On Shaky Ground

Published on 
June 14, 2016
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Pediatric residents prepare for the next big earthquake

While experts agree that the West Coast is due for a sizable earthquake, there is little consensus as to when such an event may hit. Therefore, preparation will be a key component to survival and good outcomes for major health care facilities.

That is why the effectiveness of simulation-based medical education is being tested as a teaching tool to strengthen medical decision-making.  It provides a risk-free learning environment for preparing medical residents to care for pediatric patients in the aftermath of an earthquake.

“Training residents for disasters is often difficult, because real-time disasters do not happen often, and when they do, they are very high stake” explained Rita Burke, PhD, MPH, of the Division of Pediatric Surgery at Children’s Hospital Los Angeles.

In a study designed to evaluate pediatric medical residents’ confidence and attitudes about managing the medical needs of earthquake victims, investigators used a tabletop simulation created by Yale researchers. Pediatric residents from training programs that included Yale School of Medicine, Children’s Hospital Los Angeles, Keck School of Medicine at USC, David Geffen School of Medicine at UCLA and the Medical University of South Carolina, participated in the study.

The residents were required to triage and care for patients who had just come in from a disaster scenario – in the case of this study, an earthquake. The patients were represented by inexpensive, commercially available dolls, and resources – such as a liter of saline or IV lines – were represented by stickers.

A scale that ranged from novice to expert was used in surveys administered before and immediately after the simulation, as well as after a repeat simulation six months later, in order to determine the participants’ self-rated confidence and willingness to respond in the event of a disaster. The results showed a statistically significant improvement in self-rated confidence of residents in identification and management of victims. The number of participants identifying themselves as novice disaster responders decreased by 43 percent, while those identifying themselves as competent increased by 30 percent.

The study concluded that simulation can improve resident comfort level with rare events, such as caring for children in the aftermath of an earthquake. Tabletop simulations may be an effective way to provide disaster medical response training, and can easily be integrated into resident curriculum. The findings were published in the journal Pediatric Emergency Care.

“The time to prepare for a disaster is before it occurs, because knowing what to expect can make all the difference,” said Burke.