Simulation Scenarios
respiratory distress
After training, all teams participated in 3 sequential simulation scenarios. The order of scenario delivery was randomized to eliminate scenario order as a potential confounder. Prior to each scenario, all participants donned personal protective equipment (PPE), consisting of a gown, nitrile gloves, face shield, goggles, and a N95 respirator. Donning of PPE was guided by a standardized PPE donning checklist and checked by a research assistant prior to all scenarios. The equipment within the resuscitation room and PPE was standardized across all sites. All scenarios were 5 minutes in duration and tightly standardized by using a scenario template with scripted patient progression. The 3 scenarios were: (1) scenario A: BVM ventilation; participants were directed to initiate and continue BVM ventilation for an adolescent patient with progressive respiratory distress from suspected COVID-19; aerosolization of particles occurred prior to and during BVM ventilation (eTable 4 in Data collection occurred immediately after each scenario, prior to and after doffing of PPE. Doffing was guided by a PPE-doffing checklist and closely monitored by a research facilitator to ensure no cross contamination. A standardized cleaning protocol was used across sites, with the resuscitation room and manikin cleaned between each scenario and new equipment and PPE used for each scenario. All scenarios were videotaped from a birds-eye view angle at the head of the bed.