P3D130: Use of a Simbox Newborn Resuscitation Simulation to Measure and Improve Care Provided by Emergency Medical Services

Background: Out-of-hospital newborn deliveries are associated with increased infant morbidity and mortality and their incidence is increasing. Although Emergency Medical Services (EMS) often attend out-of-hospital deliveries, there are neither standardized training and certification requirements, nor universally adopted practice guideline or algorithm for newborn resuscitation for EMS. In fact, multiple studies have demonstrated practice deviation from the Neonatal Resuscitation Protocol (NRP) in the prehospital setting. SimBox, a free, open access simulation-based educational tool was used to further understand the gaps in training of prehospital providers caring for newborns.

Methods: A simulated case of newborn resuscitation in the prehospital setting was created to measure care as well as improve the care provided. The newborn was born limp and apneic, requiring drying, warming and stimulation, followed by positive pressure ventilation and dextrose- containing fluids. Demographic and performance data, as well as simulation assessment and satisfaction data were collected using standardized participant and facilitator online surveys.

Results: 33 facilitator and 55 participant surveys were collected across three states: Connecticut, Colorado, and Alaska. 26/33 (78.8%) of the facilitators were physicians, and 7/33 (21.2%) were paramedics or emergency medical technicians (EMTs). 46/55 (83.6%) of the participants were paramedics, 8/55 (9.1%) EMTs and 1/55 (1.8%) an emergency medical responder (EMR). Of the participants, 32/55 (58 .2%) had never completed an NRP course, and 36/55 (65.5%) had attended at least one newborn delivery in their career. 47/55 (85.5%) of the participants had participated in at least one newborn resuscitation simulation in the past 5 years. Multiple deviations from best practice were identified: a third of the teams, 10/30 (33.3%) performed chest compressions, 5/31 (21.2%) of the teams did not dry, warm, stimulate, and suction the newborn, and 7/31 (27.3%) of the teams did not perform positive pressure ventilation correctly. Furthermore, 10/30 (33.3%) of the teams administered either the incorrect dose or the incorrect type of dextrose containing fluids. All 55/55 (100%) of the participants strongly or somewhat agreed that the simulation improved their understanding of the NRP algorithm and preparedness for a delivery in the field, their teamwork and communication skills, and their psychomotor skills. The net promoter scores for the participant and facilitator surveys were 81 and 97, respectively.

Conclusion: Our study used simulation to identify deviation from the standard of practice of a newborn resuscitation by prehospital providers. The simulation was a well-accepted tool for improving care, and participants and facilitators reported improvement in medical knowledge, teamwork, communication, psychomotor skills, and level of understanding and application the neonatal resuscitation algorithm in the prehospital setting. Open access simulation resources such as SimBox can help identify, measure and address practice deviations from standardized resuscitation protocols in the prehospital setting, improving compliance and potentially patient outcomes.