Impact of primary trauma care (PTC) training on post-trauma recovery: a pre-post intervention study of health-related outcomes in Vietnam.

PISTACHIO (Primary Trauma Care Course Impact & Outcome): A prospective before and after intervention study of the Primary Trauma Care course effect on road trauma morbidity and mortality in two Vietnamese hospitals.

BackgroundThe Primary Trauma Care (PTC) course was originally developed to instruct health care workers in the management of patients with severe injuries in low- and middle-income countries (LMICs) with limited medical resources. PTC has now been taught for more than 25 years. Many studies have demonstrated that the 2-day PTC workshop is useful and informative to frontline health staff and has helped improve knowledge and confidence in trauma management; however, there is little evidence of the effect of the course on changes in clinical practice. The Kirkpatrick model (KM) and the knowledge, attitude, and practice (KAP) model are effective methods to evaluate this question.ObjectiveThe aim of this study was to investigate how the 2-day PTC course impacts the satisfaction, knowledge, and skills of health care workers in 2 Vietnamese hospitals using a conceptual framework incorporating the KAP model and the 4-level KM as evaluation tools.MethodsThe PTC course was delivered over 2 days in the emergency departments (EDs) of Thanh Hoa and Ninh Binh hospitals in February and March 2022, respectively. This study followed a prospective pre- and postintervention design. We used validated instruments to assess the participants’ satisfaction, knowledge, and skills before, immediately after, and 6 months after course delivery. The Fisher exact test and the Wilcoxon matched-pairs signed rank test were used to compare the percentages and mean scores at the pretest, posttest, and 6-month postcourse follow-up time points among course participants.ResultsA total of 80 health care staff members attended the 2-day PTC course and nearly 100% of the participants were satisfied with the course. At level 2 of the KM (knowledge), the scores on multiple-choice questions and the confidence matrix improved significantly from 60% to 77% and from 59% to 71%, respectively (P<.001), and these improvements were seen in both subgroups (nurses and doctors). The focus of level 3 was on practice, demonstrating a significant incremental change, with scenarios checklist points increasing from a mean of 5.9 (SD 1.9) to 9.0 (SD 0.9) and bedside clinical checklist points increasing from a mean of 5 (SD 1.5) to 8.3 (SD 0.8) (both P<.001). At the 6-month follow-up, the scores for multiple-choice questions, the confidence matrix, and scenarios checklist all remained unchanged, except for the multiple-choice question score in the nurse subgroup (P=.005).ConclusionsThe PTC course undertaken in 2 local hospitals in Vietnam was successful in demonstrating improvements at 3 levels of the KM for ED health care staff. The improvements in the confidence matrix and scenarios checklist were maintained for at least 6 months after the course. PTC courses should be effective in providing and sustaining improvement in knowledge and trauma care practice in other LMICs such as Vietnam.

Impact of the primary trauma care course in the Kongo Central province of the Democratic Republic of Congo over two years

How useful are Primary Trauma Care courses in sub-Saharan Africa?

Low- and middle-income countries account for over 90% of all road traffic injury deaths. Despite this, formal training in trauma management is not widely adopted in these countries. No specific training was available in prehospital or emergency department for life support before primary trauma care (PTC) course. This study was conducted to assess the effectiveness of the PTC course in the improvement of knowledge and skills of trauma management among participant in Pakistan. Two days of PTC courses were organised and conducted in various regions of Pakistan, participants per course comprising medical students, doctors, house officers, residents, and paramedics. The course comprises lectures of 5hours and 30minutes, skills workshops for 3hours and discussion and multisystem trauma scenarios for 3hours. Trauma management knowledge and clinical confidence of candidates were assessed using a predetermined multiple-choice questionnaire of 30 MCQs both at pre- and post-course, and using clinical scenarios, confidence matrix was assessed. A total 7852 of participants were trained, an average of 2 courses per month and 302 total courses. Mean score of pre-course MCQs was 60% and mean score of post-course MCQs was 82%. Among the participant postgraduate trainees, average in trauma knowledge and trauma clinical confidence were significantly higher in both pre- and post-course. The mean score of pre-course confidence matrix was 70% and the mean score of post-course confidence matrix was 93%; at the end of course, all participants showed a high level of confidence in managing trauma mock scenarios. A total of 5889 (75%) participants had a ≥78.5% post-workshop knowledge score. However, only 1963 (25%) participants had a trauma skill score with ≤75 marks. PTC workshop could be an alternative and cost-effective flexible course for gaining knowledge and clinical skills of initial trauma management and strengthening the capacity of trauma management training in developing countries with minimal resources for saving the life of trauma victims.

