P2D322: Implementation of a Trauma Resuscitation Checklist During Pediatric Trauma Simulations to Facilitate and Evaluate Pediatric Readiness

Background: Trauma is the leading cause of death and disability among children and adolescents. Therefore, it is essential that multidisciplinary provider teams are prepared for these events and that the unique elements of pediatric trauma care are addressed during training. Injured children often receive emergency care outside of pediatric centers, so it is crucial that providers are ready to treat injured children even if they do not intend to sub-specialize in pediatrics. Although pediatric traumas are often high acuity, they are lower frequency compared to adult trauma activations which results in less robust exposure during residency. Therefore, pediatric readiness can be optimized through supplemental pediatric trauma training using standardized trauma scripts and simulations designed to address the nuances of pediatric trauma care.

Methods: To address this, we implemented a multidisciplinary pediatric trauma resuscitation curriculum conducted as monthly 1-hour sessions in the emergency department pediatric resuscitation bays with all disciplines involved in pediatric trauma care encouraged to participate. The sessions included an initial simulation during which participants assessed and stabilized a pediatric trauma patient while faculty and medical students evaluated them. Teams were assessed on the comprehensiveness of their trauma evaluations using our institutional trauma resuscitation observation tool that was developed using a combination of PALS, ACLS, and ATLS guidelines (Figure 1). This tool includes the primary and secondary surveys as well as prescribed “pauses” that are implemented to build a collaborative team-based approach and ensure global team awareness of resuscitative priorities. After the initial simulation, faculty led a debriefing discussion, provided simulation-specific pediatric trauma education, and presented the trauma resuscitation observation tool for use as a cognitive aid and trauma script. Roles were then redistributed within teams before the simulation and evaluations were repeated. After each simulation, participants completed a 15-question survey with components of the NASA Task Load Index and Team Emergency Assessment Measure to assess the impact of the intervention.

Results: Since May 2022, ten pediatric trauma simulations with 120+ total participants have been conducted. Learners have included surgical residents, emergency medicine residents, emergency room nurses, respiratory therapists, and medical students. Across simulation sessions, completeness of all indicated aspects of the checklist improved from a mean of 56% to 81% (p < 0.01), with the most improvement seen in the implementation of the first and second pauses 26% to 72% (p < 0.01) and 35% to 61% (p < 0.01). Of 47 surveyed participants, 97% agreed that implementation of the cognitive aid reduced variability and 94% reported improved teamwork.

Conclusion: Implementation of a standardized trauma checklist facilitates improved comprehensiveness of pediatric trauma assessments during dedicated pediatric trauma simulations. It provides an opportunity for structured debriefing and may improve teamwork, improve performance, and reduce variability in both simulated and real pediatric trauma.