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Training Day: 10 EMS pediatric tabletop exercises

Engage your participants in pediatric resuscitation protocols, equipment and patient assessment


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As an educator – ask yourself, “what do I want to reinforce to the participant through a training exercise?” Or, “what do I want to validate through this same exercise?” To me, protocol compliance, equipment familiarity and patient assessment are my top priorities.

How can we accomplish these objectives with limited training supplies, or on a budget? Which situations need a mannikin and which don’t?

I’m not a big advocate for placing an infant mannikin on a table and running a scenario that goes something like this, “you’re dispatched to a 3-year-old patient that is unresponsive.”

Maximize your participant reach, all while limiting your equipment demands in EMS training. (Photo/courtesy www.aku.edu)
Maximize your participant reach, all while limiting your equipment demands in EMS training. (Photo/courtesy www.aku.edu)

This kind of training never really resonated with me because the mannikin just acted like a distractor. Yes, I could see how much this tiny patient weighed, but the mannikin would measure out as pink or red, while the scenario is telling me he’s yellow. And, besides, the scenario was focusing on medication calculations ... not intubation.

In search for a solution (as an educator), I determined that removing this distracting element for every scenario was my next logical step. By all means, there’s a time and place for using the standard infant, child and adult resuscitation mannikins, especially if you’re focusing on hands-on resuscitation skills. Some scenarios, like practicing the use of an infant versus child bag-valve mask, certainly do need a mannikin involved.

But not every pediatric scenario needs a mannikin present in order to be a successful training event. Scenarios focusing on medication calculations require nothing more than a weight-based reference guide and a piece of paper to write your answers on.

Tabletop pediatric EMS training

Sometimes, all you need to run an effective training exercise is a scenario printed on a piece of paper and a tabletop. Instead of having a large group crowd around a limited supply of mannikins and instructors, have the students circle around some tables (but remove the chairs ... they just bottle-neck the entire flow). Have the students complete a variety of tabletop scenarios, instead.

Here’s a breakdown of 10 pediatric tabletop scenarios that allow you to maximize your participant reach, all while limiting your equipment demands.

1.  Child shock/resuscitation with IV/IO access

Scenario: A 4-year-old patient involved in a major trauma event

Equipment: Weight-based reference guide, example pain medications, pediatric IV arm or IO bone with necessary supplies

Objective: Determine the child’s weight based off reference guides, then determine an appropriate fluid bolus dose for resuscitation and pain management medication, which is delivered through the IV or IO access

2. Infant tachycardia

Scenario: An 18-month-old patient with malaise, not feeding well and tachycardic

Equipment: ECG rhythm strip or 12-lead ECG (SVT), weight-based reference guide, example medications (including adenosine)

Objective: Interpret the rhythm (SVT) and determine the proper medication and dose to administer per protocol

Level up: To add to this scenario, include additional ECG rhythm strips for atrial fibrillation and ventricular tachycardia

3. Child accidental overdose

Scenario: A 9-year-old patient with accidental overdose with opioid overdose symptoms

Equipment: Weight-based reference guide, example medications (including naloxone)

Objective: Determine the child’s weight based off of reference guides, then determine the appropriate medication (naloxone) and dose to administer per protocol

Level up: To add to this scenario, have the participants list the names of prescription opioids that they may encounter in the field

4. Infant bradycardia

Scenario: A 9-month-old patient with bradycardia

Equipment: Weight-based reference guide, example medications (including epinephrine 1:10,000)

Objective: Determine the infant’s weight based off of the reference guide, verify that the provider would perform CPR if the heart rate is less than 60, and determine an appropriate dose of epinephrine to administer during the resuscitation

5. Child bradycardia

Scenario: An 8-year-old patient with bradycardia

Equipment: ECG rhythm strip (sinus bradycardia, junction rhythm or AV-block), weight-based reference guide, example medications (including atropine and vasopressors)

Objective: Interpret the ECG rhythm and formulate an appropriate treatment plan based off of local protocols

6. Infant respiratory failure

Scenario: A 6-month-old patient in respiratory failure

Equipment: Infant mannikin, oral pharyngeal airway (OPA), infant bag-valve mask device

Objective: Properly insert an appropriately-sized OPA and ventilate with an infant BVM for 2 minutes while a partner counts/times the ventilations delivered

7. Adolescent trauma

Scenario: A 10-year-old patient fall with knee injury

Equipment: Weight-based reference guide

Objective: Determine an appropriate medication and dose for pain management and outline which splinting equipment/techniques the provider would use to properly splint/immobilize the injured site

8. Child cardiac arrest

Scenario: A 7-year-old patient experiences sudden cardiac arrest while in gym class

Equipment: Weight-based reference guide, cardiac monitor, ECG rhythm strips (VF)

Objective: Determine an appropriate defibrillation energy level, then correlate that to what your defibrillator will actually allow for an energy selection; then determine appropriate medication doses for both epinephrine 1:10,000 and amiodarone or lidocaine

9. Child nausea and vomiting

Scenario: A 3-year-old patient with nausea and vomiting

Equipment: Weight-based reference guide

Objective: Determine what normal vital sign ranges are for the patient, then determine an appropriate anti-emetic medication and dose to administer, along with an appropriate fluid bolus dose for dehydration treatment

10. Pull-push fluid bolus

Scenario: A 22 kg (48 lbs) child requires a fluid bolus via pull-push method (or other acceptable means)

Equipment: IV bag, IV tubing, 3-way stopcock, 50-60 mL (or larger) syringe, IV extension set (if you’re creative, you could even create a closed-loop system to allow the participants to pull fluid from an IV bag, and then push it right back into the same bag)

Objective: Determine an appropriate fluid bolus dose, assemble a pull-push delivery system, and then practice pull-push techniques

To add in some validation mechanisms, provide each participant with corresponding skills or answer sheet to track their progress. Have them write their scenario answers on the form as they move through the stations. Have either the instructor or their partner check off their skills performance as they complete each task. To add some additional challenge into the mix, set a time restriction not only to add some pressure, but also to keep things moving along (in a controlled fashion).

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