title: Simulation-based assessment of paramedic pediatric resuscitation skills.
abstract: BACKGROUND
  Emergency medical services (EMS) providers infrequently encounter seriously ill and injured pediatric patients. Clinical simulations are useful for assessing skill level, especially for low-frequency, high-risk problems.
  
  
  OBJECTIVE
  To identify the most common performance deficiencies in paramedics' management of three simulated pediatric emergencies.
  
  
  METHODS
  Paramedics from five EMS agencies in Michigan were eligible subjects for this prospective, observational study. Three clinical assessment modules (CAMs) were designed and validated using pediatric simulators with varying technologic complexity. Scenarios included an infant cardiopulmonary arrest, sepsis/seizure, and child asthma/respiratory arrest. Each scenario required paramedics to perform an assessment and provide appropriate pediatric patient care within a 12-minute time limit. Trained instructors conducted the simulations by following strict guidelines for sequences of events and responses. Videos of CAMs were reviewed by an independent evaluator to verify scoring accuracy. Percentage of steps completed for each of the three scenarios and specific performance deficiencies were recorded.
  
  
  RESULTS
  Two hundred twelve paramedics completed the CAMs. The average percentages of steps completed were as follows: arrest CAM, 45.3%; asthma CAM, 51.6%; and sepsis CAM, 47.1%. Performance deficiencies included lack of airway support or protection; lack of support of ventilations or cardiac function; inappropriate use of length-based treatment tapes; and inaccurate calculation and administration of medications and fluids.
  
  
  CONCLUSIONS
  Multiple deficiencies in paramedics' performance of pediatric resuscitation skills were objectively identified using three manikin-based simulations. EMS educators and EMS medical directors should target these specific skill deficiencies when developing continuing education in prehospital pediatric patient care.
authors.affiliation: Department of Emergency Medicine, Michigan State University/Kalamazoo Center for Medical Studies, Kalamazoo, Michigan, USA. lammers@kcms.msu.edu
authors.forename: Richard Lee
authors.initials: RL
authors.lastname: Lammers
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Byrwa
authors.forename: William D
authors.initials: WD
authors.lastname: Fales
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hale
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D004634:Emergency Medical Technicians / Q000592:standards*; D006801:Humans; D007223:Infant; D008824:Michigan; D019370:Observation; D011446:Prospective Studies; D011795:Surveys and Questionnaires