State Spotlight: How Missouri EMSC leverages partnerships for a statewide simulation program

For the past four years, Missouri’s EMSC Program has been led by manager Dani Zoellner, EMT-P, who is making significant strides in pediatric education. One of Zoellner’s most notable projects is the Pediatric Simulation Training program, now in its third year, which is creating positive change throughout the state, in part through strong partnerships with local children’s hospitals.

What does Missouri’s simulation training involve?

Missouri EMSC offers Pediatric Simulation Training for EMS and ED personnel across the state. Facility requirements to host the training are minimal, making it accessible to a range of hospitals and agencies. Missouri EMSC collaborates with Cox Health EMS, which provides high-fidelity manikins and a specialized operator for simulation events each year. EMSC also partners with local children’s hospitals, including Cardinal Glennon Children’s Hospital in St. Louis and Children’s Mercy in Kansas City (both Pediatric Pandemic Network [PPN] sites), to supply expert educators at each SIM location. These educators are aligned with EMSC’s mission to enhance Pediatric Readiness, with Missouri EMSC covering their travel expenses and their home institutions supporting their time commitment.

Simulations are conducted annually, with comprehensive assessments every two years. Lake Regional was the first facility to undergo a full simulation in 2022, and it recently completed its two-year renewal. In alternating years, hospitals receive a Pediatric Emergency Evaluation Checklist analysis, which provides a roadmap for improvement based on simulation outcomes.

How did this program start?

The Pediatric Simulation Program has been running for three years and is planning five simulations for 2025. Organizing each simulation requires significant coordination from host hospitals, which are responsible for attending planning meetings, assembling rosters, forming participant groups, ensuring physician attendance, and obtaining sign-offs from their chief medical officer or chief nursing officer. While many hospitals express interest, some fall off due to these planning requirements. This structure, however, ensures institutional buy-in and a commitment to improving Pediatric Readiness.

How have you partnered with PPN?

We credit the program’s success to our longstanding relationships with Missouri’s children’s hospitals. When both children’s hospitals became PPN sites, it was a natural extension of their ongoing collaboration. The PPN relationship has allowed Missouri EMSC to increase educator support through additional positions. Each PPN site has identified three hospitals it aims to work with in 2025, and these facilities will receive invitations to participate as simulation sites.

What are the rewards and challenges of this program?

One of the most rewarding aspects of this program is watching hospitals improve their pediatric care practices over time. Lake Regional is a prime example: two years ago, their initial Pediatric Emergency Evaluation Checklist analysis highlighted numerous areas for improvement. Under the leadership of PECC Megan Lawrence, RN, Lake Regional systematically addressed these gaps. Now, the hospital has transformed into a Pediatric Ready facility, extending improvements from the ED to the ICU and inpatient floors. This simulation training led the hospital to join the National Pediatric Readiness Quality Improvement Initiative, establish a PECC committee, require PALS (Pediatric Advanced Life Support) for all staff, and garner strong physician support.

However, engaging hospitals in the program can be challenging. While the simulation training offers significant benefits, hospitals must handle a substantial portion of the administrative workload. In the early stages, Zoellner and her team managed these tasks, but found that without hospital involvement, attendance was low. By requiring hospitals to be part of the planning process, buy-in and participation have increased.

What’s next for Missouri’s EMSC Program?

The Pediatric Simulation Training program was developed to provide not only hands-on training but also a structured improvement plan for each hospital. The Pediatric Emergency Evaluation Checklist analysis serves as a two-year guide, helping hospitals make continuous improvements in pediatric emergency care. Looking ahead, Missouri EMSC is also developing a pediatric emergency care course for 2025, which will focus on essential training for managing critically ill children. The course will be free and offer CME credits for nurses and physicians, further supporting hospitals interested in Missouri’s Facility Recognition Program.

With programs like these, Missouri’s EMSC is creating meaningful changes in pediatric readiness across the state, and the impact is only expected to grow in the years to come.

If you would like to learn more about Missouri’s EMSC program you can visit its website or contact Zoellner at leedani@health.missouri.edu.