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Pedi-STEPPs Training for EMS at Texas Children’s Hospital

This training will be offered free of charge to the City of Houston for 500 firefighters over the next two years.

Pedi-STEPPs started when Dr. Paul Sirbaugh, Associate Medical Director of the Emergency Center and Director of Pre-hospital Medicine at Texas Children’s Hospital, and Dr. Jennifer Arnold, Neonatologist and Medical Director of the Simulation Center at Texas Children’s Hospital, started talking about the advantages of simulation training with Houston Fire Department’s EMS providers. Dr. Sirbaugh knew that since pediatric emergency calls were rare in the fire department/EMS field, being able to practice high-risk scenarios in a safe environment was critical.

Three years later, with the help of a grant secured from the Cullen Trust for Healthcare, Dr. Sirbaugh’s vision of the Pedi-STEPPs simulation curriculum started.

The Pedi-STEPPs curriculum also had the advantage of using The Simulation Center at Texas Children’s Hospital which is equipped with a clinical skills room, 5 simulet (standard patient) rooms, 2 simulation theaters, a labor and delivery room, and debriefing rooms. The 9,000 square foot simulation center, located in Houston, Texas, opened in November 2009.

Following on the heels of the newly opened Pavilion for Women, Texas Children’s Hospital has embarked on a two year training project to provide Pediatric Simulation Training for Emergency Pre-hospital Providers (Pedi-STEPPs) to members of the Houston Fire Department (HFD) EMS.

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Gaumard’s NOELLE® S550 and Newborn HAL® S3010 were one of the early members of the simulation center, and since then the simulation center has reached almost every department at Texas Children’s Hospital. The Simulation Center at Texas Children’s Hospital alone has 25 ongoing simulation courses, each in different departments. Scenarios are written by simulation trained faculty, who are part of an extended simulation center team. In developing the simulation curriculum, the simulation center faculty works with department faculty and puts them through a 2-day course packed with how to develop scenarios specific to their department and how to effectively debrief.

“Our focus in the 2 ½ years we’ve been open is focusing on high risk and/or rare clinical situations so that our providers can practice their team work, communications, high-stakes resuscitation, and other skills,” said Dr. Jen Arnold.

Preparing for Pedi-STEPPs, Dr. Sirbaugh and Dr. Arnold teamed up with 2 emergency medicine faculty members, Dr. Manish Shah and Dr. Cara Doughty, from Texas Children’s Hospital and developed the curriculum to build on technical skills training and communication/team skills training utilizing hi-fidelity simulators. And, in February 2012, the first Pedi-STEPPs classes started.

For the first two years, nearly 500 firefighters will attend the Pedi-STEPPs class. Each class is about 8 hours long and covers, on average, 5 different scenarios, each 20-25 minutes each. Each scenario is then replayed and discussed in the debriefing room, and facilitated by a pediatric emergency medicine faculty member or Dr. Arnold, along with one of the Houston Fire Department EMS educators who were simulation trained.

“This is obviously the biggest thing that we’ve ever undertaken to train our pre-hospital care providers,” said Dr. Arnold.

The scenarios may involve respiratory illnesses, newborn resuscitation, neonatal care, pediatric seizure management, management of special needs, and trauma. And, will cover neonatal and pediatric emergency technical skills, including intubation, airway management, bagless ventilation, central line skills, securing a cervical spine, and CPR on a newborn versus an adult.

Gaumard’s Newborn HAL S3010 was a perfect fit for the Pedi-STEPPs curriculum.

“We love the heart and lung sounds,” said Dr. Arnold, “The visualization is much more enhanced in HAL, you can really see ribcage movement, you can tell if you’re dealing with a pneumothorax, and he has a great seizure mechanism, IOs, access and intubation are perfectly fine for what we do along with the cyanosis which is key when it comes to babies.”

Also, the fact that Newborn HAL is tetherless has not only been a huge advantage but also has made a big impact for the reality of the scenario.

