Simulation based education in paediatric resuscitation.

There is increasing use of clinical Simulation Based Education (SBE) in healthcare due to an increased focus on patient safety, the call for a new training model not based solely on apprenticeship, a desire for standardised educational opportunities that are available on-demand, and a need to practice and hone skills in a controlled environment. SBE programs should be evaluated against Kirkpatrick level 3 or 4 criteria to ensure they improve patient or staff outcomes in the real world. SBE programs have been shown to improve outcomes in neonatology - reductions in hypoxic ischaemic encephalopathy, in brachial plexus injury, rates of school age cerebral palsy, reductions in 24hr mortality and improvements in first pass intubation rates. In paediatrics SBE programs have shown improvements in paediatric cardiac arrest survival, PICU survival, reduced PICU admissions, reduced PICU length of stay and reduced time to critical operations. SBE can improve the non-technical tasks of teamwork, leadership and communication (within the team and with patients and carers). Simulation is a useful tool in Quality and Safety and is used to identify latent safety issues that can be addressed by future programs. In high stakes assessment simulation can be a mode of assessment, however, care needs to be taken to ensure the tool is validated carefully.

COVID-19 and Pediatric Mental Health Hospitalizations.

OBJECTIVES: To analyze Australian national data to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health-related hospital presentations among children and adolescents during the pandemic period with restrictions, and the period after the restrictions eased. METHODS: We analyzed the monthly mental health-related inpatient admissions and emergency department (ED) attendances data from 6 large pediatric hospitals across Australia, using the Bayesian structural time series models. The COVID-19 restriction period was from March 2020 to December 2021 and the COVID-19 restriction-eased period from January to June 2022. RESULTS: A total of 130 801 mental health-related hospital admissions (54 907) and ED attendances (75 894) were analyzed. During the COVID-19 restriction period, there was a significant increase in inpatient admissions related to deliberate self-harm behaviors (82%, 95% credible interval [CrI], 7%-160%) and ED attendances related to overall mental health disorders (15%, 95% CrI, 1.1%-30%) and eating disorders (76%, 95% CrI, 36%-115%). The increase was higher among females and those living in the least socioeconomically disadvantaged areas, suggesting a widening gap between mental health-related presentations by sex and socioeconomic status. After the restrictions eased, there were slight declines in mental health-related hospital presentations; however, the numbers remained higher than the pre-COVID-19 levels. CONCLUSIONS: The increase in mental health-related hospital presentations during the COVID-19 period calls for additional support for pediatric mental health care, particularly for eating disorders and deliberate self-harm among female adolescents. It is important to monitor pediatric mental health service use as we enter "COVID-19 normal" period.

Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia.

INTRODUCTION: Self-harm presentations in children and young people have increased internationally over the last decade. The COVID-19 pandemic has the potential to worsen these trends. OBJECTIVE: To describe trends in emergency department self-harm or suicidal ideation presentations for children and young people in New South Wales before and since the COVID-19 pandemic. METHODS: We studied presentations for self-harm or suicidal ideation by 10- to 24-year-olds to New South Wales emergency departments, using interrupted time series analysis to compare annualised growth before COVID (2015 to February 2020) and since COVID (March 2020 to June 2021). Subgroup analyses compared age group, gender, triage category, rurality and disadvantage. Time series decomposition via generalised additive models identified long-term, seasonal and short-term trends. RESULTS: Self-harm or suicidal ideation presentations by young people in New South Wales increased by 8.4% per annum pre-COVID. Growth accelerated since COVID, to 19.2% per annum, primarily due to increased presentations by females aged 13-17 years (47.1% per annum since COVID, from 290 per 10,000 in 2019 to 466 per 10,000 in 2021). Presentations in males aged 10-24 years did not increase since COVID (105.4 per 10,000 in 2019, 109.8 per 10,000 in 2021) despite growing 9.9% per annum before COVID. Presentation rates accelerated significantly in socio-economically advantaged areas. Presentations in children and adolescents were strongly linked to school semesters. CONCLUSION: Emergency department self-harm or suicidal ideation presentations by New South Wales young people grew steadily before COVID. Understanding the sustained increase remains a priority. Growth has increased since COVID particularly for adolescent females, but not among adolescent males. Surprisingly, the largest post-COVID increases in annual growth occurred in socio-economically advantaged and urban regions. The COVID-19 pandemic appears to have added new challenges, particularly in females in the developmentally critical early adolescent and teenage years.

