A Simulation-Based Course for Prehospital Providers in the Developing Emergency Medical Response System

Abstract

Audience: This simulation-based training focuses on emergency prehospital medical stabilization. It was created to augment the skills of prehospital providers in developing emergency medical services (EMS) systems. We designed and implemented the curriculum in the Republic of Botswana and trained the public prehospital providers employed by the Ministry of Health (MOH). Length of Curriculum:The entire course was designed to be presented over 2 days for approximately six to eight total hours. Introduction: Prehospital medicine continues to develop around the world. Many new, public programs are steadily emerging in Sub-Saharan Africa which utilize fewer resources than many of the more established EMS models. Because of the unique practice environment, and the novelty of these organized EMS programs, educational and interventional initiatives are needed, as well as research on prehospital medicine in lowerand middle-resource settings, particularly in Sub-Saharan Africa. The novel, prehospital, medical simulationbased, educational curriculum we have presented here was specifically created to develop EMS systems in lower-and middle-income countries (LMIC) in Africa. The course was successfully implemented multiple times in Botswana as a collaborative effort between the providers of well-established EMS systems and the emerging Botswanan system. This simulation-based training program was considered an appropriate, effective, and welcome means of teaching the relevant concepts, as indicated by the statistically significant improvement in test scores and participant feedback. CURRICULUM 196Educational Goals: This curriculum presents a refresher course in recognizing and stabilizing an acutely ill patient for prehospital providers practicing in a low/middle-income developing EMS system. Educational Methods:The educational strategies used in this curriculum include rapid cycle deliberate practice (RCDP) medical simulation, written testing, and simulation testing.Research Methods: Learners completed pre-and post-tests covering the concepts taught in the curriculum. Continuous variables (written and simulation test scores) were compared between two dependent groups (pre-and post-training) using paired t-test. Results:The mean scores were 67% [standard deviation (SD) = 10] on the written pre-test and 85% (SD = 7) on the written post-test (p < 0.001). The mean scores for the simulation were 42% (SD = 14.2) on the pre-test and 75% (SD = 11.3) on the post-test (p < 0.001).Discussion: This curriculum was specifically developed based on the needs of the Botswana EMS system. Nevertheless, we strongly believe that only minor adaptations would be required for teaching it in other developing, lower-resourced prehospital systems, considering the relative ubiquity of the clinical concepts being covered. The curriculum described in this study represents an invaluable educational tool that serves to educate healthcare providers, disseminate practical knowledge, and standardize clinical procedures. We hope that these measures, when taken ...