Award Candidate Poster Presentation


Implementation of pediatric emergency in situ simulations in Latvia

Tuesday, May 15
09:45 - 10:45
Location: Saturn 1&2

Background: : Pediatric emergency medicine is not recognized as a separate subspecialty in Latvia and most emergencies are attended by general pediatricians or pediatric surgeons, while more severe cases are treated by pediatric intensivists. Recent pediatric readiness assessment has demonstrated the need for more formal training in pediatric emergency management of the staff of the only pediatric children’s hospital in Latvia.

Research Question: : Our aims were to (i) train the multidisciplinary team in pediatric emergencies, (ii) evaluate their confidence, technical skills and teamwork and (iii) assess quality of simulation delivery.

Methodology: : We carried out a prospective observational study using in situ simulation. During the study we implemented a monthly in situ simulation training program in the Emergency Department of Children's Clinical University Hospital - the only pediatric hospital in Latvia with a patient volume of about 70 000 annual visits. Eight different scenarios were used during 11 in situ simulation sessions including hypovolemic shock, septic shock, hemorrhagic shock, seizure, ventricular fibrillation, drowning, anaphylaxis and diabetic ketoacidosis. Participants were 8 pediatricians, 4 pediatric surgeons, 10 residents and 21 nurses. Simulation team assessment tool (STAT) was used to evaluate participants’ technical skills and human factors. Debriefing Assessment for Simulation in Healthcare (DASH) tool was used to assess the debriefing process. Custom questionnaire was used to analyze medical staff confidence in a critical situation.

Results: : The average score for STAT was 74 ±15%. The highest STAT score was achieved in septic shock scenario - 89%, compared to VF scenario were score was only 59%. According to DASH scores participants rated debriefing as very good or outstanding in the majority of dimensions. Only in 6 out of 23 positions 23% of participants evaluated part of debriefing as average or poor. DASH values remained high (6.4 average) throughout the project. Most doctors (N=19; 86%) reported not being completely confident while performing advanced life support in a critical situation, whereas majority of nurses reported as being completely confident in 3/8 dimensions provided. Feedback by all participants showed that the major benefits of the simulation were practice of technical skills and teamwork in real-life environment. All participants were willing to take part in simulations more often.

Discussion/Conclusions: : The feedback was extremely positive from both physicians and nurses, as well as from hospital managers. Participants found in situ simulations as a worthwhile tool to practice their skills, teamwork and to be more confident in critical situations.

Luize Bidina, MD

Pediatric resident
Children's clinical university hospital, Riga, Latvia

Dr. Luize Bidina - 3rd year pediatric and children cardiology resident in Children's Clinical University Hospital in Riga, Latvia. Luize is a 2nd year PhD student in Riga Stradins University and her research field is arrhythmogenic cardiomyopathies. Sha has also worked as a senior house officer in the department of cardiology in Great Ormond Street Hospital in London.
Luize initiated pediatric in situ simulation project in Latvia in 2016. It was a challange to use it as a training tool as well as perform research simultaneously, because in situ simulations were a novelty for the medical staff in Latvia. Her team is satisfied with the outcome of the project and hope that in near future their volunteer work will result in a permanent training method in Latvia.


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Baiba Ziemele, MD

Pediatric Resident
Children's Clinical University Hospital, Riga, Latvia

Baiba Ziemele, MD.
Resident in pediatrics and neonatology, Riga Stradins University, Faculty of Continuing Education, Latvia
Resident in Children's Clinical University Hospital, Riga, Latvia
In pediatric simulation since 2017, one of the author of " EUROPE Sim (EUropean Readiness fOr Pediatric Excellence using SIMulation) Latvia", "Implementation of pediatric emergency in situ simulations in Latvia "


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Reinis Upenieks, Mg. Psych.

Quality and Patient Safety consultant
Children's Clinical University hospital, Riga, Latvia


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Madara Blumberga, BSN

Nurse in Pediatric Emergency Medicine
Children's Clinical University hospital, Riga, Latvia


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Isabel T. Gross, MD PhD MPH

Pediatric Emergency Medicine Fellow
Yale University School of Medicine
New Haven, CT

Dr. Gross was born and raised in Germany. She earned her MD and PhD at the Albert-Ludwigs University Freiburg, Germany. Thereafter, she started her pediatric residency in Germany and then moved to the United States to complete a pediatric residency and chief residency at the University of South Florida. During residency, she completed an MPH with a concentration on Disaster Management and Humanitarian Relief at the University of South Florida, Tampa. Dr. Gross is currently a pediatric emergency medicine fellow at Yale University School of Medicine. She is the Chair of the Scientific Review Committee of the INSPIRE pediatric research network as well as the Trainee Liaison of the Emergency Medicine Section, Society of Simulation in Healthcare. She has been active in simulation education and research for five years with a focus on community outreach simulations, tele-simulations, and international simulations.


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Reinis Balmaks, MD PhD

Pediatric Critical Care Attending
Children's Clinical University Hospital, Riga, Latvia

Reinis Balmaks, Dr. med. Assistant Professor, Department of Clinical Skills and Medical Technology, Riga Stradins University; Consultant, Paediatric Intensive Care Unit, Children's Clinical University Hospital, Riga.

Dr. Reinis Balmaks works in Paediatric Intensive Care Unit at Children’s Clinical University Hospital and teaches medical students at Riga Stradins University. Dr. Balmaks earned medical degree at RSU in 2007. After medical studies he did residency in paediatrics at Children’s Hospital in Riga and then two fellowships in paediatric critical care medicine – at St. Louis Children’s Hospital, US, and Great Ormond Street Hospital, UK. In 2014 Dr. Balmaks earned Dr. med. at RSU. Currently, his research interests are paediatric intensive care epidemiology and outcomes and technology enhanced medical education. Dr. Balmaks studies more effective to improve educational experience and uses simulations as environment for clinical studies.


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Catherine Allan, MD

Associate Program Director - Simulator Program
Boston Children's Hospital
Boston, Massachusetts

Catherine Allan, MD is the Associate Program Director of the Simulator Program and Medical Director of the Cardiac Intensive Care Unit at Boston Children’s Hospital. Over the last 10 years she has helped to develop a robust, interdisciplinary program in ECMO Simulation at Boston Children’s Hospital. Dr. Allan has translated this model to other insitutions on both a National and International level to help these programs build new clinical ECMO Programs. She has published on the use of ECMO Simulation Skills Training and on clinical outcomes following ECMO support in the congenital heart disease population and has presented on ECMO simulation at multiple National and International Meetings.


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Implementation of pediatric emergency in situ simulations in Latvia


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