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Updated: Aug 1, 2025
A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Creation of a Novel Child Simulator and Curriculum to Optimize Administration of Seizure Rescue Medication
Coral M Stredny1, Theodore Sheehan, Justice Clark
1From the Division of Epilepsy and Clinical Neurophysiology, Department of Neurology (C.M.S., T.S., J.C., C.T., C.G., T.K., C.C., T.L.), Boston Children's Hospital, Boston, MA; Immersive Design Systems (B.O'C., K.G., G.L., S.W., P.H.W.), Boston Children's Hospital, Boston, MA; Clinical Research Center (P.W.F.), Boston Children's Hospital, Boston, MA; Department of Anesthesiology, Critical Care and Pain Medicine (P.H.W.), Boston Children's Hospital, MA; and Harvard Medical School (C.M.S., P.H.W., T.L.), Boston, MA.
Insights
Caregivers need training for pediatric seizure rescue medications. A realistic rectal diazepam simulator and scoring system improved medication administration accuracy and speed in simulations.
Area of Science:
- Pediatric Emergency Medicine
- Medical Simulation Training
Background:
- Pediatric convulsive status epilepticus often begins pre-hospital, yet many patients remain untreated.
- Caregiver training in administering prehospital seizure rescue medications is insufficient.
Purpose of the Study:
- To develop and evaluate a novel simulation model for training rectal diazepam administration.
- To assess the effectiveness of a standardized scoring system for this training.
Main Methods:
- A proof-of-principle mannequin and simulation were developed for rectal diazepam administration.
- A scoring paradigm was created to standardize and assess the educational process.
- Healthcare providers and parents/guardians participated in the simulation study.
Main Results:
- The rectal diazepam simulator demonstrated high realism (≥4/5 Likert scale).
- Simulation training reduced treatment time (-12.3 seconds) and improved medication delivery accuracy (-4.2 points).
- The scoring technique showed good interrater reliability (≥86%) and feasibility.
Conclusions:
- A novel child simulator and scoring system effectively train caregivers in using seizure rescue medications.
- This innovative approach enhances preparedness for pediatric emergencies.
Introduction:
Although most cases of pediatric convulsive status epilepticus start in the prehospital setting, many patients do not receive treatment. The use of prehospital seizure rescue medications by caregivers is crucial, but studies suggest a lack of proper training on medication use.
Methods:
We created a novel proof of principle mannequin and simulation for training proper administration of rectal diazepam, with a scoring paradigm to standardize and assess the educational process.
Results:
Twenty-three health care providers (nurses and nurse practitioners, residents/fellows, and attending physicians) and 5 patient guardians/parents were included in the study. The rectal diazepam simulator displayed a high degree of physical and emotional realism (mean ≥ 4/5 on Likert scale survey) that effectively decreased time to treatment (-12.3 seconds; SD, 16.3) and improved the accuracy of medication delivery in a simulation setting (-4.2 points; SD, 3.1). The scoring technique had appropriate interrater reliability (≥86% on all but 2 prompts) and was a feasible instrument to assess the effectiveness of the educational intervention.
Conclusions:
A unique procedure-focused child simulator and rescue medication score offer an innovative and effective means to train caregivers on the use of lifesaving seizure rescue medications.
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