Deborah Parkman Henderson

Paramedic Self-efficacy and Skill Retention in Pediatric Airway Management

OBJECTIVES The objectives were to determine the effect of pediatric airway management training on paramedic self-efficacy and skill performance and to determine which of several retraining methods is superior. METHODS A total of 2,520 paramedics were trained to proficiency in pediatric bag-mask ventilation (BMV) and endotracheal intubation (ETI) on mannequins. Subjects were a convenience sample of 245 (10% of original cohort) presenting for voluntary retraining. A total of 212 of 245 (87%) completed skills testing. Self-efficacy was measured prior to and following initial training and retraining events. Paramedics were assigned to control (no retraining), videotape presentation, self-directed learning, or instructor-facilitated lecture and demonstration retraining. Following retraining, BMV and ETI skills were tested. RESULTS Paramedics from low-call-volume areas reported lower baseline self-efficacy and derived larger increases with training, but also experienced the most decline between training events. Pass rates for BMV and ETI were 66% (139/211) and 42% (88/212), respectively. However, overall cohort self-efficacy was maintained over the study period. In ordinal regression modeling, only the lecture and demonstration method was superior to control, with an odds ratio (OR) of achieving higher scores of 2.5 (95% confidence interval [CI] = 1.2 to 5.2) for BMV and 5.2 (95% CI = 2.4 to 11.2) for ETI. Poor performance with ETI but not BMV was associated with time elapsed since training (p = 0.01). Self-efficacy ratings were not predictive of skill performance. CONCLUSIONS Training provides increases in self-efficacy, particularly among paramedics from low-call-volume areas. A gap exists between self-efficacy and skill performance, in that self-efficacy may be maintained even when skill performance declines. Pediatric airway skills decay quickly, ETI skills drop off more significantly than BMV skills, and a lecture and demonstration format seems superior to other retraining methods investigated.

Education of Out-of-Hospital Emergency Medical Personnel in Pediatrics: Report of a National Task Force

The Pediatric Education Task Force has developed a list of major topics and skills for inclusion in pediatric curricula for EMS providers Areas of controversy in the management of pediatric patients in the prehospital setting are outlined, and helpful learning tools are identified.

Priorities for research in emergency medical services for children: results of a consensus conference.

STUDY OBJECTIVE To arrive at a consensus on the priorities for future research in emergency medical services for children. METHODS A consensus group was convened using the Rand-UCLA Consensus Process. The group took part in a 3-phase process. Round 1 involved reviewing a compendium of relevant research articles and answering a mailed questionnaire. Panel members were asked to prioritize topics on the basis of the 1993 Institute of Medicine Report on Emergency Medical Services for Children. Participants were asked to rate each topic based on the significance of the research, and whether the topic would (1) improve general knowledge, (2) change behavior, (3) improve health, (4) decrease the cost of care, or (5) change public policy. A 4-point Likert scale was used. Participants were also asked if the research would require a multicenter study and if the research were feasible. Round 2 of the study involved a meeting of the panel, where the results of Round 1 were discussed and the topics were reprioritized. The topics were given a rank order and a final ranking was done in Round 3. RESULTS The panel considered a list of 32 topics; these were combined and reworded to give them more precise meaning. Several new topics were also added. Fifteen topics were given a rank order and placed within the 7 broad categories of the Institute of Medicine report. Clinical aspects of emergency care, systems organization, configuration, and operation and injury prevention were given high priority rankings. The first 5 topics were very close in point-rank order. CONCLUSION The panel was able to develop a list of important topics for future research in emergency medical services for children that can be used by foundations, governmental agencies, and others in setting a research agenda for such services.

Evaluation of a curriculum for intimate partner violence screening in a pediatric emergency department.

OBJECTIVE. We sought to describe the assessment of course participant changes in attitudes, self-efficacy, and behaviors after completion of the Its Time to Ask training curriculum for screening for intimate partner violence (IPV) in a pediatric emergency department (PED). METHODS. A 22-item Likert scale questionnaire was administered at baseline (before training), after training, and at 6-month follow-up to PED employee participants in a 2-hour IPV education program. Mean participant responses were compared between baseline/posttraining and baseline/6-month follow-up. Participants also completed a course-satisfaction survey. RESULTS. A total of 79 PED staff completed the baseline questionnaire before the training. Eighty-seven participants completed the posttraining questionnaire, and 48 completed the 6-month follow-up questionnaire. Participants had consistent, positive changes in attitudes after training that persisted at the 6-month follow-up for 5 items on the questionnaire. Attitudes that did not change showed baseline means already in disagreement with questionnaire statements. Participants reported significant, positive changes for all 7 self-efficacy statements at 1 or both of the posttraining evaluations. The only changes in behavior were observed at 6 months. The majority of participants were satisfied with the training and would recommend it to colleagues. CONCLUSIONS. Significant, self-reported changes in attitudes, self-efficacy, and behaviors/clinical practice regarding screening for IPV in a PED can be achieved through participation in a brief training curriculum.