Background: Injuries in all shapes are accounting for more than five million deaths worldwide. Road traffic accidents injuries are the main threat to people and national health systems. Annually, road traffic injuries are resulting in the deaths of more than five million people globally. The Primary Trauma Care Foundation was organized to run the workshop for front-line staff in such countries to attempt and decrease the human and economic consequence of the injury. Methods : A one group pre-test and post-test experimental research design was used. Subjects were invited to complete a multiple-choice question. The overall number of subjects who were taking the primary trauma care course during the period (from Jun 2014 to Oct 2017) was 586 subjects. Results: More than two-thirds of subjects were men and doctors included specialties, physicians and medical students. (90.8%) of participants were carried bachelor's degree. (22.2%) were staff nurses and nurse's students, (1.9%) were midwives. Wilcoxon Signed Ranks Test shows a statistically significant difference between pre and post course score of PTC knowledge (p<0.001). 567 (96.75%) of the participants were shown an improvement after a PTC course. Conclusion: PTC course in Palestine is a valuable and informative course to increase and improve knowledge toward physicians, staff nurses, and midwives. Keywords: Primary Trauma Care (PTC), Effectiveness, Emergency, Palestine. DOI : 10.7176/JEP/10-9-12 Publication date :March 31 st 2019

Objectives In 2014, the primary trauma care curriculum was delivered at a national trauma center in San Salvador, El Salvador. A quantitative analysis demonstrated that subsequent incorporation of primary trauma care algorithms did not occur. The purpose of this qualitative analysis is to explore why the delivery of the primary trauma care curriculum did not have a measurable effect on provider observance of primary trauma care algorithms. Methods Key informant interviews of primary trauma care instructors and students, trauma care observers, and hospital administrators involved in the delivery of the primary trauma care curriculum were conducted in February 2015. Interview transcripts were analyzed qualitatively using a grounded-theory approach and thematic analysis for insights and common themes. Results Four common themes emerged to explain why adherence to primary trauma care algorithms did not improve: Primary Trauma Care course delivery problems, insufficient equipment, insufficient nurse training, and unsystematic team response. Conclusions Despite the delivery of the primary trauma care curriculum, adherence to the primary trauma care algorithms did not improve as a result of problems integral to the primary trauma care model—including the teach-the-teachers method of curriculum dissemination—as well as local conditions at this hospital. These findings suggest that an isolated educational intervention may not be successful unless the host institution is able to commit to the implementation of the educational material in an ongoing and comprehensive fashion.

For the last 14 years the Primary Trauma Care Foundation, of which I am the Patron, has delivered courses in Primary Trauma Care to over 40 developing countries. Doctors in these countries, both in the cities and in rural areas, have then been better equipped to deal with patients with serious injuries. The courses, which are systematic and didactic, are of two days duration and are conducted by volunteers. These are followed by a one-day course for instructors, who then assume responsibility for teaching the course to doctors and nurses in their local area. The training manual has now been translated into 14 languages, including Arabic. For the last 14 years the Primary Trauma Care Foundation, of which I am the Patron, has delivered courses in Primary Trauma Care to over 40 developing countries. Doctors in these countries, both in the cities and in rural areas, have then been better equipped to deal with patients with serious injuries. The courses, which are systematic and didactic, are of two days duration and are conducted by volunteers. These are followed by a one-day course for instructors, who then assume responsibility for teaching the course to doctors and nurses in their local area. The training manual has now been translated into 14 languages, including Arabic.

Dear Editor, I read the recent article on Training in Trauma Care [1] with great interest. Trauma management of road traffic accidents has to be dealt with at various steps—starting from prevention of accidents, safety devices to reduce severity of trauma, training of first responders, transport of trauma victims, management at trauma center, and rehabilitation. Medical colleges in India do not have a curriculum that teaches how to deal with a polytrauma patient [2]. There is no single teaching session where faculty from all specialties and superspecialties come together and train students on trauma care. This is being done at various centers now as trauma courses such as PTC (primary trauma care course) and ATLS (advanced trauma and life support course). We have been doing the primary trauma care training in association with Primary Trauma Care Foundation, the UK [3]. Over 1,000 medical and paramedical personnel have been trained over the past 7 years. We would like to share the following experience: A first responder course is required to train people for dealing with a trauma victim on site. These responders can be security guards, policemen, ambulance and fire engine personnel. Ambulance service is essential part of trauma care and training of ambulance staff is important. Then comes the role of the casualty medical officer who receives the patient hopefully in the golden hour. Hardware in terms of mannequins, airway equipment, cervical collar, splints, scoops, etc., is important to give hands-on training. Simulated accident scenarios to be used for practical training. More emphasis to practical training than lectures. Getting the trainees to become trainers for future courses in order to enhance the impact of training. Refresher courses are designed for faculty and delegates. A comprehensive program has to be developed that covers all aspects of trauma care. Medical profession and public need to come together for the success of such a program.

