Paramedic Student Clinical Performance During High-Fidelity Simulation After a Physically Demanding Occupational Task: A Pilot Randomized Crossover Trial
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Published on: May 6, 2020
Alex Sandy MacQuarrie1, Jayden R Hunter, Samantha Sheridan
1From the Paramedicine Program (A.M.), Griffith University School of Medicine, Gold Coast, Queensland; Holsworth Research Initiative (J.R.H.), La Trobe University, Bendigo, Victoria; Paramedicine Program (S.S.), Charles Sturt University, Port Macquarie, New South Wales; Paramedicine Program (A.H.), Australian Catholic University, Brisbane, Queensland; Charles Sturt University (C.S.), School of Biomedical Sciences, Bathurst; and Charles Sturt University (J.W.), School of Biomedical Sciences, Orange, New South Wales, Australia.
Introduction:
Paramedic duties include assessing, treating, and maneuvering patients in physically challenging environments. Whether clinical skills and patient care are affected by these occupational demands is unknown. High-fidelity simulation affords the opportunity to study this in a controlled setting.
Methods:
Using a randomized crossover design, 11 regional paramedicine students and graduates (mean ± SD age = 23 ± 2 years) completed two, 20-minute high-fidelity simulations that included cardiopulmonary resuscitation (CPR) immediately after either an acute bout of occupational physical activity (OPA) or a rest period (REST). Heart rate, respiratory rate, and mean arterial pressure were measured throughout. Clinical performance was scored using the Global Rating Score and a patient care record. Measures of CPR efficacy were recorded in the manikin.
Results:
There were no significant differences in Global Rating Score ( P = 0.07, ES = 0.03) or CPR efficacy between conditions. Patient care record accuracy was higher after the OPA versus REST simulations (mean ± SD = 61.8 ± 12.6% vs. 55.5 ± 12.0%, P = 0.03, ES = 0.5). Mean heart rate was higher during OPA simulations versus REST simulations (121 ± 14 vs. 84 ± 9 beats per minute, P < 0.01, ES = 3.1), as was mean respiratory rate (19 ± 3 vs. 16 ± 3 breaths per minute, P < 0.01, ES = 1.0). Mean arterial pressure was higher for OPA versus REST at simulation start (105 ± 11.3 vs. 95.8 ± 11.8 mm Hg, P = 0.01, Effect Size = 0.8), although not different after simulation.
Conclusions:
Paramedicine students including recent graduates performed as well, or better, in a simulated clinical scenario immediately after occupation-specific acute physical exertion compared with a REST, despite higher physiological exertion. Whether this is the case for more experienced but potentially less physically fit paramedics in the workforce warrants investigation.
