Trauma is the leading cause of morbidity and mortality among children in the United States. Pediatric trauma patients’ unique anatomy and physiology can pose a challenge for most clinicians as specialized knowledge and training are required for successful resuscitation and management. However, many clinicians receive insufficient education and practice in pediatric trauma care resulting in healthcare teams that lack the skills and experience needed to provide adequate care. Incorporating simulation-based training into the healthcare curriculum and skill maintenance programs can help address knowledge and experience gaps, ultimately improving pediatric trauma care.
The gap in pediatric trauma education
Over 12,000 children die each year in the United States from traumatic injuries1. Research has shown that one-third of these deaths occur from errors made by clinicians during the initial evaluation and management of these pediatric trauma patients. A lack of sufficient education and training in pediatric emergency medicine is the direct cause of errors.
One possible solution to this problem is placing a greater focus on the specific care needs of this patient group in the curriculum. Healthcare students receive training in Advanced Trauma Life Support early on in their academic careers, but these protocols are designed with adult patients in mind. Children have anatomic and physiologic differences from adults that require specialized skills to provide effective care.
However, finding opportunities for inexperienced clinicians to work hands-on and learn how to manage pediatric trauma cases is rare. As such, many students enter the workforce with gaps or deficiencies in their knowledge and skills. Their lack of experience working with this patient group creates a greater risk for errors.
Improving pediatric trauma education with simulation
One way to help reduce trauma-related pediatric deaths each year is better training. Students ought to know how to make safe decisions and develop their clinical performance. Learning in the classroom, enhanced with time spent applying that knowledge hands-on with simulated patients, will ensure better outcomes. Instead of training with real pediatric patients first, simulation can be used to help bridge the gap in training and prepare students for the realities of pediatric patient care.
Simulation-based training fosters experiential learning to help students acquire, rehearse, and maintain the knowledge and skills needed to treat complex and high-risk cases like pediatric trauma injuries. High-fidelity patient simulators like Gaumard’s Pediatric HAL S2225 have many advanced features that help create immersive and lifelike training scenarios that can replicate the stressors and rapid pace inherent in these emergency scenarios.
HAL can cry, provide relevant facial cues, and his vital signs can be monitored using real clinical equipment. Moreover, his physical symptoms and vitals change based on the provider’s interventions, meaning students can observe HAL’s condition deteriorate if correct treatment is not given. Students must think critically about their actions, communicate clearly with their teammates, and remain calm as they work in a high-pressure environment.
Practicing repeatedly on the simulator reinforces essential concepts and protocols better than traditional classroom learning alone because students engage in experiential learning. In the simulation session, students learn by observing the results of their actions and adjusting their behavior based on what they have learned. This knowledge helps them improve their performance over time as they master how to effectively recognize an ailment’s symptoms, make the correct diagnosis, and provide timely intervention.
Students receive real-time feedback from HAL on how well they perform skills essential to pediatric trauma care like CPR and ventilator application. Along with input provided by their educator, students can apply what they have learned to the following scenario and repeatedly practice until the procedures become second nature.
Since HAL supports experiential learning, utilizing real tools and equipment allows students to gain proficiency with the same machines available in the clinical environment. Thus, learners can enter the workforce with practical knowledge, reducing device use errors linked to clinician inexperience. Students will have the know-how and confidence to minimize delays in care which often increases the risk for mortality among pediatric trauma patients.
Preparing clinicians for summertime trauma injuries
In emergency departments (ED) across the United States, summertime is referred to as “trauma season” as the admittance of pediatric patients with injuries from falls, burns, drowning, bicycle/traffic accidents, and other traumatic events almost double during the summer months. However, not all EDs have equipment designed for pediatric patients. Moreover, the level of pediatric emergency care training and experience among physicians and nurses working in the ED can vary widely from one institution to another2.
Only a highly-trained trauma team can significantly improve the care of injured children. However, this requires that clinicians maintain proficiency in the specific skills needed to respond to pediatric trauma events. Research demonstrates that clinical skills erode in as little as 6 to 12 weeks without regular practice. Since pediatric trauma occurs less frequently than adult trauma1 , many ED clinicians have had few opportunities to regularly rehearse those pediatric clinical skills by the time summer comes around.
Therefore, simulation-based training should be used to maintain the skills of existing clinicians year-round. Taking advantage of the tools and resources already available in the ED, in situ simulation sessions can be scheduled periodically to keep pediatric care skills and protocols fresh in the minds of clinicians and staff.
Skillset practice can easily incorporate portable patient simulators like the Code Blue® III Pediatric simulator since it was designed to facilitate the hands-on practice of Advanced Life Support (ALS) skills and protocols essential in trauma care. Clinicians benefit from practicing ALS-recommended techniques on pediatric anatomy as this can ensure accuracy in chest compressions, and they can gain familiarity with a child’s airway during intubation.
Understanding and knowing how to react to these anatomical differences and the specific needs of these patients can reduce errors. What’s more, regular practice will help to reduce the level of uncertainty a clinician might feel when encountered by a relatively rare event. The experiences gained in the simulation-based learning event (SBLE) allow them to maintain proficiency, so they make those critical, time-sensitive decisions without hesitation.
Moreover, ED teams must quickly coordinate care and work collectively to ensure the proper protocols are followed when treating trauma patients. SBLE allows clinicians to keep these protocols top of mind, helping them designate roles, practice clear communication, and collaborate on treatment. Through regular practice of simulation-based learning events, clinicians can develop good communication skills and coordination so that real patients will receive appropriate and seamless care.
 “CDC Childhood Injury Report.” Centers for Disease Control and Prevention, 6 Feb. 2019, https://www.cdc.gov/safechild/child_injury_data.html.
 Snow, Sally K. & David W. Tuggle. “Management of Pediatric Trauma.” Pediatrics, vol. 138, no. 2, 2016, pp. 1-11.
 Ahmed, Rami A, et al. ” Pediatric Trauma Boot Camp: A Simulation Curriculum and Pilot Study.” Hindawi: Emergency Medicine International, vol. 2018, no. 7982315, 2018, pp. 1-8.
 Toland, Bill. “Summertime is ‘trauma season’ for hospital ERs.” Pittsburg Post-Gazette, www.ehow.com/how_10727_make-vegetarian-chili.html. Accessed 29 July 2021.
 Adamas-Rappaport, William J, et al. “Clinical skills temporal degradation assessment in undergraduate medical education.” Journal of Advances in Medical Education & Professionalism, vol. 6, no. 1, 2018, pp. 1-5.
 “Accidents or Unintentional Injuries.” Centers for Disease Control and Prevention, 9 April 2021, https://www.cdc.gov/nchs/fastats/accidental-injury.htm.