Using the Evidence-Development-Validation-Consensus (EDVC) Approach to Develop and Validate maxSIMdrone: A Training Program for Healthcare Professionals to Provide Cardiac Arrest Care Using Drones.

Introduction The challenges of delivering cardiac arrest (CA) courses in rural and remote (R&R) locations worldwide have been further exacerbated by the COVID-19 pandemic. However, it is important to note that this problem has always existed. The implementation of social distancing measures to combat the pandemic has had a significant impact on healthcare and medical education, particularly in relation to the training of students, laypeople (LP), and healthcare professionals (HCPs) in CA care. The combination of pandemic restrictions and pre-existing difficulties faced in R&R locations and large cities has disrupted the provision of comprehensive medical education. The suspension of basic life support and defibrillation (BLSD) courses during the pandemic may have negatively affected pre-hospital care for CA. However, it is essential to acknowledge that challenges in delivering these courses in R&R areas predate the pandemic. Materials and methods A 2021 epidemiological study in the Brazilian Amazon identified CA as the primary cause of death, followed by COVID-19. This highlights the importance of providing BLSD courses and training to emergency medical service (EMS) personnel in R&R locations. Even during a pandemic. Researchers from Ontario Tech University and Memorial University School of Medicine developed a drone with a simulation scenario to train HCPs in automated external defibrillators (AED) operation and guide LP in safe use through BLSD protocols. A literature review showed that different training methods yielded similar outcomes. Based on these findings, the evidence-development-validation-consensus (EDVC) hybrid approach was used to develop and validate an online training program using a learning management system (LMS) as a model. Results Teaching HCPs and LP in R&R locations, such as northern Canada and the Brazilian Amazon, presents challenges due to limited resources and internet access. One potential solution lies in the utilization of remote online LMS that facilitate the administration, documentation, tracking, reporting, automation, and delivery of educational courses and training programs. The literature review indicated that mixed training approaches, including face-to-face, online, and hybrid formats, produced similar outcomes in learning assessment, self-confidence, performance, skills, and knowledge acquisition. These findings support the viability of using LMS as a model to develop and validate a course where drones deliver AEDs and provide training to HCPs and LP in R&R locations. A comprehensive training program should encompass cognitive, affective, and psychomotor learning domains, addressing various skills and knowledge aspects. Conclusion This research study develops and validates LMS teaching methods to support a training program for HCPs and LP in using AEDs delivered by drones. The program combines design-based research and consensus development methods, such as design thinking and think-aloud observations. Drones are used to provide AEDs and develop simulation scenarios for training in R&R locations. The hybrid approach ensures a valid and evidence-based training program. The study presents the EDVC approach used to enhance the maxSIMdrone training program, enabling effective out-of-hospital CA care. The program incorporates participant feedback and improves knowledge and techniques in AED use. It has the potential to improve patient outcomes in resource-limited R&R locations.

Comparing Learning Outcomes in Cardiopulmonary Resuscitation (CPR) and/or Automated External Defibrillator (AED) Training for Laypeople in Face-to-Face, Online, and Mixed Training Methods: An Integrative Literature Review.

Cardiovascular diseases and cardiac arrest (CA) are the main causes of death worldwide. This review aims to identify publications on the learning outcomes for the use of an automated external defibrillator (AED) and/or cardiopulmonary resuscitation (CPR) to train laypeople (LP), the method of training used, the year of publication and their recommendations. We employed Miller's assessment pyramid to describe learning outcomes as knowledge, skills, and confidence. The methods of training are face-to-face, online, and mixed. The evidence found in this study will be used to support the development and validation of a simulation-based training program to teach LP to operate AEDs delivered by drones in rural and remote (R&R) locations. This article is an integrative literature review with a quantitative and qualitative research design and is composed of seven steps: research question, inclusion and exclusion criteria, search and selection of studies, the role of a second reviewer of the findings, data analysis, interpretation and discussion of the results, and finally knowledge synthesis. The results of this review demonstrate that there are no significant differences in the learning outcomes of the different training methods. Since these findings suggest good results in all methods, the development of a training program based on face-to-face, online, and mixed, especially for places with few resources such as R&R places, indicates all methods can be used as good practices to develop training programs.

