The effect of a targeted clinical toxicology training intervention on the diagnostic accuracy and management of paramedics exposed to clinical simulation: a repeated measures study

Abstract

Background – As first contact practitioners in a variety of medical emergencies, paramedics are frequently required to manage a number of toxicological emergencies. Although mortality from poisonings is low, timely and appropriate management can help to prevent subsequent sequelae such as acute coronary syndromes in cocaine toxicity, dangerous arrhythmias after tricyclic antidepressant overdose and regurgitation of gastric content following opioid poisoning. Paramedics potentially have underdeveloped knowledge of toxic syndromes (toxidromes), instead relying on heuristics and experience to manage poisoning emergencies. Moreover formal teaching of pharmacology and toxicology on paramedic undergraduate programmes is not universal, potentially leading to suboptimal management of poisoned patients. Study objectives – To evaluate baseline diagnostic accuracy and management of poisoning emergencies by undergraduate paramedics and the effect of participation in a targeted toxicological training intervention on diagnostic accuracy and management among undergraduate paramedics when assessed through clinical simulation. Methods – The research utilised a two-stage repeated measures design; following completion of a Likert scale questionnaire a cohort of final year undergraduate paramedics from the University of Northamptonshire undertook three 5-minute simulated patient scenarios on a Laerdal SimMan® programmed to display specific clinical signs; a written sheet with a brief history accompanied each scenario. The scenarios were designed to reflect current paramedic practice comprising opioid (scenario 1), tricyclic antidepressant (scenario 2) and beta blocker overdoses (scenario 3). Two weeks after completing the scenarios the cohort attended a targeted 90-minute educational intervention; a further two months later the cohort repeated the scenarios although the order in which the individual cases were encountered was changed.