Pediatric Emergency Medicine Didactics and Simulation (PEMDAS): Armed Penetrating Trauma

Firearms are the leading cause of pediatric death in the U.S., with a rising number of firearm-related injuries presenting to Pediatric Emergency Departments (PED). Trauma centers that manage firearm injuries have higher rates of weapon confiscation. Many healthcare workers have encountered concealed firearms in the ED, despite a lack of workplace firearm handling training. To address this gap, this technical report describes a novel simulation-based curriculum for Pediatric Emergency Medicine (PEM) trainees involving a 15-year-old male presenting with a gunshot wound (GSW) to the chest requiring chest decompression, intubation, and blood products. A concealed firearm discovered on the patient required proper handling protocols. Afterward, a debrief was conducted, and participants completed an evaluation based on pre- and post-simulation knowledge using a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree). Learners rated the simulation as highly relevant (Mean (M) = 4.8) and realistic (M = 4.7) and reported improvements in teamwork and communication skills (M = 4.6). They also demonstrated increased comfort with identifying firearm injury patterns (pre M = 4.2, post M = 4.6), stabilizing critically ill trauma patients (pre M = 4.1, post M = 4.4), handling firearms in a healthcare setting (pre M = 3.4, post M = 4.3), and functioning effectively as a team in the trauma bay (pre M = 4.5, post M = 4.6). This simulation was well received and provided a psychologically safe environment for trainees to address key knowledge gaps and improve comfort with firearm-related trauma care and safety practices in the pediatric emergency department.