Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers

Abstract

Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients. This prospective study was conducted at a U.S. simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests. A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 seconds, P=0.01), automated external defibrillator (AED) placement (+9.5 seconds, P=0.01), intraosseous line insertion (+7 seconds, P<.0001), tourniquet (+8.5 seconds, P<.0001), intramuscular injection (+21–23 seconds, P<.0001), and pulse oximetry (+4 seconds, P<.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use. PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.