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Small Victims, Big Challenges:Refining Pediatric Disaster TriageAlgorithms and Education in the Pre-Hospital Setting Linda Brown MD, MSCE email@example.com Mark Cicero, MD, Frank Overly, MD, Jorge Yarzebski BA, Marc Auerbach MD, MS, Antonio Riera, MD, Eric Goedecke DO, David Cone MD, and Carl Baum MD
Background• Disasters have a potentially devastating effect on children• Triage strategies: JumpSTART, Smart, Sacco, SALT – Unique physiology/developmental considerations – How best to teach pediatric disaster triage (PDT)? – How triage strategy impacts clinical outcomes of child disaster victims? – No direct comparison of these strategies has yet been completed• Mark Cicero, MD – PI on EMS-C targeted issues grant, 2011 – PRIDE (pediatric research in disaster education)
PICO Question• Population – Paramedics and paramedic students from CT, RI, MA• Intervention – Bundled: Simulated disaster scenarios followed by expert structured debriefing and standardized pediatric disaster learning module• Comparison – Participants are compared against themselves in their performance in “pre” and two “post” disaster scenarios at 2 weeks and 6 months• Outcome – Accuracy and efficiency in scenarios – Global assessment of function (videotaped performance in scenarios with expert review) – Results of questionnaires
ApproachEducational intervention 1. Each paramedic: 10 patients in simulated house fire, utilizing state’s triage algorithm 2. Facilitated debriefing (qualitative semi-structured interviews) 3. Brief learning module
Pilot Year Results• 14 experts developed 10-patient disaster scenarios• 93 participants enrolled• Accuracy best with “black” versus others – 92-99% black versus 51-63% yellow• Global assessment of function improved from 1st to 2nd scenario (78.1% vs 82.9% p=0.002)
3 Questions• How to best create/modify a curriculum that is engaging and effective?• How best to manage difficulties with standardization of actors/SPs, simulation environment and facilitators?• Plans for validation and dissemination??? – Funding, manikin-based vs web-based/VR? firstname.lastname@example.org