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

Cardiopulmonary resuscitation (CPR) during interfacility neonatal and pediatric transport is a rare phenomenon (0.33% and 0.18%, respectively). The ability to maintain high-quality manual CPR in a moving vehicle with limited personnel and equipment impacts its effectiveness. There are limited data about neonatal and pediatric transport teams training staff on resuscitation during transport. This study evaluated the feasibility of in situ, simulation-based CPR training for a tertiary hospital's pediatric-neonatal transport team to better replicate real-world constraints.

Critical care teams-each comprising a nurse, respiratory therapist, and paramedic-completed an in situ simulation aboard a moving ambulance. Generally, 18 participants formed 6 teams, managing a hypoxia-induced bradycardia scenario requiring CPR. Operational metrics, teamwork, and resource management were evaluated. Post-simulation, participants completed a deidentified survey.

The mean participant age was 41.7 (standard deviation [SD] = 8.29) years with 8.9 (SD = 6.19) years of transport experience; 27% had not previously performed CPR during transport. Median time for bag-valve-mask initiation was 0.47 (SD = 0.41) minutes, CPR start was 0.62 (SD = 0.65) minutes, epinephrine administration was 1.25 (SD = 1.61) minutes, and contact with medical command was 1.40 (SD = 0.76) minutes. Post-simulation, 89% preferred in situ training over traditional simulation. Confidence improvements in prehospital care, logistics, and team resource management were negatively correlated with years of transport experience (P < .05).

In situ simulation enhances training fidelity, improves provider confidence, and may be especially valuable for onboarding new transport team members, supporting safer patient care during transport.