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Assessing the New Norm: A Simulation Study to Assess Pediatric Emergency Physician Success in Critical Procedures
Noormah Mehmood1, Jo-Ann O Nesiama1, Kenneth Yen1
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX.
Insights
Advanced personal protective equipment (PPE) did not affect procedural success or ease of use for pediatric emergency physicians during common procedures. Increased PPE use is still encouraged for physician safety during patient care.
Area of Science:
- Emergency Medicine
- Infectious Disease Control
- Medical Simulation
Background:
- Physicians face high COVID-19 infection risk, necessitating robust personal protective equipment (PPE).
- The study evaluates advanced PPE impact on critical procedures performed by pediatric emergency physicians.
Purpose of the Study:
- To assess the effect of advanced personal protective equipment (PPE) on procedural success and ease of use.
- To compare outcomes of endotracheal intubation, bag-valve mask ventilation, intraosseous insertion, and lumbar puncture with varying PPE levels.
Main Methods:
- Procedures were simulated by physicians using standard precautions versus air-purifying respirators (APRs).
- Success rates, number of attempts, procedure time, and sterility were recorded.
- Physician feedback on ease of use was collected via post-procedure surveys.
Main Results:
- No statistically significant differences were found in success rates, attempts, or time for intraosseous insertion and lumbar puncture with APRs versus standard precautions.
- Similarly, endotracheal intubation and bag-valve mask ventilation showed no significant differences in success or attempts between different APR types.
- Physician-reported ease of use for APRs did not differ significantly from standard precautions across all procedures.
Conclusions:
- Enhanced PPE, including air-purifying respirators, did not negatively impact procedural outcomes or physician experience.
- Physicians should continue to utilize all appropriate PPE to mitigate infection risk during high-risk procedures.
- The findings support the use of advanced PPE without compromising procedural efficiency or physician comfort.
Introduction:
Physicians caring for patients with COVID-19 are at high risk for contracting the disease, thus, significant emphasis has been placed on personal protective equipment (PPE). The study aims to assess the impact of advanced PPE across 4 common procedures: endotracheal intubation, bag-valve mask ventilation, intraosseous (IO) insertion, and lumbar puncture (LP) performed by pediatric emergency physicians.
Method:
Physicians performed the procedures in a simulated environment. Lumbar puncture and IO were performed with standard precautions versus an air purifying respirator (APR). A direct comparison was drawn for endotracheal intubation and bag-valve mask ventilation between 2 commonly used APRs. Success rate and number of attempts toward successful completion was recorded for all 4 procedures. Physicians filled out a postprocedure survey to assess their ease of use of the APR.
Results:
Twenty participants performed IO and LP using an APR and standard precautions. There was no statistical difference in the success rate, number of attempts, average time, or maintenance of sterility (LP only) for both procedures. Twenty total participants divided across 2 types of APR groups performed intubation and BMV. Success rate and number of attempts had no statistical difference for both procedures. Physician feedback surveys to assess the ease of use of APR compared with standard precautions had no statistically significant difference for all 4 procedures.
Conclusions:
Wearing increased levels of PPE did not impact procedural success, length of time, sterility, number of attempts, or the physicians' ease in our study. Physicians should be encouraged to wear all appropriate PPE.
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