A Simulated Scenario to Improve Communication Skills of Residents Providing Online Medical Command of Emergency Medical Service Providers
The primary audience for this simulation exercise is emergency medicine (EM) residents. Additionally, this scenario may be adapted to provide education for any EM provider involved in providing pre-hospital, on-line medical command of emergency medical services (EMS).
Exposure to pre-hospital medical command and the ability to provide high quality and effective EMS medical direction are essential components of residency training in Emergency Medicine. The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements for Emergency Medicine1 stipulate that EM residents must have educational experiences in EMS, which should include direct medical oversight of EMS providers. Despite this requirement, there is a paucity of literature to provide clear direction on how residency programs should teach residents how to provide pre-hospital medical command. Prior literature has outlined that the majority of EM residency programs utilize a mix of didactics, structured readings, protocol review, observing EMS crews, and providing care in the field.2,3 A recent survey revealed that the majority of residency programs meet the EMS requirement through a one-month rotation involving observation of ground-based pre-hospital care. In addition, 92% of residency programs have residents provide online medical command during their regularly scheduled ED shifts or during dedicated medical command shifts, but only 41% of programs have residents complete medical command certification training, although type of training is not delineated.2 Additionally, a recent description of a model curriculum for EM resident training in EMS provides education on the principles of providing direct online medical command via didactics, asynchronous activities, and dedicated medical command shifts; however, it does not recognize or utilize simulation as a training modality.3 To our knowledge, simulation scenarios of on-line medical command have not previously been described as a curricular component in EM residency training. This case provides an opportunity for residents to learn how to communicate with pre-hospital providers while they are at the scene of a call—effectively teaching them to provide high quality and appropriate medical command, while simulating many of the challenges EM providers face.
By the end of this simulation, learners will be able to:
- Discuss appropriate medical command instructions for pediatric cardiac arrest.
- Describe alternative methods to obtain weight-based dosing of pediatric critical care medications, if Broselow tape is unavailable.
- Identify need for a definitive airway in a pulseless patient without interruption of chest compressions.
- Identify need for rapid intraosseous access in a pulseless pediatric patient.
- Describe the indications for helicopter transfer in a critically ill child.
This scenario is a simulated medical command phone-call, with details of patient presentation and condition being relayed to a medical command physician from a field EMS crew, as they would in a standard call.
The performance of this simulation scenario as a curricular instrument was evaluated utilizing an internally developed evaluation survey that is part of the standard simulation curriculum at West Virginia University (WVU). The survey consisted of both questions regarding effectiveness of the instructor and of the simulation scenario rated on a Likert scale as well as free response questions asking the learners to describe aspects of the simulation they felt positively about, as well as opportunities for improving the scenario.
Learners completing the EMS command simulation reviewed the performance of the simulation and instructors positively, with all learners responding with a 4 or a 5 on a Likert scale. Responses to the free response questions demonstrated that the learners felt that the simulated medical command call was realistic, pertinent to their education, and helped them to realize what resources that EMS providers have available to them as well as the limited information that may be available to the field provider when they seek on-line medical command. The most common opportunity to improve the simulation cited by the learners was to introduce interruptions and distractions during the scenario to help increase the realism.
Exposure to and instruction in providing on-line medical command for EMS providers is an integral part of EM residency training. This simulation scenario provides a realistic, low cost curricular instrument that could be applied in any residency training program as a component of an EMS didactic curriculum.
Emergency medical services (EMS); pre-hospital medical command; pediatric advanced life support (PALS); pediatric critical care; airway management, weight-based dosing, pediatric medication dosing.