Medical Education: Simulation & Technology
Medical Education 6: Simulation & Technology 1
Benjamin A. Lang, MD, MPH (he/him/his)
Pediatric Emergency Medicine Fellow
Dell Children's Medical Center of Central Texas
Austin, Texas, United States
High-quality CPR and on-scene interventions are associated with increased survival in pediatric out-of-hospital cardiac arrest. During on-scene resuscitation attempts, families report opportunities for improved communication from EMS professionals. Yet, EMS professionals receive little training on how to communicate the death of a child to families and report a desire for bereavement training. The Compassionate Options for Pediatric EMS (COPE) bereavement curriculum was developed in 2017 and has yet to be evaluated for effectiveness in diverse EMS agencies.
Objective: Using hands-on simulation among varied EMS settings and provider credentialing levels, we assessed providers’ comfort and knowledge of pediatric bereavement techniques before and after COPE training as well as knowledge retention at 4 month follow-up.
Design/Methods: Participants' demographics, comfort with pediatric declaration of death, and knowledge of bereavement principles were collected prior to COPE training. COPE training consisted of participation in a 1-hour didactic session followed by a simulation in which participants informed family members about the death of a child in the field. Simulations were followed by a debriefing, including a discussion of coping with emotional stress. Participants completed a post-assessment including knowledge uptake and stress level associated with the training. Participants also completed a 4-month follow-up assessment of knowledge and a qualitative assessment of whether COPE techniques were used in the field.
Results: A total of 297 EMS professionals from 12 different agencies participated. Comfort with discussing the death of a child with families improved from 33.7% (93) before to 75.6% (177) after the curriculum. More than 91% (213) of participants felt that the skills were helpful to their clinical practice and should be part of required first responder training. Providers' knowledge of pediatric bereavement communication improved immediately after the training, but the knowledge was not sustained at 4 months.
Conclusion(s): Pediatric deaths are uncommon but termination of resuscitative efforts in the field is increasingly frequent. Utilizing the COPE curriculum can improve paramedic and EMT comfort and knowledge about communication of pediatric death. Prehospital professionals feel this training is important and should be utilized more widely. The decreased knowledge four months following COPE training suggests the need for more frequent repetition. This data bolsters support for standardized bereavement training amongst EMS providers throughout the course of their careers.