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Small Victims, Big Challenges:Refining Pediatric Disaster TriageAlgorithms and Education in the       Pre-Hospital Setting...
Background• Disasters have a potentially devastating effect on  children• Triage strategies: JumpSTART, Smart, Sacco, SALT...
PICO Question• Population   – Paramedics and paramedic students from CT, RI, MA• Intervention   – Bundled: Simulated disas...
ApproachEducational intervention  1. Each paramedic: 10 patients in simulated house fire,     utilizing state’s triage alg...
Pilot Year Results• 14 experts developed 10-patient disaster  scenarios• 93 participants enrolled• Accuracy best with “bla...
3 Questions• How to best create/modify a curriculum that is  engaging and effective?• How best to manage difficulties with...
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  1. 1. Small Victims, Big Challenges:Refining Pediatric Disaster TriageAlgorithms and Education in the Pre-Hospital Setting Linda Brown MD, MSCE lbrown8@lifespan.org Mark Cicero, MD, Frank Overly, MD, Jorge Yarzebski BA, Marc Auerbach MD, MS, Antonio Riera, MD, Eric Goedecke DO, David Cone MD, and Carl Baum MD
  2. 2. Background• Disasters have a potentially devastating effect on children• Triage strategies: JumpSTART, Smart, Sacco, SALT – Unique physiology/developmental considerations – How best to teach pediatric disaster triage (PDT)? – How triage strategy impacts clinical outcomes of child disaster victims? – No direct comparison of these strategies has yet been completed• Mark Cicero, MD – PI on EMS-C targeted issues grant, 2011 – PRIDE (pediatric research in disaster education)
  3. 3. PICO Question• Population – Paramedics and paramedic students from CT, RI, MA• Intervention – Bundled: Simulated disaster scenarios followed by expert structured debriefing and standardized pediatric disaster learning module• Comparison – Participants are compared against themselves in their performance in “pre” and two “post” disaster scenarios at 2 weeks and 6 months• Outcome – Accuracy and efficiency in scenarios – Global assessment of function (videotaped performance in scenarios with expert review) – Results of questionnaires
  4. 4. ApproachEducational intervention 1. Each paramedic: 10 patients in simulated house fire, utilizing state’s triage algorithm 2. Facilitated debriefing (qualitative semi-structured interviews) 3. Brief learning module
  5. 5. Pilot Year Results• 14 experts developed 10-patient disaster scenarios• 93 participants enrolled• Accuracy best with “black” versus others – 92-99% black versus 51-63% yellow• Global assessment of function improved from 1st to 2nd scenario (78.1% vs 82.9% p=0.002)
  6. 6. 3 Questions• How to best create/modify a curriculum that is engaging and effective?• How best to manage difficulties with standardization of actors/SPs, simulation environment and facilitators?• Plans for validation and dissemination??? – Funding, manikin-based vs web-based/VR? lbrown8@lifespan.org

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