O3304: In-Situ Simulation Training for Pediatric-Neonatal Transport Team: A Pilot to Assess Feasibility

Background: The incidence of cardiopulmonary resuscitation (CPR) during pediatric transport is 0.18 % and for neonatal transports is 0.33%. (1) Though rare, it is challenging to administer adequate CPR en route by a transport team, in a moving, highly constrained, restricted environment with limited personnel. (2) Evidence also indicates that the quality of CPR in transit is worse than on-scene. (3) We decided to investigate the feasibility of introducing in-situ, simulation-based training for CPR scenario for our highly specialized pediatric-neonatal transport team. The aim of this study was to increase simulation fidelity for our transport team by exposing them to a realistic CPR scenario in a moving ambulance to mimic the human resource, equipment, and space limitations they encounter during CPR while en route.

Methods: Our critical care team composition is a RN, RT and a paramedic. During transport, paramedic drives while the RN and RT are with the patient in the back of the ambulance. Eighteen transport team members participated in the study forming six critical care teams. Each team while transporting a mannequin had to respond to a hypoxia-induced bradycardia scenario resulting in CPR. Teams were evaluated based on their reaction times to operational metrics, overall teamwork, and management of human and material resources. The Sim scenario was followed by a short debrief and then we had the participants fill out a de-identified survey to provide feedback on their experience.

Results: The mean age of participants was 41.7 years (SD 8.29) with a mean of 8.9 years (SD 6.19) of transport experience. During their time in inter-facility transport, 27% had not performed CPR en route.

During the simulation scenario of a hypoxic infant who becomes bradycardic, the mean time to administer Epinephrine was 2.12 minutes and the mean time to start discussing the decision to go lights and sirens or to pull over was 2.37 minutes.

Post-sim survey revealed that 66% of the participants found the in-situ simulation very helpful. 89% rated it a better training experience when asked to compare the in-situ scenario vs traditional simulation training in the Sim center. 83% of the participants expressed interest in incorporating more in-situ training.

Conclusion: In-situ simulation immerses transport personnel in the clinical environment that they routinely work in and increases the fidelity of sim training. Incorporating this technique is beneficial to a majority of providers regardless of their experience in transport, may be of greatest benefit to those new to the transport role and will help improve patient care.