On the Move: Simulation to Improve and Assure Transport Team Performance☆

https://doi.org/10.1016/j.cpem.2013.08.002Get rights and content

There are proven benefits to specialized pediatric transport teams. However, there is a need to address a scarcity of clinical practice opportunities and competing demands for technical and nontechnical competence of these teams. Simulation-based training for transport teams should include human factors, crew resource management, and error management training. Simulation-based training is ideally suited to these needs; however, there is a relative paucity of evidence specific to transport medicine. Preliminary work has assessed feasibility and efficacy of simulation-based training for aeromedical transport. Experience suggests that current simulation-based training in other domains provides a foundation for and is applicable to transport medicine. Considering the unique challenges faced by transport professionals, simulation-based training offers great potential benefit in attending to those challenges; addressing performance gaps; and, ultimately, improving patient outcomes.

Section snippets

Simulation and Transport Training: What We Know

Unfortunately, there is very little direct evidence concerning the use of simulation-based training and assessment of interhospital transport teams, especially in pediatrics. We propose that although the analogy is not exact, there are a number of parallels between simulation-based training and assessment of prehospital medical teams and interhospital transport teams. It is recognized that comparing interhospital transport to prehospital transport is akin to comparing “apples and oranges,”

How Simulation Can Make a Difference

Orr et al2 reported that patients experiencing more than 1 unexpected event during transport had a higher risk of mortality. Twenty percent of the unexpected events for nonspecialized transport teams involved airway events. Other significant contributors to unexpected events during transport included cardiopulmonary arrest, sustained hypotension, loss of a crucial intravenous line, equipment failure, and pneumothorax.2 Although not specifically studied for transport teams, it is clear that

The Future of Simulation in Transport Team Training

There is a growing emphasis on training health care providers with nonpatient modalities in an attempt to improve patient safety without placing patients at risk. Medical simulation training is one such method.49 One advantage of simulation-based training is the ability to create a realistic environment that reproduces rare and high-risk cases. This guarantees that all team members are exposed to standardized training and debriefing as often as necessary until a minimum performance level is

Summary

The current evidence of the effectiveness of simulation-based training and assessment in interhospital or prehospital transport is extremely limited. When it exists, it is only at Kirkpatrick levels 1, 2a, and 2b. Moving forward, instructors should recognize the unique challenges that interhospital transport professionals face and apply simulation-based training toward overcoming those challenges. In addition, investigators should focus simulation-based training on identified performance gaps

References (55)

  • J. Capella et al.

    Teamwork training improves the clinical care of trauma patients

    J Surg Educ

    (2010)
  • W. Riley et al.

    Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital

    Jt Comm J Qual Patient Saf

    (2011)
  • J. Britto et al.

    Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team

    BMJ

    (1995)
  • R.A. Orr et al.

    Pediatric specialized transport teams are associated with improved outcomes

    Pediatrics

    (2009)
  • Agency for Healthcare Research and Quality

    Healthcare cost and utilization project (HCUP)

  • Commission on the Acreditation of Medical Transport Systems

    9th edition accreditation standards of the Commission on the Acreditation of Medical Transport Systems

  • M.T. Bigham et al.

    Quality metrics in neonatal and pediatric critical care transport: a consensus statement

    Pediatr Crit Care Med

    (2013)
  • S.T. Youngquist et al.

    Paramedic self-efficacy and skill retention in pediatric airway management

    Acad Emerg Med

    (2008)
  • E. Su et al.

    A randomized controlled trial to assess decay in acquired knowledge among paramedics completing a pediatric resuscitation course

    Acad Emerg Med

    (2000)
  • R.L. Lammers et al.

    Simulation-based assessment of paramedic pediatric resuscitation skills

    Prehosp Emerg Care

    (2009)
  • R. Lammers et al.

    Root causes of errors in a simulated prehospital pediatric emergency

    Acad Emerg Med

    (2012)
  • D. Barsuk et al.

    Using advanced simulation for recognition and correction of gaps in airway and breathing management skills in prehospital trauma care

    Anesth Analg

    (2005)
  • D.L. Gordon et al.

    Stroke training of prehospital providers: an example of simulation-enhanced blended learning and evaluation

    Med Teach

    (2005)
  • Hinchey PR, De Maio VJ, Patel A, et al. Air medical providers' physiological response to a simulated trauma scenario....
  • J.R. Studnek et al.

    The association between emergency medical services field performance assessed by high-fidelity simulation and the cognitive knowledge of practicing paramedics

    Acad Emerg Med

    (2011)
  • P.P. Bredmose et al.

    Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model

    Scand J Trauma Resusc Emerg Med

    (2010)
  • S.K. Howard et al.

    Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents

    Aviat Space Environ Med

    (1992)

    • Cited by (1)

    • Education Needs of Australian Flight Nurses: A Qualitative Study

      2020, Air Medical Journal
      Citation Excerpt :

      With debriefing and feedback, whether following a simulation activity, case review, or in situ buddy flight observation, the participant can begin to assimilate new knowledge, skill, and attitudes to their preexisting thinking structures and change behavior.20 Using real air medical events to simulate both technical and nontechnical skills in the air medical setting can assist flight nurses to develop their teamwork skills.20,23 The use of in situ observation through buddy flights with an experienced mentor was highlighted by the flight nurses in this study as a useful education and learning activity.

    ☆

    Grant support: Not applicable.

    View full text
    Copyright © 2013 Elsevier Inc. All rights reserved.