Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jul 2, 2021
Date Accepted: Aug 8, 2021
Impact of a Mobile App on Paramedics’ Perceived and Physiologic Stress Response During Simulated Prehospital Pediatric Cardiopulmonary Resuscitation: a Study Nested Within a Multicenter Randomized Controlled Trial
ABSTRACT
Background:
Out-of-hospital cardiac arrests (OHCA) are stressful, high-stakes events associated with low survival rates. Acute stress experienced in this situation is associated with lower cardiopulmonary resuscitation performance in calculating drug dosages by emergency medical services (EMS). Children are particularly vulnerable to such errors. No app has so far been validated to specifically support emergency drug preparation by paramedics with the aim of reducing the stress hassle of this procedure and medication errors.
Objective:
This study aimed to determine the effectiveness of an evidence-based mobile app in reducing paramedics’ acute stress both at the psychological and physiological levels compared with conventional preparation methods while safely preparing emergency drugs during simulated pediatric OHCA scenarios.
Methods:
In the context of a parent, multicenter, randomized, controlled trial at 14 EMS, perceived and physiologic stress of advanced paramedics with drug preparation autonomy was assessed during a 20-minute, standardized, fully video-recorded, and highly realistic pediatric OHCA scenario concerning an 18-month-old child. The primary outcome was participants’ self-reported psychological stress perceived during sequential preparations of four intravenous emergency drugs (epinephrine, midazolam, 10% dextrose, sodium bicarbonate) with the support of an app (PedAMINES) designed to help pediatric drug preparation (intervention) or conventional methods (control). The State-Trait Anxiety Inventory (STAI) and Visual Analog Scale (VAS) questionnaires were used to measure perceived stress. The secondary outcome was physiologic stress, measured by a single continuous measurement of participants’ heart rate with optical photoplethysmography using a wrist-worn monitor.
Results:
From September 3, 2019, to January 21, 2020, a total of 150 advanced paramedics underwent randomization. Seventy-four were assigned to the mobile app (intervention group) and 76 without the app (control group). Six-hundred drug doses were prepared. A higher STAI-perceived stress increase from baseline was observed during the scenario using the conventional methods (mean [SD]: 35.4 [8.2] to 49.8 [13.2]; a +41.3% [35.0] increase) than the app (36.1 [8.1] to 39.0 [8.4]; a +12.3% [29.0] increase). This represented a 30.1% [95% CI 20.5-39.8: P<.001] lower relative change in stress response in participants who used the app. On the VAS questionnaire, control group participants reported higher increase of stress at the peak of the scenario (7.1 [1.8] vs 6.4 [1.9]; a -0.8 [95% CI -1.3 to -0.2] difference; P=.005). The increase in heart rate during the scenario and over the four drugs was not different between both groups.
Conclusions:
Compared with conventional method, dedicated mobile apps can reduce acute perceived stress while preparing emergency drugs in the prehospital setting during critical situations. These findings can help advance the development and evaluation of mobile apps for OHCA management and should be encouraged. Clinical Trial: ClinicalTrials.gov Identifier: NCT03921346, https://clinicaltrials.gov/ct2/show/NCT03921346.
Citation
