Abstract
Background:Lower extremity trauma during earthquakes accounts for the largest burden of geophysical disaster-related injuries. Insufficient pain management is common in disaster settings, and regional anesthesia (RA) has the potential to reduce pain in injured patients beyond current standards. To date, no prospective research has evaluated the use of RA in a disaster setting. This cross-sectional study assesses knowledge translation and skill acquisition outcomes for lower extremity RA performed with and without ultrasound guidance among a cohort of Médecins Sans Frontières (MSF) volunteers who will function as proceduralists in a planned randomized controlled trial evaluating the efficacy of RA for pain management in an earthquake setting.Methods:Generalist humanitarian healthcare responders, including both physicians and nurses, were trained in ultrasound guided femoral nerve block (USGFNB) and landmark guided fascia iliaca compartment block (LGFICB) techniques using didactic sessions and interactive simulations during a one-day focused course. Outcome measures evaluated interval knowledge attainment and technical proficiency in performing the RA procedures. Knowledge attainment was assessed via pre- and post-test evaluations and procedural proficiency was evaluated through monitored simulations, with performance of critical actions graded by two independent observers.Results:Twelve humanitarian response providers were enrolled and completed the trainings and assessments. Knowledge scores significantly increased from a mean pre-test score of 79% to post-test score of 88% (p<0.001). In practical evaluation of the LGFICB, participants correctly performed a median of 15.0 (Interquartile Range (IQR) 14.0-16.0) out of 16 critical actions. For the USGFNB, the median score was also 15.0 (IQR 14.0-16.0) out of 16 critical actions. Inter-rater reliability for completion of critical actions was excellent, with inter-rater agreement of 83.3% and 91.7% for the LGFICB and USGFNB evaluations, respectively.Discussion:Prior to conducting a trial of RA in a disaster setting, providers need to gain understanding and skills necessary to perform the interventions. This evaluation demonstrated attainment of high knowledge and technical skill scores in both physicians and nurses after a brief training in regional anesthesia techniques. This study demonstrates the feasibility of rapidly training generalist humanitarian responders to provide both LGFICB and USGFNB during humanitarian emergencies.
Highlights
Lower extremity trauma during earthquakes accounts for the largest burden of geophysical disasterrelated injuries
This study demonstrates the feasibility of rapidly training generalist humanitarian responders to provide both landmark guided fascia iliaca compartment block (LGFICB) and ultrasound guided femoral nerve block (USGFNB) during humanitarian emergencies
Study Design Setting and Population. This crosssectional study was designed to evaluate the efficacy of a focused training in regional anesthesia for lower extremity injuries provided to Médecins Sans Frontières (MSF) volunteers who will serve as research proceduralists in a future randomized controlled trial (RCT) of RA for pain management in earthquake victims[21]
Summary
Between 1994 and 2013, approximately 7000 natural disasters were reported, affecting more than 200 million people and accounting for over one million deaths globally. Prior studies have demonstrated that regional anesthesia (RA) is a rapid and safe method for reducing pain caused by lower extremity trauma, and as such may have a role in improving pain management during the acute response phase of a major earthquake[11,12,13,14,15]. Limited prior research on training nonspecialist providers in RA in prehospital and emergency department settings has demonstrated successful skill attainment[24,25,26,27] This evidence supports the concept of generalist humanitarian providers being capable of performing RA, no data exists pertaining to this population, who provide care in unique practice environments. Assesses knowledge translation and skill acquisition for simulated lower extremity RA performed both with and without ultrasound guidance by a cohort of MSF association members and describes the focused training methodology used
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