title: Improving bariatric patient transport and care with simulation.
abstract: BACKGROUND
  Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics' knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes.
  
  
  METHODS
  Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions and 95% confidence intervals are presented as appropriate. We determined the magnitude of significant pre-post differences with Cohen's d. We assessed scale reliability using Cronbach's alpha and was found to be reliable with scores of 0.83 and 0.88 across pre- and post-test responses, respectively.
  
  
  RESULTS
  Participants exhibited a significant increase in confidence in performing procedures (p<0.01) and knowledge of bariatric patient management (p<0.001) after the simulation. The current study also found an increase in knowledge of transport, vascular access/circulation and airway management (p<0.001). Participant background showed no effects on these changes.
  
  
  CONCLUSIONS
  This study suggests that simulation paired with a didactic is an effective method of education for paramedics caring for and transporting bariatric patients. The data show a significant increase in knowledge and confidence with a 3-hour training session, irrespective of previous training or experience with bariatric patients. This is the first study of its kind to apply simulation training for the pre-hospital care of bariatric patients.
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio ; Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio.
authors.forename: Brad D
authors.initials: BD
authors.lastname: Gable
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Gardner
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio.
authors.forename: Dan H
authors.initials: DH
authors.lastname: Celik
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio ; Northeast Ohio Medical University, Department of Emergency Medicine, Rootstown, Ohio.
authors.forename: Mary Colleen
authors.initials: MC
authors.lastname: Bhalla
authors.affiliation: Summa Akron City Hospital, Department of Emergency Medicine, Akron, Ohio ; Northeast Ohio Medical University, Department of Emergency Medicine, Rootstown, Ohio.
authors.forename: Rami A
authors.initials: RA
authors.lastname: Ahmed
mesh_terms: D058109:Airway Management; D000488:Allied Health Personnel / Q000193:education*; D016887:Cardiopulmonary Resuscitation / Q000193:education; D002406:Catheterization, Peripheral / Q000379:methods; D004521:Educational Measurement; D006801:Humans; D017148:Infusions, Intraosseous / Q000379:methods; D008348:Manikins; D017145:Models, Educational; D009765:Obesity / Q000628:therapy*; D014187:Transportation of Patients / Q000379:methods* / Q000592:standards