A Remotely Supported Pediatric Simulation-Based Procedural Training Curriculum for EMS Clinicians: Partnering PECCs and Pediatric Experts at a Distance

Emergency medical services (EMS) clinicians rarely perform pediatric critical procedures, necessitating continued education for skill maintenance, which presents unique challenges. This study transitioned a previously reported, traditional, simulation-based training (SBT) curriculum delivered by on-site pediatric simulation experts (On-Site Phase 1), into a program delivered by agency Pediatric Emergency Care Coordinators (PECCs) supported by remote pediatric experts (Remote Phase 2). Primary outcome was non-inferiority of Remote Phase 2 compared to On-Site Phase 1 as analyzed using bag-valve-mask (BVM) ventilation, supraglottic device (SGD) placement, and intraosseous (IO) catheterization assessment tool scores.
This was a non-randomized, prospective study of simulated procedural outcomes by emergency medical technicians and paramedics recruited from the same three EMS agencies that participated in On-Site Phase 1, along with their PECCs. Without additional on-site simulation staff, PECCs incorporated the program into their regular training schedule over the one-year study period and submitted participants’ first-person-view videos for remote expert assessment across two sessions. Assessment data were analyzed longitudinally across both phases for non-inferiority testing, and between agencies. Qualitative comments from participants and PECCs were solicited via e-mail.
Remote Phase 2 was found to be non-inferior to On-Site Phase 1 for each procedure (p = 1.0). Procedural performance during Remote Phase 2 Session 1 was similar to the end of On-Site Phase 1 (BVM p = 0.62; SGD p = 0.87; IO p = 0.60); by Remote Phase 2 Session 2, BVM (p = 0.01) and SGD (p = 0.01) performance improved, but IO (p = 0.19) performance remained the same. Performance across sites was similar at all time points, except for higher BVM scores at the rural site during Session 2 (p = 0.00). Qualitatively, PECCs reported scheduling difficulties due to competing educational and administrative tasks.
In this prospective study of EMS clinicians, we found non-inferiority between a traditional on-site approach and a remotely-supported approach in simulation-based pediatric procedural training. Skill overall was high and BVM and SGD performance improved. This demonstrates a viable method for PECCs to deliver recurring evidence-based education while receiving curricular and assessment support from remote pediatric experts. While still effort-intensive, this methodology may help to address several barriers of time, cost, and accessibility for pediatric prehospital education.