title: Simulation and Web-based learning increases utilization of Bier block for forearm fracture reduction in the pediatric emergency department.
abstract: OBJECTIVE
  Bier block (BB) is a safe and effective alternative to procedural sedation for analgesia during forearm fracture reductions, yet remains infrequently used in the pediatric emergency department (PED). No standardized methods of BB training have previously been described. The objective of this study was to determine whether a multimodal instructional course increases comfort with BB and translates to increased use of this technique.
  
  
  METHODS
  A novel interdisciplinary simulation and Web-based training course was developed to teach the use of BB for forearm fracture reduction at a tertiary PED. Participants were surveyed pre-/post-training, and at 2 and 6 months regarding their comfort with BB. In parallel, we prospectively assessed the clinical use of BB for children ages 6 to 18 years requiring closed reduction of forearm fractures during the 24-month post-course period.
  
  
  RESULTS
  Course participation included 26 physicians and 12 nurses. Survey response rate was 100%. Course participation increased both comfort (10% pre-training v. 89% post-training, p<0.001) and the willingness to use BB (51% pre-training v. 95% post-training, p<0.001), an effect sustained at 6 months post-course (66% and 92%, respectively, p<0.001 for both). In clinical practice, there were no BBs performed prior to course administration. We observed a consistent and sustained increase in clinical use among the BB-trained physicians, with 37% of all forearm reductions performed using BB at 24 months post-course completion.
  
  
  CONCLUSIONS
  A novel combined simulation and Web-based training course increased comfort and willingness to use BB and was associated with increased use of this technique for forearm fracture reduction in the PED.
authors.affiliation: *Division of Pediatric of Pediatric Emergency Medicine,The Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Brett
authors.initials: B
authors.lastname: Burstein
authors.affiliation: *Division of Pediatric of Pediatric Emergency Medicine,The Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Fauteux-Lamarre
authors.affiliation: †Section of Emergency Medicine,Department of Pediatrics,Alberta Children's Hospital,University of Calgary,Calgary,AB.
authors.forename: Adam
authors.initials: A
authors.lastname: Cheng
authors.affiliation: *Division of Pediatric of Pediatric Emergency Medicine,The Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Dominic
authors.initials: D
authors.lastname: Chalut
authors.affiliation: *Division of Pediatric of Pediatric Emergency Medicine,The Montreal Children's Hospital,McGill University Health Centre,Montreal,QC.
authors.forename: Adam
authors.initials: A
authors.lastname: Bretholz
mesh_terms: D000328:Adult; D002648:Child; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D005592:Fracture Fixation / Q000193:education*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000706:statistics & numerical data*; D059408:Pain Management / Q000379:methods; D011792:Quebec; D011885:Radius Fractures / Q000601:surgery*; D012189:Retrospective Studies
keywords: intravenous regional anesthesia; lidocaine; procedural sedation