To assess the improvement of knowledge and skills of trauma management among participant of Primary Trauma Care (PTC) workshop. A two days Primary Trauma Care (PTC) provider workshop was organized at Dow International Medical College, Karachi - Pakistan on March 5(th) and 6th 2011. Participant's knowledge was assessed by 30 Best Choice Questions (BCQs) and their trauma management skills were assessed by management of trauma case scenario both at pre and post workshop. All scenarios performed by participants were video recorded and marked on a 20 points check list and evaluated by two PTC trainers and graded after consensus. Percentage of participants who scored more than 70% marks on knowledge and skills component were also analyzed. Data was analyzed by SPSS version 17. Wilcoxon Sign Rank test was used to find out significant difference between pre and post workshop score. A total of 20 participants attended the full workshop. Median One best question score before the workshop was 19.5 and post workshop was 25 (p<0.0001). Trauma skills scenario score also showed marked improvement with median score of 3.5 pre workshop and 9.5 post workshop (p<0.0001). Total 19 participants had ≥70% post workshop knowledge score. However, only 4 participants had trauma skill score with ≥70 marks. Primary Trauma Care workshop could be an effective course for gaining of knowledge and skills of initial management of trauma patients. However, some modifications need to be done for training of skills components to maximize the output of this interactive workshop.

Do trauma courses change practice? A qualitative review of 20 courses in East, Central and Southern Africa

Background In El Salvador, over 32% of all deaths are due to trauma. However, El Salvador lacks any established standardized trauma response system to treat the most critical of Salvadoran patients. In an effort to improve trauma response in El Salvador, we assessed the impact of a trauma-specific skills training, which could improve trauma care in a setting where no formal trauma training exists. Methods We used a pre- and post-interventional design study to measure the critical actions performed during a trauma event, as well as the case-fatality rate, emergency ward-to-operating room time, and utilization of ultrasound. The intervention was a primary trauma care course taught to all study participants. Results Eighteen providers were observed over a six-month period and 194 patient encounters (48 pre- and 146 post-intervention) were recorded. There was no significant difference in observed critical actions during major trauma between the pre-intervention and post-intervention periods. There was a significant improvement in ultrasound usage post-intervention (9.5% to 21.4%; p = 0.04). Conclusion The lack of behavior change observed following a two-day trauma training underscores the gap between physician knowledge and applied behavior change. This is a limited single center study, but further examination is necessary to determine the role of two-day training courses in the larger context of behavior change within a health system that has no formal post-graduate training in or defined algorithmic trauma care.

The mortality rate from road traffic injuries has increased in sub-Saharan Africa as the number of motor vehicles increase. This study examined the capacity of hospitals along Malawi's main north-south highway to provide emergency trauma care. Structured interviews and checklists were used to evaluate the infrastructure, personnel, supplies, and equipment at all four of Malawi's central hospitals, ten district hospitals, and one mission hospital in 2014. Most of these facilities are along the main north-south highway that spans the country. Between July 2013 and March 2014, more than 9 200 road traffic injuries (RTIs) and 100 RTI deaths were recorded by the participating hospitals. All of the hospitals reported staff shortages, especially during nights and weekends. Few clinicians had completed formal training in emergency trauma management, and healthcare workers reported gaps in knowledge and skills, especially at district hospitals. Most central hospitals had access to the critical supplies and medications necessary for trauma care, but district hospitals lacked some of the supplies and equipment needed for diagnosis, treatment, and personal protection. The mortality and disability burden from road traffic injuries in Malawi (and other low-income countries in sub-Saharan Africa) can be reduced by ensuring that every central and district hospital has a dedicated trauma unit with qualified staff who have completed primary trauma care courses and have access to the equipment necessary to save lives.

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

Delivering trauma training to multiple health-worker cadres in nine sub-Saharan African countries: lessons learnt from the COOL programme