Original Article

Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

Authors: David M. French, MD, Ragan A. DuBose-Morris, PhD, Frances W. Lee, DBA, Stanley J. Sulkowski, BS, Greig A. Samuelson, BS, Edward C. Jauch, MD

Abstract

Objectives: Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies.

Methods: Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre- and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results.

Results: A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training.

Conclusions: This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Abelsson A, Rystedt I, Suserud B-O, et al. Learning by simulation in prehospital emergency care—an integrative literature review. Scand J Caring Sci 2016;30:234–240.
 
2. Gurňáková J, Gröpel P. Prior participation in simulation events is associated with insimulation team performance among emergency medical services professionals. Simul Healthc 2019;14:235–240.
 
3. McCoy CE, Rahman A, Rendon JC, et al. Randomized controlled trial of simulation vs. standard training for teaching medical students high-quality cardiopulmonary resuscitation. West J Emerg Med 2019;20:15–22.
 
4. Van Dillen CM, Tice MR, Patel AD, et al. Trauma simulation training increases confidence levels in prehospital personnel performing life-daving interventions in trauma patients. Emerg Med Int 2016;2016:1–5.
 
5. Kosoko AA, Glomb NW, Laba B, et al. Evaluating a novel simulation course for prehospital provider resuscitation training in Botswana. West J Emerg Med 2019;20:731–739.
 
6. McKenna KD, Carhart E, Bercher D, et al. Simulation use in paramedic education research (SUPER): a descriptive study. Prehospital Emerg Care 2015;19:432–440.
 
7. Jewer J, Parsons MH, Dunne C, et al. Evaluation of a mobile telesimulation unit to train rural and remote practitioners on high-acuity low-occurrence procedures: pilot randomized controlled trial. J Med Internet Res 2019; 21:e14587.
 
8. McCoy CE, Sayegh J, Rahman A, et al. Prospective randomized crossover study of telesimulation versus standard simulation for teaching medical students the management of critically ill patients. AEM Educ Train 2017; 1:287–292.
 
9. Ohta K, Kurosawa H, Shiima Y, et al. The effectiveness of remote facilitation in simulation-based pediatric resuscitation training for medical students. Pediatr Emerg Care 2017;33:564–569.
 
10. Hayden EM, Khatri A, Kelly HR, et al. Mannequin-based telesimulation: increasing access to simulation-based education. Acad Emerg Med 2018; 25:144–147.
 
11. Curran V, Lockyer J, Sargeant J, et al. Evaluation of learning outcomes in Web-based continuing medical education. Acad Med 2006;81(10 suppl): S30–S34.
 
12. Issenberg SB, McGaghie WC, Hart IR, et al. Simulation technology for health care professional skills training and assessment. JAMA 1999; 282:861–866.
 
13. Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004;13(suppl_1):i2–i10.
 
14. McGaghie WC, Issenberg SB, Petrusa ER, et al. A critical review of simulation-based medical education research: 2003–2009. Med Educ 2010; 44:50–63.
 
15. Robin BR, McNeil SG, Cook DA, et al. Preparing for the changing role of instructional technologies in medical education. Acad Med 2011;86:435–439.
 
16. Donohue LT, Hoffman KR, Marcin JP. Use of telemedicine to improve neonatal resuscitation. Children 2019;6:50.
 
17. Beissel A, Lilot M, Bauer C, et al. A trans-atlantic high-fidelity mannequin based telesimulation experience. Anaesth Crit Care Pain Med 2017; 36:239–241.
 
18. Collins C, Lovett M, Biffar D, et al. The use of remote and traditional faciliation to evaluate telesimulation to support interprofessional education and processing in healthcare simulation training. In: 2019 Spring Simulation Conference, SpringSim 2019, Piscataway, NJ: Institute of Electrical and Electronics Engineers; 2019:13.
 
19. Ghiyasvandian S, Khazaei A, Zakerimoghadam M, et al. Evaluation of airway management proficiency in pre-hospital emergency setting; a simulation study. Emerg (Tehran, Iran) 2018;6:e58. .
 
20. Crewdson K, Rehn M, Lockey D. Airway management in pre-hospital critical care: a review of the evidence for a “top five” research priority. Scand J Trauma Resusc Emerg Med 2018;26:89.
 
21. Wang HE, Donnelly JP, Barton D, et al. Assessing advanced airway management performance in a national cohort of emergency medical services agencies. Ann Emerg Med 2018;71:597–607.e3.
 
22. Yang D, Wei YK, Xue FS, et al. Simulation-based airway management training: application and looking forward. J Anesth 2016;30:284–289.
 
23. Grande B, Kolbe M, Biro P. Difficult airway management and training: simulation, communication, and feedback. Curr Opin Anaesthesiol 2017; 30:743–747.
 
24. Culmer N, Smith T, Stager C, et al. Evaluation of the triple aim of medicine in prehospital telemedicine: a systematic literature review. J Telemed Telecare 2019:1357633 x 1985346.
 
25. Jung J, Shilkofski N. Pediatric resuscitation education in low-middle-income countries: effective strategies for successful program development. J Pediatr Intensive Care 2017;6:12–18.
 
26. Heldal I, Lundberg L. Simulation technologies supporting collaborative training for emergency medical services personnel. In: Smart Innovation, Systems and Technologies. Vol. 71. New York: Springer Science and Business Media; 2018:110–120.