (10.9, 12.2) for SGD. There was significant improvement post-intervention: 11.5 (10.7, 12.3) for IO; 11.0 (10.7, 11.4) for BVM; and 13.6 (12.8, 14.4) for SGD. Improvement was maintained at follow-up after a median of 9.5 months: 10.5 (9.8, 11.2) for IO; 10.2 (9.9, 10.6) for BVM; and 12.4 (11.7, 13.1) for SGD. There were no statistical differences between sites. Of survey respondents, half had not cared for a critically ill or injured child in at least a year, the vast majority had not had hands-on pediatric training in over 6 months, and the majority felt that training should occur at least every 6 months. Our pediatric-focused, simulation-based procedural training program was associated with improvement and maintenance of high-baseline procedural performance for EMS clinicians over the study period. Findings were consistent across sites. Remote assessment was feasible. Participant surveys emphasized a desire for more pediatric-focused training and highlighted the low frequency of clinical exposure to procedures potentially needed in the care of critically ill or injured pediatric patients.

Emergency medical services (EMS) clinicians are expected to provide expert care to all patients, but face obstacles in maintaining skillsets required in the care of critically ill or injured children. The objectives of this study were to describe and assess the effectiveness of a pediatric-focused, simulation-based, procedural training program for EMS clinicians, delivered on-site by a pediatric simulation education team. We also describe a novel, remote, asynchronous performance outcome measurement system using first-person-view video review. This was a prospective study of simulation-based training and procedural outcomes. The study population involved EMS clinicians at three fire-based EMS agencies stratified as urban, suburban, and rural sites. The primary outcome was performance of intraosseous catheterization (IO), bag-valve-mask ventilation (BVM), and supraglottic device placement (SGD), measured across three time points. Secondary outcomes were identification of differences across EMS agencies and participant survey responses. We obtained video data from 122 clinicians, totaling 561 videos, with survey response rates of 89.0–91.3%. Pre-intervention scores were high: least-square means (95% confident-intervals) 9.5 (8.9, 10.2) for IO; 9.6 (9.3, 9.9) for BVM; and 11.6 (10.9, 12.2) for SGD. There was significant improvement post-intervention: 11.5 (10.7, 12.3) for IO; 11.0 (10.7, 11.4) for BVM; and 13.6 (12.8, 14.4) for SGD. Improvement was maintained at follow-up after a median of 9.5 months: 10.5 (9.8, 11.2) for IO; 10.2 (9.9, 10.6) for BVM; and 12.4 (11.7, 13.1) for SGD. There were no statistical differences between sites. Of survey respondents, half had not cared for a critically ill or injured child in at least a year, the vast majority had not had hands-on pediatric training in over 6 months, and the majority felt that training should occur at least every 6 months. Our pediatric-focused, simulation-based procedural training program was associated with improvement and maintenance of high-baseline procedural performance for EMS clinicians over the study period. Findings were consistent across sites. Remote assessment was feasible. Participant surveys emphasized a desire for more pediatric-focused training and highlighted the low frequency of clinical exposure to procedures potentially needed in the care of critically ill or injured pediatric patients.