Abstract
INTRODUCTION: Obstetrical emergencies in the field require coordinated time-sensitive teamwork between emergency medical services (EMS) and hospital-based teams. Simulation is effective at preparation for emergencies. The study objective was to determine the educational and clinical impacts of simulation training sessions for emergency medical service personnel by obstetrical teams within the same communities. METHODS: A multi-center prospective pre/post educational study design was used to assess the effectiveness of a curriculum designed for emergency medical service providers on obstetrical emergencies. Instructional strategies included team-based checklist review and skills coaching using low-fidelity task trainers, taught by interdisciplinary teams. Outcomes were measured using pre/post educational tests, team performance assessments, course evaluations and clinical impacts. Internal review board exemption was obtained. Paired t-tests were used for data analysis. RESULTS: Over 18 months, 185 EMS personnel participated in the curriculum taught at 2 community hospitals. Instructors included obstetricians, emergency physicians, nurses, and medical students. Significant improvement in knowledge was achieved (pre 47.8%, post 89.6%, P<.0001). Confidence (1=high, 5=low) improved in managing precipitous delivery (pre 3.77, post 1.52, P<.0001), shoulder dystocia (pre 4.0, post 1.48, P<.0001), eclampsia (pre 2.68, post 1.29, P<.0001), breech (pre 4.68, post 2.21, P<.0001), and PPH (pre 3.68, post 1.33, P<.0001). Team performance assessments demonstrated significant improvement (pre 68.54%, post 93.54%, P<.0001). Qualitative clinical impacts included improvements to EMS protocols, transfer of care and communication between teams. CONCLUSION: Simulation training in obstetrical emergencies for emergency medical service providers improves knowledge, skills, and performance. Instruction by obstetrical teams in the same communities enhances communication and collaborative care.
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