The Impact of Trauma Simulation on Pre-hospital Emergency Operations Staff

 Trauma is a leading cause of death and disability worldwide. Prehospital care is the first part of the trauma treatment and care system. Improving the skills of caring for trauma patients before the patient arrives at the hospital can have a significant impact on the survival of critically ill patients.Simulation enables employees to use learning, cognitive and psychological learning experiences.Simulation of trauma casualties causes subjective and objective changes among operational staff and, in fact, casualty care, which is a positive result of PHTLS simulated courses.The aim of this study was to evaluate the skills of pre-hospital emergency operations staff in dealing with a trauma patient after performing simulation training.

[FR1] : This study was a quasi-experimental evaluation with a pre-test-post-test design. The research environment was Shiraz Medical Emergency and Accident Management Center. Sampling in 2019 was done by simple random method among 200 pre-hospital emergency staff. To determine the required number of samples at a confidence level of 0.95 and a test capacity of 80% and assuming that the skills of dealing with trauma patients in pre-hospital emergency operations staff after simulation training change at least eight points to be considered statistically significant. After placement in the relevant formula, the required sample size of 50 people was obtained, which was considered to be 60 people, taking into account the 20% drop.Staff performance in terms of clinical skills in dealing with trauma patients was evaluated by the OSCE (Objective Structured Clinical Skills Evaluation) method in 9 stations. To collect data from the observation checklist, the performance of clinical skills in dealing with trauma patients was evaluated. Used by evaluators. In total, this workshop was held for 2 days. After passing theoretical and practical trainings based on simulations, the staff was finally tested with several different scenarios based on the patient's condition. Immediately after the mentioned training, the clinical skills of the staff were re-evaluated based on their participation in the OSCE test and with the checklist of clinical skills of dealing with patients with trauma.Pre- and post-test data were adjusted in the initial tables and then skills were assessed using methods of descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (paired t-test and Cohen effect size) by SPSS 22 software.

Most of the subjects were men (88.5%), single (56.9%) and in the age group of 20 to 30 years (56.9%).Most of the pre-hospital emergency operatives in the study had nursing or emergency medical records (84.6%), had a history of trauma training (59.6%) and a history of activity in the pre-hospital emergency (90.4%).The average total skill score of pre-hospital emergency operations staff in the face of a person with trauma before training was 40.51 with a standard deviation of 11.93, which was lower than the mean score of the instrument, ie 74.5. To compare 9 skills, scores were each calculated from 0 to 100 and the results showed that the lowest mean score was in oral-tracheal ventilation and intubation skills (20.78 16 16.11) and the highest in restricted spinal movement restriction skills. (36.20 36 36.32). The average total skill score of pre-hospital emergency operations staff in the face of a trauma patient after training was 113.17 with a standard deviation of 10.24, which was higher than the average score of the instrument, ie 74.5.The results showed that the lowest mean score obtained based on zero to one hundred was in the skill of using traction splint (71.1 73 18.73) and the highest was in the skill of controlling bleeding and shock treatment (81.4 75 22.75).The results of paired t-test showed that general clinical skills as well as 9 standard skills of dealing with trauma patients in pre-hospital emergency operations staff after simulation training were significantly higher than before (p <0.001).The results of Cohen's effect size showed that the highest effect of the intervention was on the examination of the trauma patient (3.33) and the least on the limitation of the patient's spine movement (1.55) and in general in the standard skills of dealing with trauma patients was 4.64. .

The results showed that the clinical skills of pre-hospital emergency operations staff in dealing with a trauma patient had increased after simulation training. In all nine skills and general skills were significantly higher (p <0.001).Statistical results show that training by trauma simulation method increases the total score of clinical skills of coping with trauma.According to the results, simulation-based training was effective in improving the skills of pre-hospital emergency operations staff.Therefore, using this new educational method can be used as a way to teach and learn more effectively and take steps to provide quality and safe care for patients.This training allows participants to experience a critical and emergency situation without compromising patient safety. Using this training method and encouraging employees to participate in it in the form of continuous training, while using this new training method, will improve the clinical skills of operational staff.