The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia - a time series analysis.

BACKGROUND: The first wave of the COVID-19 pandemic hit New South Wales (NSW) Australia in early 2020, followed by a sharp state-wide lockdown from mid-March to mid-May. After the lockdown, there had been a low level of community transmission of COVID-19 over a year. Such pandemic experiences provide unique opportunity to understand the impact of the pandemic on paediatric health service use as countries emerge from the pandemic. METHODS: We examined the difference between the observed and the predicted numbers of inpatient admissions and emergency department (ED) attendances, respectively, related to chronic, acute infectious and injury conditions, for each month during the COVID-19 period (January 2020-February 2021), based on the numbers from 2016 to 2019, using records from two major paediatric hospitals in NSW. All analyses were conducted using autoregressive error models and were stratified by patient age, sex and socioeconomic status. FINDINGS: Health service use was significantly lower than predicted for admissions and/or ED attendances related to chronic conditions, acute infections, and injury during the lockdown in 2020. Change in health service use varied by chronic conditions, from the largest decrease for respiratory conditions (40-78%) to non-significant change for cancer and mental health disorders. After the lockdown, health service use for most health conditions returned to pre-COVID-19 predicted levels. However, for mental health disorders, increased health service use persisted from June 2020 up to February 2021 by 30-55%, with higher increase among girls aged 12-17 years and those from socioeconomically advantaged areas. There was persistently lower health service use for acute infections and increased health service use for injuries. Differences by socio-demographic factors were noted for mental health disorders and injuries. INTERPRETATION: The immediate return to pre-COVID-19 levels for most chronic conditions after the first lockdown in NSW highlights the healthcare needs for children affected by chronic conditions. Persistently lower health service use for acute infections is likely attributable to the decreased social contact. Sustained and targeted mental health support is essential to address the potentially increased demand for services among children during and beyond the pandemic. FUNDING: Financial Markets Foundation for Children Chair (RL, NN), NHMRC Investigator Grant (APP1197940) (NN), NHMRC Career Development fellowship (GNT1158954) (SW).

Personal protective equipment in the paediatric emergency department during the COVID-19 pandemic: Estimating requirements based on staff numbers and patient presentations.

OBJECTIVE: To estimate the personal protective equipment (PPE) required in a paediatric ED during the COVID-19 pandemic comparing the use per patient to use per patient zone, based on the NSW Clinical Excellence Commission (CEC) guidelines in place at the time of the study. METHODS: A retrospective case note review of all patients and staff present in the ED of The Children's Hospital at Westmead, Sydney, Australia in the 24 h period of Sunday 5 April 2020. The primary outcome of PPE estimates was generated from identifying the number of patient contacts and aerosol generating procedures (AGPs) performed per patient as well as the number of staff on shift. RESULTS: One hundred patients attended the ED (50% of usual) and all were included in the study. For a low-risk community environment allocating PPE per patient contact required 48 face shields, 382 surgical masks, 48 N95 masks and 430 gowns for the day, increasing to 430 face shields, 331 surgical masks, 430 N95 masks and 761 gowns in a high-risk community environment. Allocating PPE using zoning reduces the requirement to 48 face shields, 192 surgical masks, 48 N95 masks and 204 gowns, increasing to 196 face shields, 96 surgical masks, 196 N95 masks and 292 gowns per day in a high-risk community environment. CONCLUSION: This study has demonstrated the considerable requirement for PPE in a paediatric ED, which varies according to presentation type and the background prevalence of COVID-19 in the community.

Attitudes of health professionals to using routinely collected clinical data for performance feedback and personalised professional development.

