Abstract

Background
Paramedics face unique challenges when managing paediatric emergencies due to limited clinical exposure, insufficient training, the unpredictable prehospital environment, and scarce resources [1]. These factors increase anxiety and medical error risk, especially during rare, high-stakes events [2]. Simulation-based education (SBE) provides a safe, controlled environment that bridges the gap between  knowledge and practice by allowing learners to rehearse decision-making and technical skills.

Aim
This review assesses the current state of paediatric simulation literature, evaluates the effectiveness of SBE in paramedic training using the Kirkpatrick evaluation framework, and identifies directions for future research.

Methods

A comprehensive search was conducted across PubMed, PsycINFO, CINAHL, ERIC, and Scopus for studies published between 2003 and 2023, using keywords and MeSH terms related to paramedics, prehospital care, paediatrics, and simulation. The review followed  PRISMA 2020 guidelines, and methodological quality was appraised using the Joanna Briggs Institute checklists. Studies were  categorised according to the four Kirkpatrick levels.

Findings
A total of 227 articles were identified, and upon removing duplicates, 184 were screened, and 60 were assessed for eligibility, following which 46 were excluded. In the remaining 14 studies, the use of SBE was generally reported to have had a positive impact on paramedics’ confidence and competence in performing several procedures (Table 1). Several studies reported that paramedics often felt uncomfortable providing care to children, made fewer errors, and wished they had more such training opportunities. No studies reported on how the training interventions contributed to improving actual patient care to fulfil the criteria of Kirkpatrick level 4. The full details of the findings have recently been reported [3].

Conclusion
Simulation shows promise in improving paramedics' readiness for paediatric emergencies, especially knowledge, skills, and  confidence. Future studies should use longitudinal designs to determine whether simulation training improves patient safety and
clinical outcomes.

Author contributions
All authors contributed equally and validated the final version of record.
Acknowledgements
This work was primarily conducted by the first author as part of his Master in Medical Education with Dundee University, Scotland
Declarations
Conflicts Of Interest
The Authors declare that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Registration
No registration applicable.
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Ethical approval
Ethical approval for this study was not required.

References

1.      Yuknis ML, Weinstein E, Maxey H, Price L, Vaughn SX, Arkins T, et al. Frequency of pediatric emergencies in ambulatory practices. Pediatrics. 2018;142(2). https://doi.org/10.1542/peds.2017-3082

2.      Der Sahakian G, Buléon C, Alinier G. Chapter 14 – Educational Foundations of Instructional Design Applied to Simulation-Based Education. In: Chiniara G, editor. Clinical Simulation (Second Edition). Academic Press. 2019:185–206. https://doi.org/10.1016/B978-0-12-815657-5.00014-0

3.      Al Badawi AK, Alinier G, Nashwan AJ, Kunjavara J, Tomeh B. Effectiveness of paediatric simulation in paramedic education: a literature review. International Paramedic Practice. 2025 Aug 2;15(2):43–51. https://doi.org/10.12968/ippr.2025.0001