Applying classical learning theories to quality improvement interventions among mid-level providers in Kenya

Abstract

Program/Project Purpose: El Salvador is one of three Central American countries with no emergency-trained physicians and one of five with no emergency-trained nurses (WHO, 2011). It has the lowest percentage of seriously-injured patients who are transported to hospital by ambulance (WHO, 2011). Given these statistics, there is a significant need for a comprehensive emergency response system, including trauma trained physicians and nurses and a functioning transport system. Emergency care is currently fragmented, with a lack of comprehensive emergency medical services, trauma training and high mortality related to traumatic injuries. Structure/Method/Design: We met with hospital leadership from hospitals in San Salvador, El Salvador and offered Primary Trauma Care (PTC) training. Participating organizations included the Hospital Militar de El Salvador, Hospital Nacional San Rafael, Instituto Salvadoreno del Seguro Social and El Sistema de Emergencias Medicas (SEM). PTC provides a systematic approach to the management of trauma patients. It uses a sustainable train the trainer model and does not require access to high-tech facilities. The curriculum covers the evaluation of trauma patients, the primary and secondary surveys, priorities in resuscitation and stabilization. Simulation cases and skill stations allow participants to practice airway management, immobilization, insertion of intraosseous lines and tube thoracostomy (PTC Manual, 2014). Outcomes & Evaluation: The first course included 38 participants and was conducted at Hospital Nacional San Rafael. It was led by three certified PTC volunteer instructors from Venezuela, Guatemala and Mexico. The course took place over two days. A registration fee was charged to cover the cost of flying the instructors to El Salvador. Glasswing International, a local non-governmental organization, and Hospital Nacional San Rafael provided materials including mannequins, intubation and immobilization equipment. The chest tube station was not offered during the first PTC training as the majority of the participants were surgeons with prior experience in tube thoracostomy. A focused assessment with sonography in trauma (FAST) station was offered instead. This was the first time a FAST skill station was offered at a PTC course in Latin America and the third time in the world. A multiple choice test written by PTC was administered before and after the training. Of those that past the post-test, 19 individuals were selected to complete an additional one day PTC instructor course. Going Forward: The PTC training is a part of a larger program assessing trauma care delivery in El Salvador and the effect on critical outcomes such as door to operating room time and mortality. The new PTC instructors have started offering their own courses, and the su Funding: No funding listed. Abstract #: 02ETC062