Testing Preparedness of EMS Personnel in Identification and Decompression of Tension Pneumothorax using High Fidelity Simulation—A Pilot Study Rishipathak Parag1, Bhandari Monesh2, Hinduja Anand3 1Director, Adjunct Faculty, Symbiosis Centre for Health Skills, Symbiosis International (Deemed University), Pune, India 2Medical Officer, Academics, Adjunct Faculty, Symbiosis Centre for Health Skills, Symbiosis International (Deemed University), Pune, India 3Adjunct Faculty, Symbiosis Centre for Health Skills, Symbiosis International (Deemed University), Pune, India Online published on 4 June, 2019. Abstract Introduction Tension pneumothorax is a life threatening medical emergency that can quickly deteriorate the cardiopulmonary function leading to high chance of mortality. A tension pneumothorax occurs when the patient cannot compensate during respiration leading to air filling in the pleural space. This leads to collapse of lung and the pressure begins to compress the heart. The diagnosis is primarily clinical and hence depends on the judgement of the Emergency Medical Services (EMS) personnel. Hence, the confidence level of the EMS personnel in tackling this dire emergency is of utmost significance. While needle decompression can be lifesaving, if performed incorrectly, complications can be life threatening including serious penetrating cardiac injury leading to death. High Fidelity Simulation offers an excellent opportunity to practice diagnosing this emergency as well as honing the skill of needle decompression in a safe environment. Objective The study aims to test preparedness of EMS personnel in identifying and managing tension pneumothorax by performing needle decompression using high fidelity simulation. Methodology A high fidelity simulation manikin, was utilized for preparing three simulated clinical experiences of trauma leading to Tension Pneumothorax. The EMS students were already aware of Tension Pneumothorax-diagnosis and management through didactic lectures and practicals conducted in low fidelity skill stations. Three groups (Group 1, 2 & 3) of six students each performed the simulation and were evaluated using the advance course protocol of patient assessment by International Trauma Life Support (ITLS). The students were also evaluated on the accuracy of diagnosis and the correctness of the technique of needle decompression. The time taken for diagnosis and further to successfully achieve decompression. The entire simulation scenario was video recorded with consent and later evaluated by two different trainers to reduce bias. Result Students from Group 1 could not diagnose tension pneumothorax in the simulated patient. Based on the findings Group 2 and 3 diagnosed tension pneumothorax. Discussion The participants in the study were already well versed with the subject of Tension pneumothorax by lectures and practical sessions conducted at low fidelity skill stations. Yet when confronted with a realistic simulation scenario on tension pneumothorax Group 1 could not diagnose the condition while Group 3 took too long to arrive at a diagnosis by which time the simulated patient's condition had worsened. Conclusion The study highlights the lack of preparedness amongst trained EMS personnel in handling tension pneumothorax cases. This is a concerning issue, yet high fidelity simulation offers a platform to learn the concept of tension pneumothorax in a realistic environment. The study being a pilot initiative would need data collection with a larger sample size to arrive at more concrete evidence of the utilization of high fidelity simulation in training EMS personnel. Additional simulation workshops could be done to assess other skills and integration of more simulation into EMS training may be useful, especially for rarely performed time critical life-saving skills. Top Keywords Tension pneumothorax, needle decompression. Top |