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Telesimulation to Improve Critical Decision-Making in Prehospital Airway Management: A Feasibility Study

This article describes the innovative design and implementation of a telehealth-infused simulation process with community emergency medicine partners to improve medical decision making. New methods for the development and dissemination of telesimulation modules focused specifically on escalating airway issues in the field. Scenarios were facilitated at an academic health center using high-fidelity simulation mannequins, telehealth education equipment, and standard technical systems deployed by emergency medical services. The study demonstrates that learners improved their medical decision-making skills through reduced time to intervention as well as their overall telesimulation comfort by participating through video interaction. Abstract Objectives Telesimulation, in which learners and evaluators use technology to connect remotely to simulation-based learning activities, is effective for skills and decision-making review. Historical models in which learners are colocated with the simulation equipment have inherent issues, especially for emergency medical services (EMS) providers. This feasibility study placed the evaluators in the simulation center, whereas the learners were at a distance steering the scenario evolution through telehealth technologies. Methods Volunteer EMS providers across South Carolina with varying levels of training and experience completed difficult airway management scenarios focused on clinical decision making. The program consisted of pre- and postexperience examinations, a lecture, and increasingly complicated simulations using high-fidelity mannequins that were facilitated by local trainers under the direction of remote trainees. Audio and video content, including vital signs and cardiac monitoring, were live streamed. Participants worked in two-person teams with lead providers on each scenario clinically assessing and managing cases of anaphylaxis. Data were collected from the simulations using Laerdal software, as well as examination and survey results. Results A total of 24 participants completed all of the elements of the training. Trends toward improvement in times to bag-mask ventilation and initial epinephrine administration were noted. Average cognitive test scores increased by 9.6%, and learners reported improved comfort with simulation (75%, P ≥ 0.0001) and videoconferencing (83%, P ≥ 0.0001). They also reported high degrees of comfort with intubation (73.3%) following the training. Conclusions This method of telesimulation appears to be a viable addition to continuing EMS education and may address access issues for some providers.