Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills

Emergency Medical Services Provider Acceptance of and Attitudes About Pediatric SimBox Simulations

OBJECTIVE

SimBox simulations allow for high-frequency open-access health care education, overcoming cost and resource barriers. Prehospital paramedics and emergency medical technician (EMT) care for children infrequently. In this study, prehospital providers evaluated pediatric SimBox simulations.

METHODS

This was a cross-sectional study of EMS professionals participating in a series of simulations conducted in a larger project assessing improvement of the quality of pediatric care in the prehospital setting. Participants were teams of two, which comprised a paramedic/paramedic, paramedic/EMT, or 2 EMTs. The simulations used facilitator resources, debriefing prompts, video depictions of patients and vital signs, and a low-fidelity manikin. Pediatric emergency care coordinators, EMS training officers, and/or emergency physicians facilitated simulations of seizure, sepsis with respiratory failure, and child abuse, followed by debriefings. Participants completed an online survey after the simulation and rated it in 4 domains: prebriefing, scenario content, debriefing, and overall. Ratings were trifold: "strongly agree," "somewhat agree," or "do not agree." Data were analyzed by case type, participant type, location, participant reaction to simulation elements, and the debriefing. Net Promoter Scores were calculated to assess participant endorsement of SimBox.

RESULTS

There were 121 participants: 103 (87%) were paramedics, and 18 (13%) were EMTs. Participant agreement of simulation benefit for clinical practice was high, for example, "I am more confident in my ability to prioritize care and interventions" (98.4% strongly or somewhat agree), and 99.2% of participants agreed the postsimulation debriefing with facilitators "provided opportunities to self-reflect on my performance during simulation." Overall, 97.5% strongly or somewhat agreed that the simulations "improved my comfort in pediatric acute care." Net Promoter Score showed 65.3% were promoters of and 24% were passive about SimBox.

CONCLUSION

SimBox simulations are associated with improved self-efficacy of prehospital care providers for care of acutely ill or injured children. The majority promotes SimBox as a learning tool.

There's an app for that: Teaching residents to communicate diagnostic uncertainty through a mobile gaming application

BACKGROUND

Clear communication is integral to good clinical care; however, communication training is cost and time intensive. Mobile applications (apps) may provide a useful adjunct to traditional simulation skills training.

OBJECTIVE

To evaluate (1) use of an app for teaching communication skills about diagnostic uncertainty, (2) feedback on app use, and (3) the association between use and skill mastery.

PATIENT INVOLVEMENT

The app under study is designed to improve doctor-patient communication.

METHODS

The study was a planned sub-analysis of a randomized controlled waitlist trial with emergency medicine resident physicians randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty. The curriculum included a web-based interactive module and the app. Metrics describing participants' use of the app, feedback on use, and association of use and achieving mastery in communicating diagnostic uncertainty are reported. Differences between groups utilizing the app were analyzed using Chi-squared test; logistic regression assessed the association between app use and achieving mastery of the communication skill.

RESULTS

Among 109 participants completing the trial, only 34 (31.2%) used the app. Most participants engaged with the app on one occasion for a median of 50 min (IQR 31, 87). Senior residents were more likely to use the app than junior residents (41.3% vs 23.8%, p=0.05). Overall reviews were positive; 76% reported the app helped them learn. There was no significant association between app use and achieving mastery of the communication skill in the trial [OR 2.1, 95% CI (0.91-4.84)].

DISCUSSION

Despite positive reviews of app use, overall use was low and there was no association with achieving mastery.

PRACTICAL VALUE

Offering an app as an auxiliary training opportunity may be beneficial to some residents, but shouldn't be planned for use as a primary didactic modality unless there is evidence for effectiveness and use is mandated.

AVAILABILITY OF DATA AND MATERIALS

The datasets generated and/or analyzed during the current study are not publicly available since some data may be identifiable but are available from the corresponding author on reasonable request.

The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals

INTRODUCTION

Death notification is a difficult task commonly encountered during prehospital care and may lead to burnout among EMS professionals. Lack of training could potentiate the relationship between death notification and burnout. The first objective of this study was to describe EMS professionals' experience with death notification and related training. The secondary objective was to assess the associations between death notification delivery, training, and burnout. Methods: We administered an electronic questionnaire to a random sample of nationally-certified EMS professionals. Work-related burnout was measured using the validated Copenhagen Burnout Inventory. Analysis was stratified by certification level to basic life support (BLS) and advanced life support (ALS). The association between the number of adult (≥18 years) patient death notifications delivered in the prior 12 months and burnout was assessed using multivariable logistic regression to adjust for confounding variables. Multivariable logistic regression modeling was used to assess the adjusted association between training and burnout among those who reported delivering at least one death notification in the prior 12 months. Adjusted odds ratios (aOR) and 95% confidence intervals are reported (95% CI). Results: We received 2,333/19,330 (12%) responses and 1,514 were included in the analysis. Most ALS respondents (77%) and one-third of BLS respondents (33%) reported at least one adult death notification in the past year. Approximately half of respondents reported receiving death notification training as part of their initial EMS education program (51% BLS; 52% ALS) and fewer reported receiving continuing education (30% BLS; 44% ALS). Delivering a greater number of death notifications was associated with increased odds of burnout. Among those who delivered at least one death notification, continuing education was associated with reduced odds of burnout. Conclusion: Many EMS professionals reported delivering at least one death notification within the past year. Yet, fewer than half reported training related to death notification during initial EMS education and even fewer reported receiving continuing education. More of those who delivered death notifications experienced burnout, while continuing education was associated with reduced odds of burnout. Future work is needed to develop and evaluate death notification training specifically for EMS professionals.

