Abstract
BackgroundPrehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial.MethodsWe conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients’ prehospital trauma charts. Thresholds for progression to a main trial were developed a priori.ResultsThe average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated—there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study.ConclusionsWe successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial.
Highlights
Prehospital care can reduce morbidity and mortality from trauma
We successfully implemented the emergency medical services (EMS)-Traumatic shock care (TruShoC) educational intervention using the High-Efficiency EMS Training (HEET) training strategy in a single-site pilot study conducted in a low-resource international setting
In 2016, we developed a novel educational intervention of bundled trauma care, which is implemented using a novel training strategy based on adult-learner principles
Summary
Prehospital (ambulance) care can reduce morbidity and mortality from trauma. There is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. Injured persons in low-and-middle income countries experience a disproportionately large burden (over 90%) of postinjury death and disability [1,2,3,4]. High-quality prehospital (i.e., ambulance-based) care is a critical component of trauma care. Prehospital care can avert 54% of all mortality from emergency conditions, including trauma, in low-and-middle income countries [5]. Despite existence of evidence-based interventions, such as on-scene hemorrhage control and maintaining short scene times, few effective implementation strategies exist to introduce interventions into clinical practice in this setting [6,7,8]
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