Hands-On Practice on Sustainable Simulators in the Context of Training for Rural and Remote Practice Through a Fundamental Skills Workshop.

Simulation-based education (SBE) is a sustainable method to allow healthcare professionals to develop competencies in clinical skills that can be difficult to maintain in rural and remote settings. Simulation-based skills training is necessary for healthcare professionals that experience difficulties accessing skills development and maintenance courses to address the needs of rural communities. However, simulators, a key element of simulation, are often prohibitively expensive and follow a "one-size-fits-all" approach. Using additive manufacturing (AM) techniques, more specifically three-dimensional (3D) printing, to produce inexpensive yet functional and customizable simulators is an ideal solution for learners to practice and improve their procedural skills anywhere and anytime. AM allows for the customization of simulators to fit any context while reducing costs and is an economic solution that moves away from the use of animal products to a more ethical, sustainable method for training. This technical report describes the delivery of a fundamental skills workshop to provide hands-on training to rural and remote healthcare professionals using 3D-printed simulators purposefully designed following design-to-cost principles. The workshop was delivered at a three-hour session hosted at a rural and remote medicine course in Ottawa, Canada. The workshop consisted of four technical skills: suturing, cricothyrotomy, episiotomy, and intraosseous infusion (tibial) (IO) and used a blended learning approach to train healthcare professionals and trainees who practice in rural and remote areas. In addition, the learners were granted access to a custom-designed learning management system, which provided a repository of instructional materials, and enabled them to record and upload personal practice sessions, review other learners' practice sessions, collaborate, and provide feedback to other learners. The feedback collected from participants, instructors, and observations on the delivery of the workshop will help improve the structure and training provided to learners. The delivery of this workshop annually is an ideal solution to ensure parsimonious delivery of simulation training for rural and remote healthcare professionals.

The Development and Initial End-Point User Feedback of a 3D-Printed Adult Proximal Tibia IO Simulator.

Intraosseous infusion (IO) remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients. In rural and remote areas, shortage of training equipment and human capacity (i.e., simulators) are the main contributors to the shortage of local training courses aiming at the development and maintenance of IO skills. Specifically, current training equipment options available for trainees include commercially available simulators, which are often expensive, or animal tissues, which lack human anatomical features that are necessary for optimal learning and pose logistical and ethical issues related to practice on live animals. Three-dimensional (3D) printing provides the means to create cost-effective, anatomically correct simulators for practicing IO where existing simulators may be difficult to access, especially in remote areas. This technical report aims to describe the development of maxSIMIO, a 3D-printed adult proximal tibia IO simulator, and present feedback on the design features from a clinical co-design team consisting of 18 end-point users.  Overall, the majority of the feedback was positive and highlighted that the maxSIMIO simulator was helpful for learning and developing the IO technique. The majority of the clinical team responders also agreed that the simulator was more anatomically accurate compared to other simulators they have used in the past. Finally, the survey results indicated that on average, the simulator is acceptable as a training tool. Notable suggestions for improvement included increasing the stability of the individual parts of the model (such as tightening the skin and securing the bones), enhancing the anatomical accuracy of the experience (such as adding a fibula), making the bones harder, increasing the size of the patella, making it more modular (to minimize costs related to maintenance), and improving the anatomical positioning of the knee joint (i.e., slightly bent in the knee joint). In summary, the clinical team, located in rural and remote areas in Canada, found the 3D-printed simulator to be a functional tool for practicing the intraosseous technique. The outcome of this report supports the use of this cost-effective simulator for simulation-based medical education for remote and rural areas anywhere in the world.