OBJECTIVES: To learn the attitudes of health professionals, health informaticians and information communication technology professionals to using data in electronic health records (eHRs) for performance feedback and professional development. DESIGN: Qualitative research in a co-design framework. Health professionals' perceptions of the accessibility of data in eHRs, and barriers to and enablers of using these data in performance feedback and professional development were explored in co-design workshops. Audio recordings of the workshops were transcribed, de-identified, and thematically analysed. SETTING, PARTICIPANTS: A total of nine co-design workshops were held in two major public hospitals in Sydney: three for nursing staff (ten participants), three for doctors (15 participants), and one each for information communication technology professionals (six participants), health informaticians (four participants), and allied health professionals (13 participants). MAIN OUTCOME MEASURES: Key themes related to attitudes of participants to the secondary use of eHR data for improving health care practice. RESULTS: Six themes emerged from the discussions in the workshops: enthusiasm for feeding back clinical data; formative rather than punitive use; peer comparison, benchmarking, and collaborative learning; data access and use; capturing complex clinical narratives; and system design challenges. Barriers to secondary use of eHR data included access to information, measuring performance on the basis of eHR data, and technical questions. CONCLUSIONS: Our findings will inform the development of programs designed to utilise routinely collected eHR data for performance feedback and professional development.

Trial of life: Well infants presenting more than 24 h after head injury with a scalp haematoma: A 10-year review.

AIM: To review the investigation, patterns of injury and short-term outcomes of infants younger than 12 months of age who presented more than 24 h after head injury with an isolated scalp haematoma. METHODS: A retrospective chart review of infants who presented with a head injury to the emergency department of a major paediatric hospital between 2006 and 2016. Patients were included if they presented more than 24 h after the injury, were clinically well and had a documented scalp haematoma. Charts were abstracted using a standardised instrument to yield patient characteristics, mechanism of injury, imaging performed, identified injuries and patient outcome. RESULTS: A total of 2433 records were reviewed, with 157 included in the study. The mean age was 7.5 months (standard deviation 2.6). Of the patients, 14 had a documented palpable skull fracture; 43 patients had a skull X-ray reported as a fracture; 13 patients had cranial ultrasounds with 3 reported as having a fracture; 124 patients had computed tomography head imaging, with 112 demonstrating a fracture; and 52 patients had acute intracranial abnormalities. There were nine unplanned representations (5.7%). No patients required any neurosurgical intervention. CONCLUSIONS: Infants presenting after 24 h with isolated scalp haematomas had good short-term outcomes despite a high prevalence of underlying injury on imaging. Expectant management, rather than imaging, may be a valid approach in this patient population. However, some of these injuries may have been the result of inflicted injury, and all of these patients require a robust assessment regardless of the decision to use a computed tomography scan.

Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre-based, high fidelity scenarios.

OBJECTIVE: To measure scenario participant and faculty self-reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre-based simulations. METHODS: A prospective survey of scenario participants and faculty completing in situ and centre-based paediatric simulations. RESULTS: There were 382 responses, 276 from scenario participants and 106 from faculty with 241 responses from in situ and 141 from centre-based simulations. Scenario participant responses showed significantly higher ratings for the centre-based simulations for respiratory rate (P = 0.007), pulse (P = 0.036), breath sounds (P = 0.002), heart sounds (P < 0.001) and patient noises (P < 0.001). There was a significant difference in overall rating of the scenario reality by scenario participants in favour of the centre-based simulations (P = 0.005); however, there was no significant difference when rating participant engagement (P = 0.11) and participant learning (P = 0.77). With the centre-based scenarios, nurses rated the reality of the respiratory rate (P < 0.001), blood pressure (P = 0.016) and abdominal signs (P = 0.003) significantly higher than doctors. Nurses rated the overall reality higher than doctors for the centre simulations (96.8% vs 84.2% rated as realistic, P = 0.041), which was not demonstrated in the in situ scenarios (76.2% vs 73.5%, P = 0.65). CONCLUSION: Some aspects of in situ simulations may be less 'real' than centre-based simulations, but there was no significant difference in self-reported engagement or learning by scenario participants. Low fidelity, in situ simulation provides adequate realism for engagement and learning.