The education of out-of-hospital emergency medical personnel in pediatrics: Report of a national task force

In the last ten years there has been considerable interest in the development of curricula in pediatric emergency care for out-of-hospital emergency medical personnel.1-4 At the same time, there has been notable controversy in regard to the design and content of the curricula. Traditionally paramedic instruction has been diagnosis-driven: emergency medical services (EMS) educators had instructed out-of-hospital providers by modifying the “medical school” approach and incorporating information based on the scope of practice of the out-of-hospital provider. Although there are few data evaluating current educational methods, many instructors and students have found the diagnosis-based approach impractical for providers in the out-of-hospital setting when implemented in the field setting. The reasons for this are multifactorial and may include the following: 1) establishing a diagnosis in the field is problematic because physical assessment may be hampered by the unpredictable ambient conditions (poor lightin...

Education in Pediatric Basic and Advanced Life Support

Curricula in pediatric resuscitation must be based on adult learning principles. The Pediatric Basic and Advanced Life Support Courses (PBLS, PALS) should use educational strategies fostering positive interactions between the instructor and learners and should take into consideration the learners motivation for taking the course. Materials should be developed for a specific target audience; course design should be flexible to meet individual needs. The PBLS and PALS courses have different audiences. PBLS is targeted toward caretakers of children. This course will continue to emphasize primary injury prevention as the major strategy but also will give learners the knowledge and skills to perform CPR. To optimize retention of knowledge and skills, the course content must be simplified, and the sequencing of steps in basic life support must be modified. Health care providers caring for pediatric patients in acute care settings are the primary audience for the PALS course. This course already incorporates adult learning principles; only minor revisions are anticipated. Discussion of the trauma patient is limited in the PALS course; additional trauma education could be facilitated by the addition of a trauma module or by other educational courses. All aspects of the PBLS and PALS educational programs must be evaluated continually to determine whether learning objectives have been met and whether the teaching format is appropriate. The answers to evaluation questions will help determine the degree to which the American Heart Association is meeting its educational objectives and how to allocate resources for development and training.

Autoerotic asphyxia in adolescents

The death of a child or young adult is always tragic, regardless of the cause. Cases of autoerotic asphyxia are often labeled as suicide, or are underreported because of embarrassment of relatives or misidentification of the initial clinical manifestations. It may be that autoerotic asphyxial death is far more common than realized. Many emergency nurses and physicians lack adequate knowledge about this phenomenon to make an accurate diagnosis. Family members are often reluctant or unwilling to provide enough data surrounding the circumstances in which the patient was found, and the cause of death is mislabeled as suicide. Autoerotic asphyxia is frequently labeled as a sexual aberrancy and an act that society would rather not acknowledge. But there are a number of implications for emergency nurses, such as prevention and sensitive support of family in the emergency department, that demand our attention.

Priorities for research in Emergency Medical Services for Children: Results of a consensus conference

OBJECTIVE To arrive at a consensus on the priorities for future research in emergency medical services for children. METHODS A consensus group was convened using the Rand-UCLA Consensus Process. The group took part in a 3-phase process. Round I involved reviewing a compendium of relevant research articles and answering a mailed questionnaire. Panel members were asked to prioritize topics on the basis of the 1993 Institute of Medicine Report on Emergency Medical Services for Children. Participants were asked to rate each topic based on the significance of the research, and whether the topic would (1) improve general knowledge (2), change behavior (3), improve health (4), decrease the cost of care, or (5) change public policy. A 4-point Likert scale was used. Participants were also asked if the research would require a multicenter study and if the research were feasible. Round II of the study involved a meeting of the panel, where the results of Round I were discussed and the topics were reprioritized. The topics were given a rank order and a final ranking was done in Round III. RESULTS The panel considered a list of 32 topics; these were combined and reworded to give them more precise meaning. Several new topics were also added. Fifteen topics were given a rank order and placed within the 7 broad categories of the Institute of Medicine report. Clinical aspects of emergency care, systems organization, configuration, and operation and injury prevention were given high priority rankings. The first 5 topics were very close in point-rank order. CONCLUSION The panel was able to develop a list of important topics for future research in emergency medical services for children that can be used by foundations, governmental agencies, and others in setting research agenda for such services.

Violent death in the pediatric age group: rural and urban differences.

Violent death (homicide and suicide) in the pediatric age group is a major public health problem. A descriptive study was undertaken to review retrospectively the 1077 pediatric coroners cases in 11 California counties for differences between urban and rural violent death rates. Pediatric violent death was more prevalent in the urban region than in the rural region (P less than 0.0007). High urban homicide rates accounted for most of this difference. Suicide rates were not significantly different (P = 0.18). Seventy-four percent of the violent deaths were in the 15- to 18-year age group, and most of these deaths were caused by firearms (81%). Blacks had the highest homicide and suicide rates. Child abuse was an important cause of death for young children in the urban area only. Socioeconomic factors, cultural differences, high population density, and the availability of firearms were proposed as factors affecting violent death in the pediatric age group.

Searching the literature: what is known (and not known) about your topic?

n the previous articles in this series (appearing in the November 2012, March 2013, and May 2013 1–3 I issues), we have discussed how evidence can change practice, how to evaluate evidence, and how to develop a clinical question. At this point in the process, you need to find out more about your problem to create workable interventions. For example, who is the best health care professional to perform triage? This is a good question; however, what do you know about this problem and possible solutions that are already in use? Before you can begin to plan to address a clinical problem, you must know what is known and not known about your particular problem. A literature search will familiarize you with the work that has already been done in your area of interest or inquiry. It should be a comprehensive survey of all publications and other information about a specific topic. The search will produce a list of references on the topic of interest.