Implementing In Situ Simulation of High-Risk/Low-Volume Emergency Situations for Pediatric Transport Teams

Area of Science:

• Emergency Medicine
• Pediatric Critical Care
• Neonatal Critical Care

Background:

• Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is infrequent but requires high proficiency.
• Maintaining effective CPR in a moving vehicle presents unique challenges due to limited resources and personnel.
• Limited data exist on the training of transport teams for resuscitation during transit.

Purpose of the Study:

• To evaluate the feasibility of in situ, simulation-based CPR training for a pediatric-neonatal transport team.
• To replicate real-world transport constraints during resuscitation training.
• To assess the impact of simulation on provider confidence and team performance.

Main Methods:

• A critical care team (nurse, respiratory therapist, paramedic) participated in an in situ simulation aboard a moving ambulance.
• Teams managed a hypoxia-induced bradycardia scenario requiring CPR.
• Operational metrics, teamwork, resource management, and post-simulation survey responses were evaluated.

Main Results:

• Median CPR initiation times were recorded, with bag-valve-mask initiation at 0.47 minutes and CPR start at 0.62 minutes.
• 89% of participants preferred in situ training over traditional simulation methods.
• Confidence in prehospital care, logistics, and team resource management showed a negative correlation with years of transport experience.

Conclusions:

• In situ simulation effectively enhances training fidelity for transport teams.
• This training approach improves provider confidence, particularly for new team members.
• Simulation-based training supports safer patient care during critical interfacility transports.