Evaluation of the Effectiveness of Advanced Technology Clinical Simulation Manikins in Improving the Capability of Australian Paramedics to Deliver High-Quality Cardiopulmonary Resuscitation: Pre- and Postintervention Study

Abstract

Background: Emergency medical services attend out-of-hospital cardiac arrests all across Australia. Resuscitation by emergency medical services is attempted in nearly half of all cases. However, resuscitation skills can degrade over time without adequate exposure, which negatively impacts patient survival. Consequently, for paramedics working in areas with low out-of-hospital cardiac arrest case volumes, ambulance services and professional bodies recognize the importance of alternative ways to maintain resuscitation skills. Simulation-based training via resuscitation manikins offers a potential solution for maintaining paramedic clinical practice skills.

Objective: The aim of the study is to examine the effectiveness of advanced technology clinical simulation manikins and accompanying simulation resources (targeted clinical scenarios and debriefing tools) in improving the demonstrable capability of paramedics to deliver high-quality patient care, as measured by external cardiac compression (ECC) performance.

Methods: A pre- and postintervention study design without a control group was used. Data were collected at the start of the manikin training forum (baseline), immediately following the training forum (time 2), and 6 to 11 months after the training forum (time 3). The study was conducted with paramedics from 95 NSW Ambulance locations (75 regional locations and 20 metropolitan locations). Eligible participants were paramedics who were employed by NSW Ambulance (N=106; 100% consent rate). As part of the intervention, paramedics attended a training session on the use of advanced technology simulation manikins. Manikins were then deployed to locations for further use. The main outcome measure was an overall compression score that was automatically recorded and calculated by the simulator manikin in 2-minute cycles. This score was derived from compressions that were fully released and with the correct hand position, adequate depth, and adequate rate.

Results: A total of 106 (100% consent rate) paramedics participated, primarily representing regional ambulance locations (n= 75, 78.9%). ECC compression scores were on average 95% or above at all time points, suggesting high performance. No significant differences over time (P>.05) were identified for the overall ECC performance score, compressions fully released, compressions with adequate depth, or compressions with the correct hand position. However, paramedics had significantly lower odds (odds ratio 0.30, 95% CI 0.12-0.78) of achieving compressions with adequate rate at time 3 compared to time 2 (P=.01). Compressions were of a slower rate, with an average difference of 2.1 fewer compressions every minute.

Conclusions: Despite this difference in compression rate over time, this did not cause significant detriment to overall ECC performance. Training and deployment of simulator manikins did not significantly change paramedics' overall ECC performance. The high baseline performance (ceiling effect) of paramedics in this sample may have prevented the potential increase in skills and performance.

Keywords: cardiopulmonary resuscitation; clinical simulation; deployment; effectiveness; manikins; paramedicine; paramedics; patient care; professional development; simulation-based training; technology.

Figure 1.. Mixed effects ordinal regression modeling for external cardiac compression performance measures. OR: odds ratio; T1: time 1; T2: time 2; T3: time 3.