High Risk/Low Volume In-Situ Simulation for Pediatric Transport Teams

Overview

Transport teams are responsible for moving critically ill patients between medical facilities via ambulance, rotor-wing, and fixed-wing aircraft. These environments are vastly different from the typical classrooms where Advanced Life Support classes are taught and the hospital units from which transport personal begin their careers. This project aims to bridge the gap by exposing teams to realistic complex scenarios in same space that they actually provide patient care.

Protocol

  • Education Needs Assessment

    Participants will answer questions regarding their general transport experience and experience with high risk/low volume activities. Additionally, demographic data for team members will be collected.

  • Simulation

    The back of a moving ambulance is a completely different milieu than a classroom or an ICU. After completing a pre-sim survey, participants will perform an AHA PALS like scenario using the equipment they have stocked on the ambulance.

  • Debrief & Surveys

    After a debrief discussing the case itself and the challenges of the simulated activity, participants will complete a post-simulation survey rating their confidence performing tasks associated with the simulation and their overall experience.

Learn more

This study is COMPLETE.

STU - 2023- 0113

Authorized by: UT Southwestern Medical Center Institutional Review Board

Location: Children’s Medical Center Dallas

Results

Below are the final results of this study. The full manuscript was published in the Air Medical Journal in 2025. A copy of the article may be viewed below.

Population

This study was approved by the Institutional Review Board of the University of Texas Southwestern Medical Center. Participants included members of the Children’s Health Transport Team, operating in three-member crews consisting of a RN, a RT and a paramedic. A total of 6 teams participated (n=18).

Participant Demographics

Sex

Needs Assessment Results

The Needs Assessment Survey was created using High Risk/Low Volume Events that occurred over the course of my experience as a transport nurse. These events were either experienced by me or by my coworkers. These were all rare events that we thought would best be experienced in simulation prior to reality. The results below are from respondents at the Transport Team at Children’s Medical Center Dallas.

Significant Events Experienced

Of 12 High Risk/Low Volume transport events queried, four proved to be statistically significant when compared to a 50/50 chance of occurrence. These included Sudden Cardiopulmonary Arrest (p = 0.02), Cabin Decompression (p = 0.00), Fire ( p= 0.00), and Emergency Landing (p = 0.01).

Objective Measures

Time to Action

A total of 6 teams (N = 18 participants) completed the simulation and we captured timestamps on the iSimualte system which revealed that the median time to initiate bag-valve-mask (BVM) ventilation was 0.47 minutes (SD = 0.41), while the median time to begin chest compressions was 0.62 minutes (SD = 0.65). Epinephrine was administered at a median time of 1.25 minutes (SD = 1.61), and contact with medical command was made at a median time of 1.40 minutes (SD = 0.76).

Subjective Measures

Qualitative Experience of Simulation

Featured at AAP 2024

An abstract from this study was delivered as an oral presentation at the 2024 AAP Experience National Conference & Exhibition in the Section on Transport Medicine in Orlando, Florida. A digital poster is available below.

Meet the Team


  • Principle Investigator

    Medical Director of Children’s Health Transport Team and Faculty at the University of Texas Southwestern Medical Center, Dr. Archana is an Attending Physician in the Pediatric and Cardiac ICUs at Children’s Medical Center Dallas


  • Co-Investigator

    As a first-year medical student at UT Southwestern Medical Center,, Jacob came up with the design for this study after having worked as a Transport Nurse for the Children’s Hospital of Philadelphia. Recognizing the challenges of transitioning from bedside to pre-hospital Jake worked with other members of the Steering Committee to implement a similar program - hoping to ensure a transport team members first time thinking of cardiac arrest logistics is with a mannequin and not a child.

This study could not be completed without the cooperation of Children’s Health Transport Team and Children’s Medical Center Dallas Simulation Center Staff.

Thank you.