Mobile Digital Education for Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background

There is a pressing need to implement efficient and cost-effective training to address the worldwide shortage of health professionals. Mobile digital education (mLearning) has been mooted as a potential solution to increase the delivery of health professions education as it offers the opportunity for wide access at low cost and flexibility with the portability of mobile devices. To better inform policy making, we need to determine the effectiveness of mLearning.

Objective

The primary objective of this review was to evaluate the effectiveness of mLearning interventions for delivering health professions education in terms of learners’ knowledge, skills, attitudes, and satisfaction.

Methods

We performed a systematic review of the effectiveness of mLearning in health professions education using standard Cochrane methodology. We searched 7 major bibliographic databases from January 1990 to August 2017 and included randomized controlled trials (RCTs) or cluster RCTs.

Results

A total of 29 studies, including 3175 learners, met the inclusion criteria. A total of 25 studies were RCTs and 4 were cluster RCTs. Interventions comprised tablet or smartphone apps, personal digital assistants, basic mobile phones, iPods, and Moving Picture Experts Group-1 audio layer 3 player devices to deliver learning content. A total of 20 studies assessed knowledge (n=2469) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning over traditional learning for knowledge (standardized mean difference [SMD]=0.43, 95% CI 0.05-0.80, N=11 studies, low-quality evidence). There was no difference between blended learning and traditional learning for knowledge (SMD=0.20, 95% CI –0.47 to 0.86, N=6 studies, low-quality evidence). A total of 14 studies assessed skills (n=1097) and compared mLearning or blended learning to traditional learning or another form of digital education. The pooled estimate of studies favored mLearning (SMD=1.12, 95% CI 0.56-1.69, N=5 studies, moderate quality evidence) and blended learning (SMD=1.06, 95% CI 0.09-2.03, N=7 studies, low-quality evidence) over traditional learning for skills. A total of 5 and 4 studies assessed attitudes (n=440) and satisfaction (n=327), respectively, with inconclusive findings reported for each outcome. The risk of bias was judged as high in 16 studies.

Conclusions

The evidence base suggests that mLearning is as effective as traditional learning or possibly more so. Although acknowledging the heterogeneity among the studies, this synthesis provides encouraging early evidence to strengthen efforts aimed at expanding health professions education using mobile devices in order to help tackle the global shortage of health professionals.

Emergency Medical Services Provider Perspectives on Pediatric Calls: A Qualitative Study

Objective: Previous research indicates that 9-1-1 response to incidents involving children is particularly distressing for emergency medical services (EMS) clinicians. This qualitative study was conducted to increase understanding about the difficulties of responding to pediatric calls and to obtain information about how organizations can better support EMS providers in managing potentially difficult calls. Methods: Paramedics and emergency medical technicians from a single U.S. ambulance service were invited to participate in focus groups about responding to 9-1-1 calls involving pediatric patients. A total of 17 providers from both rural and metro service regions participated in six focus groups held in community meeting spaces. A semi-structured focus group guide was used to explore (1) elements that make pediatric calls difficult, (2) pre-arrival preparation practices, (3) experiences with coping after difficult pediatric calls, and (4) perspectives about offered and desired resources or support. Focus groups were audio recorded and transcripts were analyzed using standard coding, memoing, and content analysis methods in qualitative analysis software (NVivo). Results: Responses about elements that make pediatric calls difficult were organized into the following themes: (1) special social value of children, (2) clinical difficulties with pediatric patients, (3) added acuity to already challenging calls, (4) caregivers as secondary patient, and (5) identifying with patient or patient's family. Pre-arrival preparation methods included mental or verbal review of hypothetical scenarios and refocusing nerves or emotions back to the technical aspect of the job. Participants described using available resources that largely took the form of social support. Suggestions for additional resources included: increased opportunities for external feedback; more frequent pediatric clinical training; institutionalization of recovery time after difficult calls; and improved storage and labeling of pediatric equipment. Conclusions: This study provides qualitative data about the difficulties of responding to pediatric calls and resources needed to support clinicians. Findings from this study can be used to guide EMS leaders in designing and implementing institutional initiatives to enhance training and support for prehospital clinicians providing care to children.

Perceptions by Families of Emergency Medical Service Interventions During Imminent Pediatric Out-of-Hospital Death

OBJECTIVE

To understand how family members view the ways Emergency Medical Services (EMS) and other first responders interact with distressed family members during an intervention involving a recent or impending pediatric death.

METHODS

In depth interviews with 11 grieving parents of young children and survey results from 4 additional grieving parents of adult children were conducted as part of a larger study on effective ways for EMS providers to interact with distressed family members during a pediatric death in the field. The responses were analyzed using qualitative content analyses.

RESULTS

Family reactions to the crisis and the professional response by first responders were critical to family coping and getting necessary support. There were several critical competencies identified to help the family cope including: (1) that first responders provide excellent and expeditious care with seamless coordination, (2) allowing family to witness the resuscitation including the attempts to save the child's life, and (3) providing ongoing communication. Whether the child is removed from the scene or not, keeping the family apprised of what is happening and why is critical. Giving tangible forms of support by calling friends, family, and clergy, along with allowing the family time with the child after death, giving emotional support, and follow-up gestures all help families cope.

CONCLUSION

The study generated hypothetical ways for first responders to interact with distressed family members during an OOH pediatric death.