Estimating the weight of ethnically diverse children attending an Australian emergency department: a prospective, blinded, comparison of age-based and length-based tools including Mercy, PAWPER and Broselow.

OBJECTIVE: To prospectively compare the actual weights of Australian children in an ethnically diverse metropolitan setting with the predicted weights using the Paediatric Advanced Weight Prediction in the Emergency Room (PAWPER) tape, Broselow tape, Mercy system and calculated weights using the updated Advanced Paediatric Life Support (APLS), Luscombe and Owens and Best Guess formulae. METHODS: A prospective, cross-sectional, observational, blinded, convenience study conducted at the Children's Hospital at Westmead Paediatric Emergency Department in Sydney, Australia. Comparisons were made using Bland-Altman plots, mean difference, limits of agreement and estimated weight within 10% and 20% of actual weight. RESULTS: 199 patients were enrolled in the study with a mean actual weight of 27.2 kg (SD 17.2). Length-based tools, with or without body habitus adjustment, performed better than age-based formulae. When measuring estimated weight within 10% of actual weight, PAWPER performed best with 73%, followed by Mercy (69%), PAWPER with no adjustment (62%), Broselow (60%), Best Guess (47%), Luscombe and Owens (41%) and revised APLS (40%). Mean difference was similar across all methods ranging from 0.4 kg (0.0, 0.9) for Mercy to -2.2 kg (-3.5, -0.9) for revised APLS. Limits of agreement were narrower for the length-based tools (-5.9, 6.8 Mercy; -8.3, 5.6 Broselow; -9.0, 7.1 PAWPER adjusted; -12.1, 9.2 PAWPER unadjusted) than the age-based formulae (-18.6, 17.4 Best Guess; -19.4, 15.1 revised APLS, -21.8, 17.7 Luscombe and Owens). CONCLUSION: In an ethnically diverse population, length-based methods with or without body habitus modification are superior to age-based methods for predicting actual body weight. Body habitus modifications increase the accuracy and precision slightly.

Improving the quality of care for children with wheeze: The use of electronic asthma action plans and electronic pre-school wheeze action plans.

AIM: To measure the long-term improvement in the documented provision of an asthma action plan (AAP) to children with asthma and wheeze discharged from the Emergency Department following the introduction of the electronic AAP (eAAP) and to determine the need for an electronic pre-school wheeze action plan in our population. METHODS: A retrospective case note review, from July 2014 to June 2015, of all patients over 12 months old discharged from the Emergency Department or Emergency Medical Unit, with a discharge diagnosis of either asthma or wheeze. The primary outcome was the documentation of an AAP, either recorded electronically as an eAAP or a report of an AAP as part of the patient medical record. RESULTS: Two thousand three hundred and forty-two patients were included in the study, 926 with asthma and 1416 with wheeze. The median age was 3.3 years (interquartile range (IQR) 3.5, range 1-15.9 years). The median age of the children with asthma was 5.3 years (IQR 4.6) and of the children with wheeze was 2.5 years (IQR 2.0).Overall, 1683 (71.9%) children had a documented AAP, with a significant difference between those with a discharge diagnosis of asthma (85.9%) compared with wheeze (62.9%), P < 0.001. These results justified the design of the electronic pre-school wheeze action plan. CONCLUSIONS: The integration of an eAAP into the Emergency Department has resulted in a sustained improvement in the documented provision of an AAP to children with a discharge diagnosis of asthma. Children with a discharge diagnosis of wheeze are significantly less likely to receive an action plan.

Training clinicians to care for children in emergency departments.

Children account for 22% of presentations to Emergency Departments in Australia, the majority presenting to mixed departments. A diverse group of clinicians looks after these children. In this review, we examine the different techniques and approaches to implementing education curricula and professional development within these emergency departments with a particular focus on bedside teaching, professional coaching, skills maintenance, e-learning and simulation.

Defining normal ranges and centiles for heart and respiratory rates in infants and children: a cross-sectional study of patients attending an Australian tertiary hospital paediatric emergency department.

