Emergency medical services often have to extricate patients from their location and take them to an ambulance. High-quality training is required to ensure patient and staff safety during moving, handling and extrication manoeuvres. This study aimed to determine student satisfaction and self-confidence regarding what they had learnt after a novel moving, handling and extrication simulation exercise in a children's soft play area.
A mixed-methods cross-sectional survey was adopted, using the validated Student Satisfaction and Self-Confidence in Learning survey tool. Qualitative data were collected from an open question for additional comments. Student paramedics and student emergency medical technicians from one higher education institution completed four time-limited scenarios, each of which involved moving an immobile patient away from their environment. Descriptive statistics were determined for the participant characteristics and survey responses. Thematic analysis was performed on the qualitative data.
The student participants were aged 18–47 years and the majority were women. They were satisfied with both their learning and their self-confidence in what they had learnt after the simulation event, and felt their communication and teamwork skills had improved. They enjoyed the event more than classroom-based simulation. While they felt the simulation was realistic, suggestions were made to make it more so.
Use of a children's soft play area for a moving, handling and extrication simulation provided student satisfaction and self-confidence in learning.
Paramedics working in a traditional ambulance service role infrequently see patients who are critically ill or injured; in addition, pressures on hospitals have caused long waiting times, further lowering exposure to all patient groups and reducing how often paramedics use their clinical skills, potentially negatively impacting performance in practice. This study sought to establish the competence of paramedics in a set of skills that included frequent and infrequent as well as simple and complex procedures. They took part in a scored clinical scenario in which they used these skills. The study also sought to explore paramedics' perception of how difficult these skills were. Participants generally scored well; however, in some instances, elements of skills were missed or performed out of sequence. The pressure created by the scenario appeared to negatively impact performance.
In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training.
The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI.
The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions.
All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage.
VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.
The prehospital environment presents numerous challenges regarding the diagnosis and subsequent management of critically ill patients—diagnostic aids are limited; point-of-care testing is almost universally unavailable and senior medical advice can be beyond timely reach. Pulse oximetry provides real-time assessment of peripheral tissue oxygen saturation, but not of ventilation adequacy. The past decade has seen the gradual introduction of end-tidal carbon dioxide monitoring or capnography into routine resuscitation practice following successive national audit reports, coronial reports and subsequent guidance regarding safe airway management. However, capnography alone does not prevent adverse outcomes, particularly if it is not properly interpreted. Capnography is now regarded as essential monitoring whenever airway management or ventilation is required. The increasing availability of capnography in the prehospital setting can provide dynamic, real-time information that can aid assessment and treatment of pathology at the first point of contact and direct onward management. This article reviews the pathophysiology associated with the production, transport and excretion of carbon dioxide and suggests a number of ways in which accurate measurement and interpretation can potentially be a useful diagnostic tool and inform management choices in the prehospital setting.
Derek Ford reflects on the importance of the four pillars of advanced practice