Simulation Trial of Telemedical Support for Paramedics

Purpose

In the United States, the current standard of prehospital (i.e. outside of hospitals) emergency care for children with life-threatening illnesses in the community includes remote physician support for paramedics providing life-saving therapy while transporting the child to the hospital. Most prehospital emergency medical services (EMS) agencies use radio-based (audio only) communication between paramedics and physicians to augment this care. However, this communication strategy is inherently limited as the remote physician cannot visualize the patient for accurate assessment and to direct treatment. The purpose of this pilot randomized controlled trial (RCT) is to evaluate whether use of a 2-way audiovisual connection with a pediatric emergency medicine expert (intervention = "telemedical support") will improve the quality of care provided by paramedics to infant simulator mannequins with life threatening illness (respiratory failure). Paramedics receiving real-time telemedical support by a pediatric expert may provide better care due to decreased cognitive burden, critical action checking, protocol verification, and error correction. Because real pediatric life-threatening illnesses are rare, high stakes events and involve a vulnerable population (children), this RCT will test the effect of the intervention on paramedic performance in simulated cases of pediatric medical emergencies. The two specific aims for this research are: - Aim 1: To test the intervention efficacy by determining if there is a measurable difference in the frequency of serious safety events between study groups - Aim 2: To compare two safety event detection methods, medical record review, and video review

Conditions

  • Emergencies
  • Cardiopulmonary Arrest
  • Acute Respiratory Failure
  • Status Epilepticus

Eligibility

Eligible Ages
Over 21 Years
Eligible Sex
All
Accepts Healthy Volunteers
No

Inclusion Criteria

  • Certified Emergency Medical Technicians (EMTs), Advanced EMTs (AEMTs), and Paramedics (EMT-Ps) who provide direct scene response. - Board-certified Pediatric Emergency Medicine (PEM) and Emergency Medicine (EM) physicians whose practice includes online medical support for EMS are eligible. - The control arm will include physicians who provide radio/telephone support in usual care at each site. In the intervention arm, experts will be PEM with/without EMS board-certification as they have relevant pediatric training and experience.

Exclusion Criteria

  • EMS personnel providing interfacility transport and/or pediatric specialty transport - Resident physicians-in-training - Non-physician providers

Study Design

Phase
N/A
Study Type
Interventional
Allocation
Randomized
Intervention Model
Parallel Assignment
Intervention Model Description
Single blind, parallel arm, multicenter simulation RCT of prehospital teams from 9 Pediatric Emergency Care Applied Research Network (PECARN) and non-PECARN sites
Primary Purpose
Health Services Research
Masking
Single (Outcomes Assessor)
Masking Description
All participants will be blinded to the simulated transport scenarios.

Arm Groups

ArmDescriptionAssigned Intervention
Experimental
Teleconsultation video arm with PEM physicians
Emergency Medical Services (EMS) providers randomized into this arm will receive video teleconsultation with Pediatric Emergency Medicine (PEM) physicians.
  • Other: Video teleconsultation
    Each team will participate in 4 video-recorded simulated transports in fully equipped ambulances. Each team will provide resuscitative care in 4 simulated high-risk pediatric transports. EMS personnel will provide care in the ambulance while PEM physicians will provide medical direction remotely using video to communicate with EMS personnel via tablet devices.
Active Comparator
Audio support arm with EM physicians
EMS providers randomized into this arm will receive audio support by usual care Emergency Medicine (EM) physicians.
  • Other: Audio support
    Each team will participate in 4 video-recorded simulated transports in fully equipped ambulances. Each team will provide resuscitative care in 4 simulated high-risk pediatric transports. EMS personnel will provide care in the ambulance while EM physicians will provide medical direction remotely using audio to communicate with EMS personnel via tablet devices.

Recruiting Locations

BostonMedical Center
Boston, Massachusetts 02118
Contact:
Tehnaz Boyle, MD PhD
617-414-3682
tehnaz.boyle@bmc.org

More Details

Status
Recruiting
Sponsor
Boston Medical Center

Study Contact

Tehnaz Boyle, MD PhD
617-414-3682
tehnaz.boyle@bmc.org