OBJECTIVE: Key components in the assessment of a child in the emergency department (ED) are their heart and respiratory rates. In order to interpret these signs, practitioners must know what is normal for a particular age. The aim of this paper is to develop age-specific centiles for these parameters and to compare centiles with the previously published work of Fleming and Bonafide, and the Advanced Paediatric Life Support (APLS) reference ranges. DESIGN: A retrospective cross-sectional study. SETTING: The ED of the Children's Hospital at Westmead, Australia. PATIENTS: Afebrile, Triage Category 5 (low priority) patients aged 0-15 years attending the ED. INTERVENTIONS: Centiles were developed using quantile regression analysis, with cubic B-splines to model the centiles. MAIN OUTCOME MEASURES: Centile charts were compared with previous studies by concurrently plotting the estimates. RESULTS: 668 616 records were retrieved for ED attendances from 1995 to 2011, and 111 696 heart and respiratory rates were extracted for inclusion in the analysis. Graphical comparison demonstrates that with heart rate, our 50th centile agrees with the results of Bonafide, is considerably higher than the Fleming centiles and fits well between the APLS reference ranges. With respiratory rate, our 50th centile was considerably lower than the comparison centiles in infants, becomes higher with increasing age and crosses the lower APLS range in infants and upper range in teenagers. CONCLUSIONS: Clinicians should consider adopting these centiles when assessing acutely unwell children. APLS should review their normal values for respiratory rate in infants and teenagers.

Simulation as a high stakes assessment tool in emergency medicine.

The Australasian College for Emergency Medicine (ACEM) will introduce high stakes simulation-based summative assessment in the form of Objective Structured Clinical Examinations (OSCEs) into the Fellowship Examination from 2015. Miller's model emphasises that, no matter how realistic the simulation, it is still a simulation and examinees do not necessarily behave as in real life. OSCEs are suitable for assessing the CanMEDS domains of Medical Expert, Communicator, Collaborator and Manager. However, the need to validate the OSCE is emphasised by conflicting evidence on correlation with long-term faculty assessments, between essential actions checklists and global assessment scores and variable interrater reliability within individual OSCE stations and for crisis resource management skills. Although OSCEs can be a valid, reliable and acceptable assessment tool, the onus is on the examining body to ensure construct validity and high interrater reliability.

Round-the-table teaching: a novel approach to resuscitation education.

BACKGROUND: Effective cardiopulmonary resuscitation saves lives. Health professionals who care for acutely unwell children need to be prepared to care for a child in arrest. Hospitals must ensure that their staff have the knowledge, confidence and ability to respond to a child in cardiac arrest. RESUS4KIDS is a programme designed to teach paediatric resuscitation to health care professionals who care for acutely unwell children. The programme is delivered in two components: an e-learning component for pre-learning, followed by a short, practical, face-to-face course that is taught using the round-the-table teaching approach. CONTEXT: Round-the-table teaching is a novel, evidence-based small group teaching approach designed to teach paediatric resuscitation skills and knowledge. Round-the-table teaching uses a structured approach to managing a collapsed child, and ensures that each participant has the opportunity to practise the essential resuscitation skills of airway manoeuvres, bag mask ventilation and cardiac compressions. INNOVATION: Round-the-table teaching is an engaging, non-threatening approach to delivering interdisciplinary paediatric resuscitation education. The methodology ensures that all participants have the opportunity to practise each of the different essential skills associated with the Danger, Response, Send for help, Airway, Breathing, Circulation, Defibrillation or rhythm recognition (DRSABCD) approach to the collapsed child. IMPLICATIONS: Round-the-table teaching is based on evidence-based small group teaching methods. The methodology of round-the-table teaching can be applied to any topic where participants must demonstrate an understanding of a sequential approach to a clinical skill. Round-the-table teaching uses a structured approach to managing a collapsed child.

A comparison of actual to estimated weights in Australian children attending a tertiary children's' hospital, using the original and updated APLS, Luscombe and Owens, Best Guess formulae and the Broselow tape.