The PHOENIX: Design and Development of a Three-Dimensional-Printed Drone Prototype and Corresponding Simulation Scenario Based on the Management of Cardiac Arrest.

Sudden cardiac arrest (SCA) remains one of the most prevalent cardiovascular emergencies in the world. The development of international protocols and the use of accessible devices such as automated external defibrillators (AEDs) allowed for the standardization and organization of medical care related to SCA. When defibrillation is performed within five minutes of starting ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT), the victim survival rate has increased considerably. Therefore, training healthcare professionals to use AEDs correctly is essential to improve patient outcomes and response time in the intervention. In this technical report, we advocate simulation-based education as a teaching methodology and an essential component of drone adaptation, novel technology, that can deliver AEDs to the site, as well as a training scenario to teach healthcare professionals how to operate the real-time communication components of drones and AEDs efficiently. Studies have suggested that simulation can be an effective way to train healthcare professionals. Through teaching methodology using simulation, training these audiences has the potential to reduce the response time to intervention, consequently, increasing the patient's chance of surviving.

Automated Inflating Resuscitator (AIR): Design and Development of a 3D-Printed Ventilator Prototype and Corresponding Simulation Scenario Based on the Management of a Critical COVID-19 Patient.

Recent surges in COVID-19 cases have generated an urgent global demand for ventilators. This demand has led to the development of numerous low-cost ventilation devices, but there has been less emphasis on training health professionals to use these new devices safely. The aim of this technical report is twofold: first, to describe the design and manufacturing process of the automated inflating resuscitator (AIR), a 3D-printed ventilator training device which operates on the principle of pushing a bag valve mask; second, to present a simulation scenario that can be used for training health professionals how to use this and similar, low-cost, 3D-printed ventilators in the context of ventilator shortages caused by COVID-19. To this end, the AIR was designed in an expedient manner in accordance with basic functionality established by the Medicines and Healthcare Products Regulatory Agency (United Kingdom) for provisional clinical use in light of COVID-19.

Prehospital Trauma Care: A Simulation Scenario for Rural-Based Healthcare Providers.

Trauma is a major cause of premature death and disability worldwide, with a disproportionate number of deaths occurring in rural and remote areas. Prehospital care is a key link in the chain of trauma survival and its role may be currently underestimated. Therefore, addressing deficiencies in prehospital trauma care may help to improve outcomes. Several potential solutions have been proposed to address the disparities that exist in rural prehospital trauma care, some of which focus on educational endeavors. Simulation-based medical education (SBME) is one cost-effective strategy to train healthcare providers in high-acuity, low-opportunity (HALO) scenarios, such as those encountered during major trauma. The aim of this technical report is to present a mass casualty simulation scenario that is intended for healthcare providers in rural and remote locations to refine their skills and comfort level with such cases. It emphasizes prehospital trauma management and effective communication skills among healthcare teams, which are two key elements in improving trauma outcomes.

The Importance of Personal Protective Equipment Design and Donning and Doffing Technique in Mitigating Infectious Disease Spread: A Technical Report.

During the current coronavirus pandemic, significant emphasis has been placed on the importance of mitigating nosocomial spread of coronavirus disease 2019 (COVID-19). One important consideration involves the appropriate use of effective personal protective equipment (PPE), which may reduce a healthcare provider's likelihood of becoming infected while simultaneously minimizing exposure to other patients that they care for. This may reduce demands placed on the healthcare system and help to preserve the workforce. First, the importance of PPE design cannot be underestimated, as the manufacturing process must strive to maximize protection of the user while ensuring adequate comfort. Second, it has been demonstrated that inadequate education and training can significantly impact compliance with PPE recommendations. Technique regarding donning and doffing of PPE is crucial to the protection of those who don it. The purpose of this technical report is two-fold: first, to describe some important considerations in the manufacturing and design process of face shields to maximize protection for healthcare providers, and second, to describe a simulation scenario that may be used to train healthcare workers in the appropriate donning and doffing of PPE.