Simulation-Based Training and Its Use Amongst Practicing Paramedics and Emergency Medical Technicians: An Evidence-Based Systematic Review
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Abstract
Objectives: This systematic review (SR) describes how simulation-based training (SBT) is utilized by paramedics and emergency medical technicians (EMTs).
Data sources: PubMed, CINAHL, Cochrane CENTRAL, Scopus, Web of Science, and Google Scholar were searched from 2010 to 2021.
Review methods: Standard SR methodology was utilized according to PRISMA guidelines. Eligibility criteria included English studies conducted in the United States or Canada published and published between 2010 and 2021. Study designs were somewhat heterogeneous and included quantitative, qualitative, and mixed-methods projects. The specific populations included paramedics and EMTs.
Results: 595 articles were initially identified and reviewed, 25 of which met our inclusion criteria. Of them, the most common SBT areas of focus documented in the literature was general assessment and treatment (7 studies) and airway management (7 studies). The majority of the studies were conducted in a mobile simulation lab (6 studies), simulation centers (5 studies), and ambulances (5 studies). Many of the studies report simulations involving using manikins alone and a combination of manikins and simulated patients. Overall, 21 studies documented the use of high-fidelity simulation. 16 studies involved paramedics only, 8 involved both paramedics and EMTs, and one study involved only EMTs. Most of the impact of SBT appeared to be on objective measures such as performance, procedural success, and ability to identify errors, as well as subjective metrics such as perceived improvement in knowledge and skill. The degree of sustained impact of SBT on skill retention was not frequently reported, and direct enhancement in patient outcomes such as length-of-stay, or mortality were not documented in any of the studies.
Conclusions: Paramedics and EMTs provide critically important, often lifesaving, prehospital care. However, the opportunities to enhance their skills are limited by several factors; most notably their undergraduate and certificate educational requirements, which are much ... (truncated)
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References
Wilkerson W, Avstreih D, Gruppen L, Beier KP, Woolliscroft J. Using immersive simulation for training first responders for mass casualty incidents. Acad Emerg Med. 2008;15(11):1152-9. Epub 2008/11/04. https://doi.org/10.1111/j.1553-2712.2008.00223.x. PubMed PMID: 18976333.
Bredmose PP, Habig K, Davies G, Grier G, Lockey DJ. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model. Scand J Trauma Resusc Emerg Med. 2010;18:13-. https://doi.org/10.1186/1757-7241-18-13. PubMed PMID: 20230636.
Varchenko-Trotsenko L, Tiutiunnyk A, Terletska T. Using Video Materials in Electronic Learning Courses. 2019:375-82. https://doi.org/10.28925/2414-0325.2019s34.
Updated Statement Regarding COVID-19. 2020. Retrieved from https://coaemsp.org/?mdocs-file=3480
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLOS Medicine. 2021;18(3):e1003583. https://doi.org/10.1371/journal.pmed.1003583.
Registry of Systematic Reviews/Meta-Analyses: Research Registry; 2022. Available from: https://www.researchregistry.com/browse-the-registry#registryofsystematicreviewsmeta-analyses/registryofsystematicreviewsmeta-analysesdetails/6209a5b1fcf7ec0020c0ecf5/.
Alphonso A, Auerbach M, Bechtel K, Bilodeau K, Gawel M, Koziel J, et al. Development of a Child Abuse Checklist to Evaluate Prehospital Provider Performance. Prehospital Emergency Care. 2017;21(2):222-32. https://doi.org/10.1080/10903127.2016.1229824. PubMed PMID: 121550053. Language: English. Entry Date: 20170314. Revision Date: 20190304. Publication Type: Article.
Asselin N, Choi B, Pettit CC, Dannecker M, Machan JT, Merck DL, et al. Comparative Analysis of Emergency Medical Service Provider Workload During Simulated Out-of-Hospital Cardiac Arrest Resuscitation Using Standard Versus Experimental Protocols and Equipment. Simul Healthc. 2018;13(6):376-86. https://doi.org/10.1097/sih.0000000000000339. PubMed PMID: WOS:000453541900002.
Ayub EM, Sampayo EM, Shah MI, Doughty CB. Prehospital Providers’ Perceptions on Providing Patient and Family Centered Care. Prehosp Emerg Care. 2017;21(2):233-41. Epub 2016/11/20. https://doi.org/10.1080/10903127.2016.1241326. PubMed PMID: 27858502.
