97 Impact of Virtual Simulation to Teach Paramedics Respiratory Failure Management During the COVID-19 Pandemic

Abstract

Methods: A retrospective, multi-center cohort study of adult patients who required hospitalization between March 01, 2020 and July 01, 2020 due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was conducted. All data was abstracted from two rural and one urban ED in Arizona. Research assistants who were blinded to the study hypothesis were trained on proper data abstraction prior to collection. With adherence to a quality-controlled protocol and structured abstraction tool, research assistants manually collected patient demographics, intake laboratory values, initial vital signs, ICU admissions, and mortality. Data was collected using a one-to-one allocation ratio based upon ethnicity for each site. Comparisons between rural and urban populations were completed using chi-square, Mann-Whitney U, and independent samples T-tests.Results: A total of 304 patients (175 urban and 129 rural) with confirmed SARS-CoV-2 infection were admitted to the hospital during the study period. Patients presenting to a rural ED were more likely to be admitted to the ICU (24 urban vs 39 rural; OR ¼ 2.1; p¼0.01). Of those hospitalized, a total of 137 (43.9%) were female (87 [47.5%] urban and 50 [38.8%] rural). The median age of patients hospitalized from the urban cohort was 67 years old (IQR¼25) and from the rural cohort was 63 years (IQR¼28).Of those studied, 43 (14.1%) patients expired from COVID-19 with 24 (13.1%) patients in the urban cohort and 19 (14.7%) in the rural cohort (p¼0.06). Those in the rural population presented to the ED 7.0 (IQR 7) days from initial symptoms onset and those in the urban population 5 (IQR 4) (p¼0.005). Patients treated at urban EDs had a higher systolic blood pressure (138.6 mmHg vs 130.3 mmHg; p¼0.01) but lower oxygen saturation (91.7% vs 93.1%; p¼0.04) than those treated at a rural ED. When intake laboratory values were considered, patients treated in an urban ED had a statistically significant lower white blood cell count and ferritin level as compared to those at a rural ED but a higher hemoglobin, hematocrit, and calcium level (Table ).Conclusion: Rural patients with COVID-19 exhibit a delay in presentation to their local ED, producing atypical prognostic laboratory measures when compared to urban centers. This delay may contribute to symptom exacerbation and a higher rate of critical care admissions among rural patients.

Emergency medical service interventions and experiences during pandemics: A scoping review

“…Most studies included combinations of paramedics and Emergency Medical Technicians (EMTs) or other types of EMS personnel (such as nurses or physicians), while some studies defined their participants as emergency prehospital medical care workforce [ 20 , 21 ], EMS personnel [ 22 , 23 ] or first responders [ 24 , 25 ]. One study [ 17 ], using a systematic Delphi procedure, included a multidisciplinary group of experts on outbreak preparedness.…”

“…Knowledge & education . Thirteen studies (17.8%) [ 20 – 22 , 32 , 33 , 38 – 45 ] explored issues around EMS staff members’ pandemic knowledge and training.…”

“…In addition, four studies (5.5%) [ 22 , 41 , 43 , 44 ] investigated the effectiveness of various educational interventions. These interventions were effective in increasing knowledge and behavioural intentions to use respirators, get vaccinated and willingness to report for duty during a potential pandemic [ 41 ]; increasing adequate choice of PPE [ 43 , 44 ], especially for those student paramedics who were also actively working in an ambulance company [ 44 ]; and increasing comfort levels in managing respiratory failure in suspected/known COVID-19 patients, as well as non-COVID-19 patients [ 22 ].…”