Q&A: Preventing pediatric emergency skills decay with AI in rural EMS

The challenges EMS faces, recruitment, retention, funding and training, are heightened in rural agencies, pushing some to the breaking point.

Training for low-volume, high-risk emergencies can be difficult to prioritize, especially in rural agencies, because it can be time-consuming, costly and labor-intensive.

Under a new program sponsored by Florida’s EMS Section, veteran EMS trainers from the Orlando Medical Institute (OMI) are teaming up with Health Scholars to provide training for up to 300 first responders via VR headsets from Oculus that are equipped with AI-assisted, voice-directed clinical training for pediatric emergencies.

“Through this collaboration, EMS professionals will have better access to advanced training in pediatric medical emergencies, including practice of critical cognitive skills necessary to treat these emergencies in the field,” said Janna Patterson, MD, FAAP, senior vice president of global child health and life support for the American Academy of Pediatrics. “The Florida program is a good testing ground to determine whether a blended-learning program utilizing VR can make real-life training more accessible and scalable to EMS personnel across the country.”

Participants in will complete an evidence-based blended simulation learning curriculum to practice the role of team lead and care for acutely ill pediatric patients in multiple settings in accordance with ILCOR evidence-based review and American Heart Association guidelines.

I recently connected with veteran EMS educator and OMI President Felix Marquez, BS, NRP, to discuss the program.

EMS1: How are rural EMS providers especially challenged to train for rare events?

Marquez: Each rural area has its own specific challenges. For example, North Florida is not as developed as some of the other areas I have trained in due to the lack of resources that are available to them. While there is a local community hospital, it is not manned by physician assistants. One doctor oversees all of the medical cases. So, if somebody had a significant trauma, it would not be managed in the local facility. The patient would need to be transferred to a major medical center. Depending where you are in North Florida, that means an hour or two for transportation. Often, you are dealing with significantly ill patients in these transfers and there is minimal education on how to properly and safely transport.

Another challenge is the lack of funding. This means there are only three ambulances. If all three ambulances are out on calls, having the proper training to stabilize patients in the field waiting for transport becomes very important. I am finding similar situations in the Florida Keys and in Tallahassee.

The final challenge has to do with the proximity of the EMS staff to these rural areas. Often the staff comes from Miami and have a several hours-long (4 to 6 hours) commute. This means that scheduling training can be a real challenge.

What are the goals of this program?

Our biggest goal is combatting skills decay and recalling the skills necessary to save lives when EMS staff is in the heat of a stressful situation. We had one student who used the education within days of taking the VR training. He was able to confidently assess what was wrong with a pediatric patient and it saved the child’s life. The goal is not only to understand the information, but retain the information days, weeks, months later and provide that good quality care to the citizens and the people who deserve it. Pediatric calls are low-volume and high risk. It is critical to recall training in the field so the child doesn’t pay the ultimate price with their life. When training fails, it often means psychological trauma, such as PTSD for the EMT/paramedic as well. This is all preventable with competent and efficient training.

How did the program get started?

There is a gap in high-risk scenario training, especially for rural EMS professionals. Several of us in the community saw a way forward and knew that with support of state funding, we could offer an efficient and effective training program to close the gap and properly support EMS staff and their communities.

I got involved though a friend who always had a passion for rural areas. At first, I helped her with her initiatives as a favor and once I started delivering education, I truly became hooked. Enabling the delivery of critical education through the use of technology has become by passion. When I pass on, the mark I want to leave is changing how education is delivered to rural areas so there is the same access as afforded to urban areas.

How does AI-assisted technology help fill rural training gaps?

Virtual reality (VR) with AI-assisted voice technology through Health Scholars has enhanced the ability for my rural EMS to learn anywhere, anytime. The biggest lesson learned during the pandemic is that learning doesn’t have to stop just because we aren’t in the same room. Connecting via Zoom, with online resources or by leveraging VR means education is accessible where the internet is accessible. There’s no boundaries. I can send you an Oculus Quest headset loaded with a training application from Health Scholars that can deliver critical clinical practice and, in almost real-time, be able to view on my phone performance reports and see how learners did. I’m then able to leverage the performance analytics as an instructor to see if staff are meeting the objectives and the competencies.

I believe in the power of technology so much so that the tagline of my school, Orlando Medical Institute, is “Where education meets technology.”

How does VR training work?

It actually couldn’t be simpler. We use Health Scholars VR software with and Oculus Quest headset and all we need to make it work is Wi-Fi. All updates are automatic. There are two controllers, you put the headset on, power it up and you are good to go. While we can never fully duplicate the stressful field environment, VR has allowed us to create some of the stress so EMS providers handle it better on the fly. EMS personnel can be virtually put in a stressful situation, be trained and retrained on how to handle it, then take the headset off and breathe.

How can this technology be operationalized in the EMS setting?

To answer this question, we need to first talk about the most important person – the EMS provider. Basic rounding on how to deal with a pediatric patient is something that a normal EMT or paramedic would already know, but the question is, when was the last time they did the pediatric assessment or had a pediatric call to keep their skills sharp? We assume because they’re certified, they’re competent, and that’s where a lot of training fails.

When you are dealing with a virtual environment, these scenarios can be created to get EMS staff up to speed and give the refreshers on-demand. Whereas before, with in-person mannikin-based training, the cost can be prohibitive. The cost effectiveness means that we can give the training whenever it is needed versus only once a year. We know skills decay, so having efficient on-demand practice means teams have the skills and confidence they need when in the field so that we can deliver the very best patient care possible.

How can rural EMS organizations in other states look for a similar program?

There are many national forums where we all talk about what is cutting edge. The real key is that other states need to be willing to pioneer or integrate something that is new.

What’s next for OMI?

Next, we are applying for a new grant to understand the best methodologies and tactics for EMS education. We have learned that VR is an important part of successful training, but we want to dig deeper and fine-tune a blended learning model. Hopefully, with the current success, this means we can train 48 more rural Florida locations with high-quality education for adult and pediatric calls.