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Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool
Nathan Bahr1, Garth Meckler2, Matthew Hansen3
1Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
Insights
Emergency medical service teams showed proficiency in equipment use but delayed critical interventions like ventilation and chest compressions during pediatric cardiac arrest simulations. A new scoring tool was developed to assess adherence to Pediatric Advanced Life Support guidelines.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Research
- Medical Simulation
Background:
- Pediatric out-of-hospital cardiac arrest (P-OHCA) is rare, with low survival and poor neurologic outcomes.
- High-performance emergency medical service (EMS) care is crucial for improving P-OHCA outcomes.
Purpose of the Study:
- To evaluate adherence to Pediatric Advanced Life Support (PALS) guidelines in out-of-hospital settings.
- To introduce a tool for scoring PALS guideline compliance and patient safety in pediatric resuscitation.
Main Methods:
- 34 EMS teams participated in standardized pediatric resuscitation simulations.
- Teams managed a simulated choking child manikin requiring advanced life support.
- A blinded video review assessed technical performance and guideline adherence using a developed scoring tool.
Main Results:
- EMS teams demonstrated proficiency in equipment selection, intubation, and tube placement.
- Delays were observed in initiating positive pressure ventilation and chest compressions.
- Significant deviations from PALS guidelines occurred, including improper chest compression techniques and medication errors (e.g., epinephrine administration, dosing).
Conclusions:
- EMS teams excelled in equipment use but were slow to initiate ventilation for bradycardia.
- Continuous chest compressions were frequently used instead of the recommended 15:2 ratio.
- A novel scoring tool can evaluate guideline compliance, performance, and educational effectiveness in pediatric resuscitation.
Introduction:
Pediatric out-of-hospital cardiac arrests (P-OHCA) are infrequent, have low survival rates, and often have poor neurologic outcomes. Recent evidence indicates that high-performance emergency medical service (EMS) care can improve outcomes.
Objectives:
To evaluate Pediatric Advanced Life Support (PALS) guideline performance in the out of hospital setting and introduce an easy-to-use tool that scores guideline compliance and patient safety.
Methods:
We observed EMS teams responding to standardized pediatric resuscitation simulations. Teams were dispatched to a mock assisted living home for a choking 6-year-old with a complex medical history. The child manikin was presented as unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals; initiate airway management and cardiopulmonary resuscitation (CPR); and establish vascular access and administer epinephrine based on PALS guidelines. We developed a tool to score the quality of care for critical tasks and had a clinical expert evaluate technical performance using blinded video review.
Results:
We observed 34 EMS teams providing care in P-OHCA simulations. Teams were proficient at assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. Teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions. Many teams (53%) deviated from guidelines in chest compressions with 17 (50%) performing continuous compressions before establishing an advanced airway and one (3%) not performing compressions. Similarly, 20 (59%) teams deviated from medication guidelines with 12 (35%) failing to administer epinephrine, six (18%) underdosing, and two (6%) overdosing by more than 20%.
Conclusion:
EMS teams were successful in selecting the appropriate equipment but delayed initiating ventilations in a child with severe bradycardia. We also noted frequent use of continuous chest CC rather than the AHA recommended 15:2 ratio. We developed a scoring tool with time-based criteria that can be used to assess guideline compliance, individual performance, and/or educational effectiveness.
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