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Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers
Maybelle Kou1,2, Aaron J Donoghue3, Helen Stacks2,4
1Department of Emergency Medicine, Inova Fairfax Medical Campus, Falls Church, Virginia.
Insights
Personal protective equipment (PPE) use by prehospital providers (PHPs) did not significantly impair their ability to perform critical resuscitation procedures on pediatric patients during simulated hazardous exposures. Findings support PHPs in pediatric emergency care while wearing protective gear.
Area of Science:
- Emergency medicine
- Pediatric critical care
- Prehospital care
Background:
- Prehospital providers (PHPs) use personal protective equipment (PPE) for hazardous exposures.
- Limited evidence exists on PPE's impact on pediatric resuscitation by PHPs.
- This study evaluated PPE effects on pediatric resuscitation procedures.
Purpose of the Study:
- To assess the impact of Level B PPE on the performance of critical resuscitation tasks in pediatric patients by paramedics.
- To identify specific procedures affected by PPE use in a simulated pediatric emergency setting.
Main Methods:
- Prospective study at a US simulation center.
- Paramedics performed timed psychomotor tasks in normal attire (baseline) and with Level B PPE.
- Wilcoxon signed-rank tests compared task completion times between sessions.
Main Results:
- Task completion times increased significantly with PPE for tracheal intubation, AED placement, intraosseous line insertion, tourniquet application, intramuscular injection, and pulse oximetry.
- No significant increase in completion time was observed for bag-mask ventilation or autoinjector use.
- 50 paramedics completed the study, demonstrating varied impacts of PPE on specific procedures.
Conclusions:
- Level B PPE did not significantly hinder PHPs performing critical tasks for pediatric patients during simulated infectious or chemical exposures.
- Findings provide guidance for PHPs managing pediatric emergencies while wearing PPE.
- The study highlights the feasibility of pediatric resuscitation with PPE in hazardous scenarios.
Background:
Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.
Methods:
This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.
Results:
A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.
Conclusions:
PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.
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