Bischof JJ, Panchal AR, Finnegan GI, Terndrup TE. Creation and Validation of a Novel Mobile Simulation Laboratory for High Fidelity, Prehospital, Difficult Airway Simulation. Prehosp Disaster Med. 2016;31(5):465-70. Epub 2016/08/18. https://doi.org/10.1017/s1049023x16000534. PubMed PMID: 27530816.
Byars D, Lo B, Yates J. Evaluation of paramedic utilization of the intubating laryngeal mask airway in high-fidelity simulated critical care scenarios. Prehosp Disaster Med. 2013;28(6):630-1. Epub 2013/09/05. https://doi.org/10.1017/s1049023x13008856. PubMed PMID: 24001719.
Choi B, Asselin N, Pettit CC, Dannecker M, Machan JT, Merck DL, et al. Simulation-based Randomized Comparative Assessment of Out-of-Hospital Cardiac Arrest Resuscitation Bundle Completion by Emergency Medical Service Teams Using Standard Life Support or an Experimental Automation-assisted Approach. Simul Healthc. 2016;11(6):365-75. https://doi.org/10.1097/sih.0000000000000178. PubMed PMID: WOS:000390028600001.
Gable BD, Gardner AK, Celik DH, Bhalla MC, Ahmed RA. Improving bariatric patient transport and care with simulation. West J Emerg Med. 2014;15(2):199-204. https://doi.org/10.5811/westjem.2013.12.18855. PubMed Central PMCID: 24672612.
Hallihan G, Caird JK, Blanchard I, Wiley K, Martel J, Wilkins M, et al. The evaluation of an ambulance rear compartment using patient simulation: Issues of safety and efficiency during the delivery of patient care. Appl Ergon. 2019;81:11. https://doi.org/10.1016/j.apergo.2019.06.003. PubMed PMID: WOS:000486359400004.
Heiner JD, McArthur TJ. The ultrasound identification of simulated long bone fractures by prehospital providers. Wilderness Environ Med. 2010;21(2):137-40. Epub 2010/07/02. https://doi.org/10.1016/j.wem.2009.12.028. PubMed PMID: 20591377.
Hoyle JD, Ekblad G, Hover T, Woodwyk A, Brandt R, Fales B, et al. Dosing Errors Made by Paramedics During Pediatric Patient Simulations After Implementation of a State-Wide Pediatric Drug Dosing Reference. Prehospital Emergency Care. 2020;24(2):204-13. https://doi.org/10.1080/10903127.2019.1619002. PubMed PMID: 142124679. Language: English. Entry Date: 20200311. Revision Date: 20200311. Publication Type: Article.
Joyce M, Tozer J, Vitto M, Evans D. Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound. Prehosp Disaster Med. 2020:1-3. Epub 2020/08/26. https://doi.org/10.1017/s1049023x20001004. PubMed PMID: 32838826.
Lammers R, Byrwa M, Fales W. Root causes of errors in a simulated prehospital pediatric emergency. Acad Emerg Med. 2012;19(1):37-47. https://doi.org/10.1111/j.1553-2712.2011.01252.x. PubMed Central PMCID: 22251191.
Lammers R, Willoughby-Byrwa M, Fales W. Medication errors in prehospital management of simulated pediatric anaphylaxis. Prehosp Emerg Care. 2014;18(2):295-304. Epub 2014/01/10. https://doi.org/10.3109/10903127.2013.856501. PubMed PMID: 24401046.
Lammers RL, Willoughby-Byrwa MJ, Vos DG, Fales WD. Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies. Prehospital Emergency Care. 2021:13. https://doi.org/10.1080/10903127.2021.1916140. PubMed PMID: WOS:000648299400001.
Leblanc VR, Regehr C, Tavares W, Scott AK, Macdonald R, King K. The impact of stress on paramedic performance during simulated critical events. Prehosp Disaster Med. 2012;27(4):369-74. Epub 2012/07/27. https://doi.org/10.1017/s1049023x12001021. PubMed PMID: 22831965.
Maloney LM, Williams DW, Reardon L, Marshall RT, Alian A, Boyle J, et al. Utility of Different Lung Ultrasound Simulation Modalities Used by Paramedics during Varied Ambulance Driving Conditions. Prehospital Disaster Med. 2021;36(1):42-6. https://doi.org/10.1017/s1049023x20001247. PubMed PMID: WOS:000611174400008.
