Implementing an Educational Model for Cardiac Arrest Patients During Interfacility Transfers

TL;DR

This study developed and tested a virtual training program for EMS workers on post-cardiac arrest care during patient transfers, showing improved knowledge and perceived value.

Contribution

A feasible virtual curriculum for post-ROSC care during interfacility transfers, not covered by existing protocols.

Findings

75% of participants completed the virtual curriculum, showing high feasibility.

Participants improved their knowledge of post-ROSC care by an average of 2.125 correct answers.

70% of participants believed the curriculum would improve patient care.

Abstract

Background

Out-of-hospital cardiac arrest (OHCA) is a significant health concern in the United States, particularly in rural areas where patient care often depends on interfacility transfers (IFTs) to tertiary medical centers. In Maine, OHCA outcomes vary widely across regions, with no standardized education or protocols for the IFT of these patients. A key step toward improving care for this population is providing emergency medical service (EMS) personnel with education on essential aspects of post-return of spontaneous circulation (ROSC) management. To address this need, we developed a pilot virtual curriculum focused on post-ROSC care during IFT. The curriculum was designed to be virtual due to restrictions on in-person didactics at the time of implementation during the COVID-19 pandemic. This study aims to evaluate the feasibility of implementing a virtual curriculum that can be easily distributed. Additionally, we seek to analyze pre- and post-survey data from EMS personnel to assess changes in confidence, anxiety, and knowledge related to post-ROSC care.

Methods

Two local EMS departments, which handle the majority of IFTs for our institution, were invited to participate in the virtual educational model. The model consisted of a 27-minute recorded session divided into sections and distributed via an online platform in collaboration with Maine EMS. To assess the impact of the curriculum, EMS personnel completed electronic surveys administered through REDCap. A pre-survey was conducted before the curriculum, followed by a post-survey after its completion. The survey included questions measured on a 5-point Likert scale, covering confidence in resuscitation (five questions), anxiety during resuscitation (six questions), knowledge about post-ROSC care (eight questions), and attitudes toward the curriculum (three questions). Data analysis was performed using the Wilcoxon paired signed rank test to evaluate changes across these variables.

Results

A total of 18 EMS personnel participated in the curriculum (18/24; 75%), with all 18 completing the pre-survey and 10 completing the post-survey. Among those who completed both surveys, 70% agreed or strongly agreed that the IFT curriculum would improve patient care. Regarding knowledge of post-ROSC care, participants showed a mean improvement of +2.125 correct answers across the eight knowledge-based questions, with an average post-survey score of 6/8 (75%). However, there were no significant changes in confidence, skill, or anxiety levels, as indicated by a p-value of >0.9.

Conclusions

This pilot curriculum demonstrated the feasibility of delivering and completing a virtual educational model for EMS personnel on a topic not currently covered by Maine’s state protocols or existing educational programs. Pre-post survey results indicated some improvement in participants; knowledge of post-ROSC care, and 70% believed the curriculum would enhance patient care. Future efforts are underway to integrate this content as a permanent component of local EMS education, given the significant role of ROSC management during IFTs.