“What I’ve learned in talking with our educators is when you get a sick baby and the baby is in the bed, or the baby is on the couch, or the baby is on mom’s arm, (if they are not working in a hospital environment), they take that baby and put him on a hard, flat surface or the floor to resuscitate them,” explained Dr. Arnold, “Having a wireless manikin is ideal for the pre-hospital care provider learner group because they can move that manikin wherever they want.”

One of the biggest challenges with neonatal and pediatric emergency calls in the EMS field is how to quickly discern between a healthy patient and an unhealthy patient.

“Sometimes that is their biggest challenge – Is this a kid I need to grab and go quickly? [Do] I need to stabilize here, [or do] I need to send to the hospital?” explained Dr. Arnold.

Captain J. Trimble - Captain Paramedic for the City of Houston Fire Department, Emergency Medical Services was one of the first participants of the Pedi-STEPPs program.



Captain Trimble has been with the Houston Fire Department for 16 years and supervises all medics and EMTs in his district.

“To be honest with you, I wasn’t sure what I was expecting,” said Captain Trimble, “except that I heard about simulation training before and it was nothing but positives.”

When pediatric emergency calls only make up, on average, 10% of emergency calls, it becomes very apparent that simulation is an integral teaching method. In general, it’s a good thing that pediatric emergency calls are rare. It means that injury prevention and vaccination programs are working. The inadvertent outcome though is that EMS professionals do not have the same familiarity with pediatric emergency care as with adult emergency care.

“You get the pediatrics that have been sick for 2 or 3 days, vomiting, diarrhea, and they get hypovolimic, they’ve lost all their fluid and their heart rate has skyrocketed,” said Captain Trimble, “They get altered mental status, listless and they’re sick, they’re bad.”

In Captain Trimble’s Pedi-STEPPs class, he and other firemen from his district trained in scenarios which mimicked these types of high-risk/low-frequency calls.

“The one thing that stood out for me was the hands-on training for the guys. The simulation, you could listen to them breathe, you could see signs and symptoms of what’s going on, you could take their blood pressure, you could take their pulse. It was real life. It wasn’t training that you had to imagine,” explained Captain Trimble.

Captain Trimble knows from being in the field for 16 years that you never know what call you are going to get. During

the interview, he recalled when he responded to a call of a 5 year old boy in full cardiac arrest. CPR was started along with establishing IV access. “We were attempting to intubate him, and I saw something in his trachea. I got the Magill forceps out and proceeded to pull out an inch long piece of hotdog.” His boy’s parents had no idea he had choked on a piece of hotdog. The piece of hotdog was removed, he was intubated, drugs were administered, and finally they got a pulse.

Looking back at the debriefing, Captain Trimble observed, “It was very good for us, as a group to see the mistakes we may have made, or the things that we did well. The debriefing was definitely worth going over and seeing, usually we don’t have that. It was a teaching moment.”

“I wish we would have had this training years ago, I’m hoping that everyone in the Houston Fire Department goes through that same training that we did,” said Captain Trimble, “We all said that this was excellent training for what we do in the field.”

Through the two year Pedi-STEPPs curriculum, the faculty will also be conducting several research projects. One will be looking at the knowledge gained – assessing pre and post test results to find out if the firefighters have learned more about how to manage the pediatric patient through the Pedi-STEPPs simulation training. A different study will be looking at patient safety data, reviewing pediatric cases to find out if the Pedi-STEPPs curriculum is improving emergency pediatric care.

“By providing this type of training to the Houston Fire Department, we’re making sure pediatric patients and their families receive the best possible care, from the moment help arrives,” said Dr. Arnold.

In the future, the Pedi-STEPPs faculty hopes to include obstetrical emergencies and emergencies involving technology-dependent pediatric patients.

For more information about Pedi-STEPPs, please visit www.texaschildrens.org.

http://www.texaschildrens.org