INTRODUCTION: During paediatric resuscitation it is essential to be able to estimate the child's weight as it determines drug doses and equipment sizes. Age and length-based estimations exist, with age-based estimations being especially useful in the preparation phase and the length-based Broselow tape having weight-based drug doses and equipment already assigned via a colour code system. The aim of this study was to compare the actual recorded weights of Australian children to the predicted weights using the original and updated APLS, Luscombe and Owens and Best Guess formulae and the Broselow tape. METHOD: A retrospective observational study of children attending an Australian tertiary children's hospital. RESULTS: From 49,565 patients extracted from the database, 37,114 children with age and weight and 37,091 children with age and height recorded were included in the analysis. Best Guess was the most accurate, with the smallest overall mean difference 0.86 kg. For <1 year old, Broselow tape was the most accurate (mean difference -0.43 kg), Best Guess was the most accurate for ages 1-5 years and 11-14 years (mean difference 0.27 and 0.20 kg respectively), and the updated APLS formula was the most accurate for 6-10 year-old (mean difference 0.42 kg). The Broselow tape was able to only classify 48.9% of children into the correct weight colour band. CONCLUSIONS: For an age-based weight estimation, in infants less than one year the new APLS formula is the most accurate and over one year the Best Guess formulae should be used.

Identifying incidents of suboptimal care during paediatric emergencies-an observational study utilising in situ and simulation centre scenarios.

AIM: Life threatening paediatric emergencies are relatively uncommon events. When they do occur staff caring for these children must have the ability to recognise the deterioration, evaluate and simultaneously treat these patients. The aim of this study was to identify suboptimal care during standardised simulated scenarios and to identify the potential causation factors. METHODS: Participants were emergency department and operating theatre staff in Sydney, Australia. Incidents of suboptimal care were identified during scenarios and were analysed by thematic qualitative assessment methods. Potential causation factors were elicited both during and immediately after the scenarios and during facilitated debriefings. Causation factors were attributed to any of seven pre-defined categories. RESULTS: Seventy-three simulations occurred over 9 month period in 2011. 270 doctors, 235 nurses and 11 students participated. 194 incidents of suboptimal care were observed and attributed to 325 causation factors. There were 76 knowledge deficits, 39 clinical skill deficits, 36 leadership problems, 84 communication failures, 20 poor resource utilisations, 23 preparation and planning failures and 47 incidents of a loss of situational awareness. Clinically important themes were: paediatric life support, drug choice and doses, advanced airway and ventilation, intravenous fluids and recognition of the deteriorating patient. Recurring incidents included the failure to recognise a cardiac arrest, inadequate fluid resuscitation and incorrect medication dose administration. CONCLUSIONS: During standardised paediatric simulations multiple incidents of suboptimal care have been identified and multiple causation factors attributed to these. Educators should use this information to adapt current training programs to encompass these factors.

Standardising paediatric resuscitation training in New South Wales, Australia: RESUS4KIDS.

AIM: A key competency for all health-care workers (HCWs) who care for children is the ability to respond to a child in respiratory or cardiorespiratory arrest. However, evidence suggests that medical and nursing staff may not have the knowledge and clinical skills to respond to these emergencies. The aim of this project was to create a standardised, evidence-based, paediatric life support course that would be available free to all HCWs in New South Wales (NSW), including NSW Ambulance. METHODS: A paediatric life support course was designed along current education principles. It used e-learning as pre-learning and a face-to-face short practical course, combining team work and communication with practical paediatric resuscitation skills training. The programme was designed to empower local trainers to deliver a standardised course to local participants. RESULTS: A total of 14,000 participants have completed the mandatory e-learning component, and over 8600 participants have completed the short practical course, across all NSW Local Health Districts, including NSW Ambulance. RESUS4KIDS has also been adopted by the universities of Sydney and Newcastle undergraduate medical and nursing programmes. Outside of NSW and ACT, over 400 participants have completed the course in facilities in Queensland, South Australia, Victoria and the Northern Territory. CONCLUSION: We have developed a course that is available, at no cost to individuals or facilities, to all HCWs in NSW, including students, paramedics and general practitioners. We would encourage all other jurisdictions to consider adopting the programme.

Treatment of a simulated child with anaphylaxis: an in situ two-arm study.

