This document proposes improving the realism and effectiveness of Pediatric Advanced Life Support (PALS) courses through the use of low-cost smart simulation tools and involving children. It suggests introducing tablet patient monitors, realistic sound sequences, and the integration of real children into training to better mimic clinical reality. A study is proposed to compare standard PALS training to training using these extended tools, measuring educational impact and potentially linking it to improved patient outcomes. The goal is to learn how to best implement PALS training with limited budgets to enhance learning and save children's lives.

1. Improving realism of PALS-courses with smart
simulation tools & children
Burkhard J. Wermter1
Jenny Siebdrat1,2
Ina Geisler1
Michael Weldi1,3
Rudolf Janz1,3
Stefan Oppermann4
Ella Scott5
Ruth Lollgen5
Becky Damazo6
Tex Kissoon7
Aaron Donoghue8
Paul Lecat9
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Pediatric Simulation Research Collaborative South Tyrol (ITA)
PICU Medical School Hannover (DEU)
Med-Sta Graz (AUT)
IFN Institute for Emergency Medicine Hamburg (DEU)
Kim Oats Australian Paediatric Simulation Center, Sydney (AUS)
Rural SimCenter CSU Chico (USA)
World Federation of Pediatric Intensive & Critical Care Societies
Children’s Hospital of Philadelphia (USA)
Clinical Pediatrics / Internal Medicine, Northeast Ohio Medical University (USA)
INSPIRE @ IMSH 2014:
San Francisco, California,USA
International Network for Simulation-based Pediatric Innovation, Research and Education

2. Background 1
• With the program “Helping Babies Breathe”,
we have learned that implementation of welldesigned, low-cost training is lowering
newborn mortality.
• What can we learn to improve implementation
of Pediatric Advanced Life Support (PALS)
courses elaborated by EXPRESS-study group
with low budget simulation?
International Network for Simulation-based Pediatric Innovation, Research and Education

3. Background 2
• How imitate clinical reality?
• 1) images of real ill patients (video clip)
• 2) a vital parameter monitor (app for tablet PC)
• 3) registered sound (heart and lung) from real patients. Sequences of
evolution
• 4) more realistic maniquins in key issues: behaviour of ventilation
(NeoNathalie/infant CPR anytime) and weight/temperature
• 5) real children (respiratory and Trauma scenarios)
• 6) change of skin colour
• 7) a cloud of perceptions creates mental processes which lead to decisions
and actions
3

4. Background 3
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5. PICO Question
• P: Children from birth to puberty
• I: Training intervention
• C: Compare standard training with
extended training
• O:Better clinical outcomes post training
International Network for Simulation-based Pediatric Innovation, Research and Education

6. Approach / Design
• Only use of BLS- and ALS mannequins during
PALS courses. Limitate the budget.
• Introduction of tablet patient monitors an all PALS
stations.
• Use of real sound sequences on 2 of 3 practical
stations comparing learning outcomes of students
in differently equipped teaching stations.
• Integration of real children.
• Change of skin colour
International Network for Simulation-based Pediatric Innovation, Research and Education

7. Approach / Design 2
Further information:
1) tablet Patient Monitor: SimMon www.castleandersen.dk
DART sim http://ecg-simulator.com
2) sound sequences: Ventriloscope www.ventriloscope.com
3) RealChildren in Simulation: webinar, poster, video
• webinar: http://ipss.adobeconnect.com/p9ohhths9dx/
• Poster: www.provinz.bz.it/se/west/mup-paednotmed/poster_real_children_in_simulation_SESAMALASIC_Coimbra2009_081109final.pdf
• video:
http://www.provinz.bz.it/se/west/mup-paednotmed/orf.
International Network for Simulation-based Pediatric Innovation, Research and Education

8. Timeline
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ALERT Presentation: IMSH Jan. 2014 – San Francisco (USA)
Grant Proposal (if applicable): after IPSSW Apr. 2014 Vienna (A)
IRB Submission: spring/summer 2014
Recruitment / Data Collection:
– Pilote project: June 2013 – April 2014
– Training of instructors June – October 2013
– First formal PALS courses with extended tools in Dec. 2013 and Jan. 2014 with
participants and instructors from Italy, Switzerland, Austria and Germany at
Brixen/Southtyrol (Italy) www.brixen.org European Alpine space area and EU-Regio Tirol
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Study: summer 2014 – winter 2015
Data Analysis: winter/spring 2015
Abstract Presentation: IPSSW 2015
Manuscript Preparation : spring 2015
International Network for Simulation-based Pediatric Innovation, Research and Education

9. 3 Questions to improve study
1. Search for more trial centers: How
would you like to participate?
2. How can we improve measurement of
educational impact?
3. Can we link educational impact &
patient outcome?
International Network for Simulation-based Pediatric Innovation, Research and Education

10. Contact Information
Burkhard J. Wermter
PSRCS Pediatric Simulation Research
Collaborative Southtyrol
psrc_suedtirol@outlook.com
+39 380 680 6021
www.provinz.bz.it/se/PaedNotmed
International Network for Simulation-based Pediatric Innovation, Research and Education

11. Appendix
• HBB: http://www.helpingbabiesbreathe.org/docs/HBB%20Tanzania.pdf
• EXPRESS: http://www.inspiresim.com/index.php/default.html
• 1st PALS-AHA/AAP-course after official release in Oct. 2011 (page
6): http://www.sesam-web.org/index.cfm?event=downloadfile&famid=294992
• IMPLEMENTATION OF SIMULATION WITH NEW BUISINESS
MODELS
http://www.provinz.bz.it/se/west/mup-paednotmed/Paedsim_ipssw2011mix.pdf
• A PAEDIATRIC SIMULATION BASED COURSE FOR ALL
BUDGETS:
http://www.provinz.bz.it/se/west/mup-paednotmed/Paedsim_sydney_toulouse.pdf
International Network for Simulation-based Pediatric Innovation, Research and Education