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Pediatric Standardized Patients Enhance Paramedic Training

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Pediatric patients constitute approximately 13% of EMS transports.1 This is generally a good thing and demonstrates how rare pediatric emergencies are, as well as how injury prevention and vaccination programs have ensured a healthy pediatric population. An unintended consequence is that EMS doesn’t have the same familiarity with pediatric emergency medical care as it does with adult emergency medical care. In addition, the clinical component in some paramedic programs can lack substance in pediatrics.

The New Haven (Conn.) Sponsor Hospital Paramedic Training Program has made a conscious effort to improve its pediatric training by offering standardized pediatric patients to its students. This increases their familiarity with an understanding of the intricacies of emergency care for this patient population.

When I was asked to give a pediatric lecture to a paramedic class this year, I found out that 80% of the members didn’t have children of their own. So I began looking for a way to augment the lecture and typical manikin teaching. I found the answer when I got home one night and my 5-year-old asked me what I did that day and wanted to know when she could go to work with the paramedics. The idea to use my children as standardized patients immediately came to mind.

My children are five, three and three months, and I thought they’d provide students the opportunity for an interesting mix of developmental differences. I enlisted the help of my wife and father to help me run the scenarios with the children. My father is a former long-time EMT and was willing to jump in and help. My wife, who’s a therapist, was a bit skeptical that a group of paramedic students 10 years our junior would be able to handle our kids.

The paramedic students weren’t expecting to see real children as patients and were nervous at first—especially because the children were the instructor’s children. I warned them my wife is a “Mama Bear” and they’d better be at the top of their game.

The paramedic students were given the task of obtaining basic demographics, as well as completing a history and physical on the children. We also did some basic moulage on the children, which made it even more challenging for them to figure out what was wrong with the children. Also adding to the increased level of difficulty was the fact that my children began to improvise. This made it difficult for me to keep up, adding realism to the situation. As it often happens in the field, the paramedics were forced to discriminate “storytelling” and play from the “true” medical concerns the children had.

The learners were also expected to calculate several medication dosages and determine appropriate endotracheal tube size using the Pedi-Wheel and the Broselow tape systems. Once I had allayed my wife’s concerns, the learners were also encouraged to feel the baby’s fontanelle. The students did an excellent job of engaging the children and gaining their trust in a short period of time. My wife and I purposely stepped out of view to give the students a taste of separation anxiety. Much to my surprise, the kids didn’t even notice we were gone because the students had engaged them so well.

Both the paramedic students and my children learned a tremendous amount that day, and they had fun while doing so. When the use of standardized patients in pediatric training was introduced to me in medical school by Ava Stanczak, DO, it was a valuable experience. I received feedback from the paramedic students that it was extremely valuable to them and they recommended it be continued. This was a low-cost and effective means to introduce the students to children prior to pediatric clinical rotations that will hopefully pay dividends to them when they are confronted with real sick and ill pediatric patients in the future. JEMS

‘When I took over as the clinical education coordinator, we had “observation-only” clinical time at our pediatric emergency department, which is common throughout the country. Through an aggressive nursing education program and an open-minded physician’s support, we were able to rewrite the pediatric clinical component. We now have a hands-on assessment and skills-oriented program. This has been very effective in bridging the gap between classroom and patient.’
—Scott Martus, New Haven Sponsor Hospital Paramedic Training Program Paramedic Instructor

‘Our students are instructed about the differences of physical, cognitive & emotional development within the pediatric age groups. Allowing the medic students to interact with kids of varying ages in class drives home these learning objectives. The fact that our students get the opportunity to assess children in a controlled setting helps in their development as paramedics. The chance to see, evaluate & interact with healthy children of varying ages gives our students an edge when they come across a truly ill child.’
—Jeff McGovern, New Haven Sponsor Hospital Paramedic Training Program paramedic instructor

Even as a parent, I am amazed at how much a child knows about themselves, and how hard it is to get them to give you the information you are looking for.’
—Brian Arms, paramedic student

‘Mainly working with adults, and not being married or having any kids of my own, it was quite an experience to sit down & spend some time with small children. They’re wonderful & make you appreciate life a little more. It takes a special individual to help a child when they’re in need, & that’s where I plan to be in the near future.’
—Gary Feathler, paramedic student

‘A common theme in our pediatrics module was rapid identification of sick vs. not sick. I do not have kids & the majority of my experience in EMS comes from treating adults. I would not hesitate to admit my own ignorance when it comes to children. Having the ability to observe, talk & practice examining healthy kids definitely helped me. There was a day at one of my clinical rotations where several children presented to the ED with respiratory distress. I felt that this exposure allowed me to differentiate sick vs. not sick more rapidly than if I had just been presented with a sick child. It provided me with a valuable foundation that I would not otherwise have obtained.’
—Kyle Bilodeau, paramedic student

References
1. Shah MN, Cushman JT, Davis CO, et al. The epidemiology of emergency medical services use by children: An analysis of the National Hospital Ambulatory Medical Care Survey. Prehosp Emerg Care. 2008;12(3):269–276.

This article originally appeared in January 2012 JEMS as “Standardized Simulations: Using standardized pediatric patients in paramedic training.”

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