Enhancing prehospital emergency care standards in Lithuania: a randomized simulation-based study

Abstract

Background. Effective prehospital emergency care faces numerous challenges influenced by various factors. Decision-support tools are recognized for their valuable role in improving provider performance and patient outcomes during clinical emergencies. While cognitive aids have shown promise, the exploration of electronic field protocols in prehospital care settings has been limited. Additionally, the use of standardized field protocols is not a common practice in prehospital settings in Lithuania. Aim. This study aimed to assess the impact of newly developed electronic field protocols on the performance of prehospital care providers within a simulated environment. Methods. Conducted at the Lithuanian University of Health Sciences from October 17 to November 18, 2022, this randomized simulation-based study employed a specially designed simulation course. The course encompassed twelve distinct scenarios representing various acute conditions: adult resuscitation, paediatric resuscitation, delivery and postpartum care, seizures in pregnancy, stroke, anaphylaxis, acute chest pain, acute abdominal pain, respiratory distress in children, severe trauma, severe infection and sepsis, and initial neonatal evaluation and resuscitation. Standardized checklists were used for evaluation. Sixteen prehospital providers, each with a minimum of three years of clinical experience, were randomly assigned to either utilize the newly developed electronic field protocols or rely solely on their memory during simulated scenarios. Participant performance scores between the two modes of operation were then compared. Results. A total of 190 simulation sessions were carried out. The use of electronic field protocols resulted in a statistically significant improvement in participant performance scores across 10 out of the 12 simulated scenarios when compared to relying on memory alone. Compliance with standardized checklists increased from 60% to 85% (p < 0.001) when the electronic field protocols were employed. Post-course survey responses indicated that participants found the electronic field protocols user-friendly and directly applicable to prehospital clinical practice. Conclusion. The outcomes of this study suggest that newly developed electronic field protocols, functioning as cognitive aids, effectively enhance prehospital care providers’ performance in simulated scenarios. These findings highlight the potential of standardized electronic field protocols to elevate the quality of prehospital care in Lithuania, indicating a promising avenue for further development and implementation in healthcare settings.