Mapping the Use of Simulation in Prehospital Care – a Literature Review Anna Abelsson1*, Ingrid Rystedt1, Björn-Ove Suserud2 and Lillemor Lindwall1
Total Page：16
File Type：pdf, Size：1020Kb
Abelsson et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:22 http://www.sjtrem.com/content/22/1/22 REVIEW Open Access Mapping the use of simulation in prehospital care – a literature review Anna Abelsson1*, Ingrid Rystedt1, Björn-Ove Suserud2 and Lillemor Lindwall1 Abstract Background: High energy trauma is rare and, as a result, training of prehospital care providers often takes place during the real situation, with the patient as the object for the learning process. Such training could instead be carried out in the context of simulation, out of danger for both patients and personnel. The aim of this study was to provide an overview of the development and foci of research on simulation in prehospital care practice. Methods: An integrative literature review were used. Articles based on quantitative as well as qualitative research methods were included, resulting in a comprehensive overview of existing published research. For published articles to be included in the review, the focus of the article had to be prehospital care providers, in prehospital settings. Furthermore, included articles must target interventions that were carried out in a simulation context. Results: The volume of published research is distributed between 1984- 2012 and across the regions North America, Europe, Oceania, Asia and Middle East. The simulation methods used were manikins, films, images or paper, live actors, animals and virtual reality. The staff categories focused upon were paramedics, emergency medical technicians (EMTs), medical doctors (MDs), nurse and fire fighters. The main topics of published research on simulation with prehospital care providers included: Intubation, Trauma care, Cardiac Pulmonary Resuscitation (CPR), Ventilation and Triage. Conclusion: Simulation were described as a positive training and education method for prehospital medical staff. It provides opportunities to train assessment, treatment and implementation of procedures and devices under realistic conditions. It is crucial that the staff are familiar with and trained on the identified topics, i.e., intubation, trauma care, CPR, ventilation and triage, which all, to a very large degree, constitute prehospital care. Simulation plays an integral role in this. The current state of prehospital care, which this review reveals, includes inadequate skills of prehospital staff regarding ventilation and CPR, on both children and adults, the lack of skills in paediatric resuscitation and the lack of knowledge in assessing and managing burns victims. These circumstances suggest critical areas for further training and research, at both local and global levels. Keywords: Simulation, Prehospital, Systematic literature review Introduction facilitates both the initial learning and repeated rehearsals Across the globe, prehospital settings are frequently as- of specific management of critical incidences [6]. It pro- sociated with premature death [1]. With more rapid and vides for training under optimal conditions [4], of import- more correct care efforts, some deaths due to high en- ance in e.g. high-stake scenarios [7]. Regularly scheduled ergy trauma could potentially be prevented [2]. How- prehospital training opportunities would enable staff to be ever, training on accident scenes are hard to create, better prepared and more confident at trauma scenes. given that high energy trauma is rare. It is frequently Consequently, simulation plays an increasing role in also unsafe to use such unstable patients as training ob- prehospital care management training [6,8]. Therefore, re- jects. Therefore, it is valuable to create real-life training search into its effectiveness and comparisons of instruc- opportunities in artificial contexts [3-5]. Simulation tional designs are increasingly important [4]. Research on simulation as a learning tool for prehospital care providers is still limited [3]. The field is a relatively young and still * Correspondence: [email protected] 1Department of Health Sciences, Karlstad University, Karlstad, Sweden relatively unsystematised although some reviews have Full list of author information is available at the end of the article © 2014 Abelsson et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Abelsson et al. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2014, 22:22 Page 2 of 12 http://www.sjtrem.com/content/22/1/22 been published [4,9,10]. However, a more complete ac- Selection counting of all existing studies is still lacking [9]. The inclusion criteria were articles published as pri- Consequently, the goal of this review is to create a map mary research, quantitative as well as qualitative stud- of the existing field of research on simulation in prehospi- ies. Furthermore, the research participants in included tal care settings. The overview can serve as a base for fu- articles should be prehospital care providers, including ture research on methods, effectiveness, efficacy and/or paramedics, EMTs, MDs, nurses and fire fighters per- technical skills. forming or participating in some kind of simulation. The review documents historical developments, in- The simulation should have been performed in a pre- cluding developments in geographical regions. It is im- hospital context. Finally, the articles should have been portant to note that the presence of research on peer-reviewed and published before January 1st, 2013. If simulation in one region does not imply that prehospital non-English articles were to be included, an abstract in care in this region necessarily is of better quality. How- English was required. ever, in order to continue to develop learning opportun- The electronic search, inspired by Jadad et al [14] and ities and continual education, each region will likely Oxman [15], generated 865 hits, of which 147 were dupli- benefit from research conducted in settings with rea- cates, resulting in 718 articles to review. Two persons then sonably similar culture, context, conditions and re- independently read titles and abstracts in order to identify sources, as their own. Further, the review documents studies that matched the aim and the inclusion criteria of what methods were targeted in the simulation exercises the review. A total of 243 relevant articles were down- and for whom, i.e., what professional categories were loaded or ordered as full-text versions. The 243 retrieved the foci of the simulation exercises, as research partici- articles were subsequently read in full by one reviewer pants. Hopefully, this overview of research may suggest (AA) to confirm the relevance to the purpose of the review knowledge gaps and important next steps regarding and to ensure that the inclusion criteria were met. Conse- simulation in the prehospital care settings. Further- quently, out of the 243 articles, 165 were included in the more, it may act as stimuli for research on simulation in study. Of these 165 articles originated 111 from Cinahl, prehospital contexts, across geographical areas and with published between 1989 and 2012. Forty articles of the methodologies which have not yet been prioritized. 165 articles were located in PubMed, published between The aim of this study was to provide an overview of 1989 and 2012. Finally, 14 articles of the 165 articles were the development and foci of research on simulation in identified in Scopus, published between 1984 and 2012 prehospital care practice. (Table 1). Three additional reviewers (IR, BOS and LL) read and assessed samples of the 165 articles, in order to confirm Methods that they made the same conclusions regarding inclu- An integrative literature review was carried out [11-13]. sion into the review. This contributed to making the se- The integrative method allowed for the inclusion of studies lection process transparent and thorough, as suggested from several different research methods. It plays a signifi- by Oxman [15]. The reviewers reached a high level of cant role in evidence-based practice as a more comprehen- agreement in the assessment process and any differ- sive understanding of specific problems within healthcare is ences were discussed and agreement reached. Jadad et formed [13]. al [14] argue that it is ideal that all relevant literature on the subject is included in a review. Given that the pur- pose of the review was to provide an overview of re- Search strategies search, it was therefore decided to include all 165 Electronic searches were conducted in the databases studies in the results. Cinahl, Pubmed and Scopus during the month of February, 2013. The searches were carefully documented [13]. Search terms which were used included: emergency medical technicians, paramedic, manikin, simulation, Table 1 The selection process ambulance and prehospital. Peer reviewed journals were Database Number of hits Full article retrieved Included and reviewed included in Cinahl, in order to get the same results in Scopus, the search was limited to articles. Further com- Cinahl 639 176 111 binations of search terms were carried out with the Pubmed 104 (49*) = 55 51 40 words: emergency, trauma, model,