Simulation Training for Community Emergency Preparedness

Blueprint for community emergency department pediatric simulation

Background

Gaps in quality of pediatric emergency care have been noted in community emergency departments (CEDs), where >85% of children receive care. In situ simulation provides opportunities for hands-on experiences and can help close these gaps. We aimed to develop, implement, and evaluate an innovative, replicable, and scalable pediatric in situ simulation-based CED curriculum, under the leadership of a local colleague, through collaborative approach with a regional academic medical center (AMC).

Methods

Kern's model was used as follows: problem identification and general needs assessment-pediatric readiness assessment and discussions with CED physician and nursing leadership; targeted needs assessment-review of recent pediatric transfer cases; goals and objectives-enhance pediatric knowledge and skills of interprofessional teams and detect latent safety threats; educational strategies-codeveloped by CED and AMC, included prelearning using podcasts and videos, simulation and facilitated debriefing, resource sharing after simulations; implementation-3-h simulation sessions facilitated in person by the CED team and remotely by AMC (leadership required participation and paid staff); and evaluation and feedback-retrospective pre-post survey, Simulation Effectiveness Tool-Modified (SET-M), Net Promoter Score (NPS), and review/feedback meetings.

Results

Based on needs assessment, the selected cases included newborn resuscitation, seizure, asthma, and tetrahydrocannabinol ingestion causing altered mental sensorium in a child. Twenty-four 3-h simulation sessions were conducted over 1 year. A total of 168 participants completed the sessions, while 75 participants (54.7% nurses, 22.7% physicians, and others) completed feedback surveys. Seventy-six percent of participants reported completing presimulation education material. Participants reported improved skills at appropriately evaluating a critically ill newborn and critically ill infant/toddler and improved teamwork during the care of a pediatric patient. The majority agreed that simulation was effective in teaching pediatric resuscitation. The NPS was 84% (excellent).

Conclusions

A locally facilitated CED in situ simulation curriculum was successfully developed and implemented under local leadership, with remote collaboration by AMC. The curriculum was well received and effective.

The relationship between knowledge and disaster preparedness of undergraduates responding to forest fires

Forest and land fires are disasters that regularly occur on the island of Kalimantan, Indonesia. Higher education students on the island of Kalimantan are considered vulnerable to these disasters, hence the need for mandatory disaster knowledge and preparedness for every individual in the area. This research aimed to: (1) determine disaster knowledge and student preparedness in dealing with forest and land fire disasters, (2) determine the relationship between knowledge and student preparedness. This study used a quantitative correlation method with a questionnaire. The data were processed using the Statistical Package for the Social Sciences 21. The research sample used purposive sampling because it followed the needs of the study, which involved 300 students affected by forest fires, representing three universities located in a forest fire-prone area in West Kalimantan province, Indonesia. Each campus has 100 students, a total of 300 students. The results showed as many as 284 students had experienced forest and land fire disasters. In addition, 202 out of 284 students were known to have low disaster knowledge. Four main parameters of disaster preparedness were used to measure student preparedness, namely (1) knowledge and attitudes, (2) emergency response plans, (3) disaster warning system and (4) resource mobilisation. The number of students with high preparedness was 141, while 143 had low preparedness. Thus, student preparedness measures need to be increased to avoid disaster impact.

CONTRIBUTION

Based on the data analysis, students' knowledge and preparedness to face forest fires are positively related. It was shown that the higher the learning of students, the higher their readiness and vice versa. It is suggested that there is a need for increasing knowledge and preparedness actions for students in dealing with forest fire disasters through regular disaster lectures, simulations and training so that they can make the right decisions in coping with disasters.

Improving Pediatric Readiness and Clinical Care in General Emergency Departments: A Multicenter Retrospective Cohort Study

OBJECTIVE

To evaluate the impact of a collaborative initiative between general emergency departments (EDs) and the pediatric academic medical center on the process of clinical care in a group of general EDs.

STUDY DESIGN

This retrospective cohort study assessed the process of clinical care delivered to critically ill children presenting to 3 general EDs. Our previous multifaceted intervention included the following components: postsimulation debriefing, designation of a pediatric champion, customized performance reports, pediatric resources toolkit, and ongoing interactions. Five pediatric emergency care physicians conducted chart reviews and scored encounters using the Pediatric Emergency Care Research Network's Quality of Care Implicit Review Instrument, which assigns scores between 5 and 35 across 5 domains. In addition, safety metrics were collected for medication, imaging, and laboratory orders.

RESULTS

A total of 179 ED encounters were reviewed, including 103 preintervention and 76 postintervention encounters, with an improvement in mean total quality score from 23.30 (SD 5.1) to 24.80 (4.0). In the domain of physician initial treatment plan and initial orders, scores increased from a mean of 4.18 (0.13) to 4.61 (0.15). In the category of safety, administration of wrong medications decreased from 28.2% to 11.8% after the intervention.

CONCLUSION

A multifaceted collaborative initiative involving simulation and enhanced pediatric readiness was associated with improvement in the processes of care in general EDs. This work provides evidence that innovative collaborations between academic medical centers and general EDs may serve as an effective strategy to improve pediatric care.