AIM: This study aims to determine whether junior medical staff correctly identify and treat paediatric anaphylaxis and whether the presence or absence of hypotension influenced the treatment, using a standardised simulated patient encounter. METHODS: Junior medical staff from the emergency department of a large paediatric tertiary hospital were invited to participate in a two-armed cohort study to assess recognition and management of anaphylaxis in a standardised scenario using a simulated patient with and without hypotension. The primary outcome measure was administration of adrenaline. The secondary outcome measures included time to adrenaline administration, ability to seek and identify relevant features of history and clinical examination and use of other medications. RESULTS: Fifty-six junior medical staff participated (90% participation rate). Only 50% of participants administered adrenaline in scenarios of definite anaphylaxis. Adrenaline was more likely to be administered if the scenario included hypotension, where the junior medical officer had previous formal resuscitation training (Advanced Paediatric Life Support) and by medical officers with more years of training. CONCLUSION: Anaphylaxis is a life-threatening presentation and requires prompt recognition and appropriate adrenaline administration. Junior medical staff may require more emphasis on recognition and prompt adrenaline administration in both undergraduate and in hospital training and education. Simulated scenarios may provide a platform to deliver this training to ultimately improve patient care.

Paediatric resuscitation training: is e-learning the answer? A before and after pilot study.

AIM: To determine whether an e-learning resuscitation programme was able to improve the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in a simulated cardiac arrest. METHOD: A prospective before and after pilot study comprising of a simulated paediatric resuscitation before and after participants undertook an e-learning programme. Participants were emergency department doctors and new graduate nurses from The Children's Hospital at Westmead, Australia. Primary outcome measures were the ability to perform successful basic life support (BLS) and advanced life support (ALS) according to published guidelines. Secondary outcome measures were the individual steps in performing the overall resuscitation and subjective feedback from participants. RESULTS: Fifty-six clinicians were enrolled in the study (29 doctors and 27 nurses). Thirty-seven were re-tested (25 doctors and 12 nurses). The mean time between tests was 49 days (17 standard deviation). The e-learning module led to an improvement in participants' ability to perform BLS by 51% (P < 0.001) and ALS by 57% (P= 0.001) overall resulting in an overall competence of 89% (BLS) and 65% (ALS). There were also significant improvements in time to rhythm recognition (P= 0.006), time to first defibrillation (P= 0.009) and participants' self-reported knowledge and confidence in BLS and ALS (P < 0.001). CONCLUSIONS: E-learning does improve both the knowledge and competence of doctors and nurses in providing cardiopulmonary resuscitation to children in the simulation environment.

Teaching medical students to resuscitate children: an innovative two-part programme.

OBJECTIVE: The objective of the present study was to design and evaluate a novel, 'blended learning' approach to the teaching of paediatric resuscitation to medical students. METHODS: Participants were recruited from the Graduate Medical Program at the University of Sydney. The course incorporated an initial e-learning module and a subsequent practical component. The e-learning module taught basic and advanced life support. Students then attended a 90 min practical session, which focussed on team work and the psychomotor components of resuscitation. Improvement in knowledge was measured by a multiple choice question (MCQ) test. The MCQ was completed prior to beginning the whole course, after completion of the e-learning module and again at follow up 8 months later. Students also completed an evaluation survey. RESULTS: Twenty-one students participated. There was a significant objective increase in knowledge from pre-course to post e-learning scores, median scores (interquartile range) from 12/23 (10.5 to 13.5) to 21/23 (20 to 22.5), P < 0.001. This significant increase in knowledge was still apparent at follow up 8 months later. Median MCQ score at follow up was 17/23 (14 to 18.5), P < 0.002. Students self-rated significant improvements in their knowledge, confidence and ability to perform basic and advanced life support for the whole course and between individual components (P < 0.001). CONCLUSIONS: A novel paediatric resuscitation course for medical students was developed and evaluated. This demonstrated significant objective improvements in student knowledge throughout the course, at course completion and at 8 month follow up. There were also significant subjective improvements in knowledge, confidence and ability to perform paediatric resuscitation.