Training Day: Equipment and environment make the difference in pediatrics training
Turn real-life situations into realistic practice scenarios by placing pediatric manikins where you’re likely to encounter them, not just the classroom table
When was the last time you inserted an advanced airway, or even provided ventilation to a pediatric patient, while they were supine on a table? Probably never.
So why do we train this way? Why not train at our patients’ level, instead of at the level of a classroom table?
Here are three scenarios for EMS training in pediatric patient management that mimic real-world encounters:
Scenario 1: On the cot
As frantic parents run to you with their listless toddler, your initial reaction may be to run straight to the ambulance – but simply driving fast to the closest hospital may not be the best option. We need to resuscitate this patient on scene.
You quickly unfasten the seat belts, position your patient supine, and go into ABC-mode. Your patient is 18 months old and approximately 25 pounds (11 kg) – that puts them into the purple or yellow color categories.
Breathing is absent, the patient is cyanotic, and you begin bag-valve mask ventilations at a rate of one every 3-5 seconds. The patient is bradycardic for their age, and your ECG shows a sinus rhythm at 80. Keeping adequate ventilations going, you’re planning to insert an advanced airway while your partner initiates IO access.
As the instructor, put yourself into the training environment. How can you replicate this call? You’ve got an ambulance, you’ve got the resuscitation equipment – but do you have the right-sized manikin?
Having an appropriately sized manikin to meet your patient’s physical specifications can make or break your scenario. Coupled with the right environment, you’re now able to take a very real-life situation and turn it into a realistic practice scenario.
“Dispatch” your trainee crew and have someone run toward the ambulance with the manikin.
Scenario 2: On the ground
Your next patient is a 10-year-old that experienced a sudden cardiac arrest event during a gym class run through the park. Your crew gets dispatched, arrives on scene, and you see someone off in the distance flagging you over.
Gather your adolescent manikin, put some clothes on it (that you don’t mind getting cut) and set up your scene about 50 yards from the roadway. I recommend doing this in a private area rather than in the middle of a park.
Now the trainees have to critically think: Should we run or drive? What do we carry? Should we bring the cot right away?
This scenario change-up, along with a new environment, changes the providers’ thought processes. It’s certainly more than simply walking into a classroom and seeing their patient supine on the floor (or a table).
Scenario 3: Under the jungle gym
Your 6-year old patient suffered a traumatic fall while playing on a jungle gym at a local park.
The patient is unresponsive, has agonal respirations, a GCS of 3 and no signs of external bleeding. Spinal motion restriction, ventilations, IO access and advanced airway placement are indicated.
This scenario might be better suited for a reserved area of a park, your backyard or inside an enclosed facility.
Position your manikin prone (or lateral) on the ground – if you really want to get tricky, position it in some form of an obstacle presentation – and have your crew respond.
Proper manikins for accurate EMS training
There’s nothing worse than trying to make believe that your infant CPR manikin is a 4-year-old, or that your adult intubation head is actually that of a 9-year-old. Similarly, pretending that your classroom is a park, gymnasium, cramped bathroom or an industrial site simply doesn’t have the same feel or ambiance as the real thing.
As an instructor, look for opportunities to put your students into a real environment. Keep a stockpile of training equipment to replicate your ambulance’s full stock and use the appropriate manikins to create accurate training scenarios.