March JA, Kiemeney MJ, De Guzman J, Ferguson JD. Retention of cricothyrotomy skills by paramedics using a wire guided technique. Am J Emerg Med. 2019;37(3):407-10. Epub 2018/06/13. https://doi.org/10.1016/j.ajem.2018.05.073. PubMed PMID: 29891124.
Mausz J, Donovan S, McConnell M, Lapalme C, Webb A, Feres E, et al. Reformulations of practice: beyond experience in paramedic airway management. CJEM: Canadian Journal of Emergency Medicine. 2017;19(4):293-304. https://doi.org/10.1017/cem.2016.371. PubMed PMID: 124252880. Language: English. Entry Date: 20180117. Revision Date: 20190207. Publication Type: Article.
Panchal AR, Finnegan G, Way DP, Terndrup T. Assessment of Paramedic Performance on Difficult Airway Simulation. Prehosp Emerg Care. 2020;24(3):411-20. Epub 2016/11/22. https://doi.org/10.3109/10903127.2015.1102993. PubMed PMID: 27870588.
Shah MI, Carey JM, Rapp SE, Masciale M, Alcanter WB, Mondragon JA, et al. Impact of High-Fidelity Pediatric Simulation on Paramedic Seizure Management. Prehosp Emerg Care. 2016;20(4):499-507. Epub 2016/03/10. https://doi.org/10.3109/10903127.2016.1139217. PubMed PMID: 26953677.
Smith MW, Bentley MA, Fernandez AR, Gibson G, Schweikhart SB, Woods DD. Performance of experienced versus less experienced paramedics in managing challenging scenarios: a cognitive task analysis study. Annals of Emergency Medicine. 2013;62(4):367-79. https://doi.org/10.1016/j.annemergmed.2013.04.026. PubMed PMID: 104228631. Language: English. Entry Date: 20131129. Revision Date: 20200708. Publication Type: Journal Article.
Stevens AD, Hernandez C, Jones S, Moreira ME, Blumen JR, Hopkins E, et al. Color-coded prefilled medication syringes decrease time to delivery and dosing errors in simulated prehospital pediatric resuscitations: A randomized crossover trial. Resuscitation. 2015;96:85-91. Epub 2015/08/08. https://doi.org/10.1016/j.resuscitation.2015.07.035. PubMed PMID: 26247145; PubMed Central PMCID: PMC4903013.
Studnek JR, Fernandez AR, Shimberg B, Garifo M, Correll M. The association between emergency medical services field performance assessed by high-fidelity simulation and the cognitive knowledge of practicing paramedics. Acad Emerg Med. 2011;18(11):1177-85. Epub 2011/11/19. https://doi.org/10.1111/j.1553-2712.2011.01208.x. PubMed PMID: 22092899.
Tremblay M, Albert WJ, Fischer SL, Beairsto E, Johnson MJ. Physiological responses during paramedics’ simulated driving tasks. Work. 2020;66(2):445-60. https://doi.org/10.3233/wor-203184. PubMed PMID: WOS:000565192400024.
Way DP, Panchal AR, Finnegan GI, Terndrup TE. Airway Management Proficiency Checklist for Assessing Paramedic Performance. Prehosp Emerg Care. 2017;21(3):354-61. Epub 2017/01/24. https://doi.org/10.1080/10903127.2016.1263368. PubMed PMID: 28112989.
Nash DB, Joshi M, Ransom ER, Ransom SB. The healthcare quality book : vision, strategy, and tools 2019.
Al-Elq AH. Simulation-based medical teaching and learning. J Family Community Med. 2010;17(1):35-40. https://doi.org/10.4103/1319-1683.68787. PubMed PMID: 22022669.
Heuer A, Bienstock J, Zhang Y. Simulation-based training within selected allied health professions: an evidence-based systematic review. Journal of Allied Health. 2021.
Total Nationally Certified EMS Personnel NREMT: National Registry of Emergency Medical Medical Technicians: The Nations EMS Certification; 2018. Available from: https://www.nremt.org/maps.
Saxena N, Kyaw BM, Vseteckova J, Dev P, Paul P, Lim KTK, et al. Virtual reality environments for health professional education. Cochrane Database Syst Rev. 2018;2018(10):CD012090. https://doi.org/10.1002/14651858.CD012090.pub2. PubMed PMID: PMC6516963.