PC1048: Tailored Neonatal Resuscitation Curriculum for Emergency Medical Services (EMS) to Improve Out-of-hospital Newborn Care

Purpose/Objectives: Out-of-hospital births are associated with a 2 to 11-fold increase risk of death compared to in-hospital births. EMS personnel have limited exposure to manage out-of-hospital birth emergencies. Our prior research found deficiencies in critical steps of warming and drying, and initiating bag mask ventilation(BMV) for a newborn in distress.

Currently there is no standardized curriculum for neonatal resuscitation for medical providers who work outside of the hospital environment. Neonatal Resuscitation Program(NRP) guidelines are the standard of care for infants born in the United States(US) but assume resources that are available only in hospitals.

Design/Methods: We developed an EMS-tailored, NRP-based educational curriculum focusing on the critical initial steps of newborn resuscitation in the out-of-hospital setting, with feedback from EMS medical directors and EMS educators. The 90-minute interactive virtual curriculum (due to COVID-19) begins with an NRP-based didactic going over the NRP algorithm, with focus on the initial steps, as well as memory aids (i.e. count of BMV rate is like ballroom dancing). Teaching points are reinforced with videos demonstrating the actions. Following the lecture there are hands-on skill stations to practice "warm, dry, stimulate” and perform breathing assistance with bag mask ventilation, including correct ventilation rate and volume delivery. The skill stations reinforce muscle memory for the information learned. At the end of each training session participants were asked to complete a survey (via a QR code) assessing the curriculum based on a Likert-scale (0=very unlikely, to 10=highly likely).

Results: 69 EMS agencies, representing 350 EMS providers, participated in this multi-agency training event that occurred over 3 days in December 2021. The majority of providers took part in training as groups from their firehouses. Eighty-nine percent (313/350) of participants responded to the curriculum assessment survey. Eighty-three percent would highly recommend the training to other EMS agencies, 91% reported they would change their clinical practice based on the training, and 76% found the course valuable relative to other EMS education. Sixty-six percent of participants would prefer the training to be in-person, citing more effective hands-on skills training, less disruptions from station calls, other learners talking while muted on screen, and no concerns about Wi-Fi connectivity. However,13% preferred the virtual format stating it’s “a great way to provide a lot of training to a lot of people,” and provided “speed and efficiency with which we can get through material” and 21% reported no preference.

Conclusion/Discussion: Out-of-hospital births are high-stakes, low-frequency events. Out of hospital births have been increasing, likely due to the pandemic. Our EMS-tailored, NRP-based educational curriculum was well received and accessible, and could potentially better prepare EMS teams for out-of-hospital birth resuscitation.