Trauma Care Education Research Articles

Queensland Trauma Education (QTE): an innovative simulation program that addresses the needs and barriers of interprofessional trauma care education across a complex landscape.

Effective trauma care requires the rapid management of injuries. Rural and remote areas face inequity in trauma care due to time, distance and resource constraints, and experience higher morbidity and mortality rates than urban settings. A training needs analysis (TNA) conducted with stakeholders across Queensland, Australia, revealed a lack of contextual, accessible and interprofessional trauma education for clinicians. The Clinical Skills Development Service and Jamieson Trauma Institute developed the Queensland Trauma Education (QTE) program to address these concerns. QTE comprises a face-to-face training course and open access to online training resources created and reviewed by trauma experts. QTE also supports local training through a statewide simulation network and free access to simulation training equipment. The aim of this article is to review the QTE program and assess the benefits to clinicians in both the delivery of education and the provision of trauma care. To evaluate the QTE program, a desktop review was conducted. This included analyses of website data, course and website content, and facilitator, stakeholder, participant and user feedback. The data were evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, and the program's alignment with the original TNA outcomes was assessed. The results showed that QTE aligns with the identified training needs. Specifically, QTE provides trauma education that is relevant, sustainable, employs best practice, is locally delivered, provides continuous support, is multidisciplinary, multi-platformed, physically accessible and accredited by the Australasian College for Emergency Medicine. The review also highlights how QTE has effectively been reaching its target population, improves knowledge and skills, has become widely adopted, and been implemented and maintained with relative success. The innovative QTE program addresses the previous deficits in trauma education and meets the needs identified in the TNA. The review also reveals further opportunities for continuous improvement and program sustainability.

Innovation in surgical trauma care education: assessment of a Panamerican Trauma Society online surgical skills course hosted by the Spanish Surgical Association.

Incorporating surgical skills education in trauma care is essential for young surgeons and surgical trainees. This study describes an innovative e-learning course for teaching trauma care surgical skills in an international cooperative setting. Furthermore, it aims to offer valuable insights on enhancing e-learning practices. The Panamerican Trauma Society and the Spanish Surgical Association have joined forces to launch an online course focusing on advanced trauma care surgical skills. This report provides an in-depth examination of the project and scrutinizes participant feedback through a post-course survey. The survey thoroughly evaluates their satisfaction level, the usefulness of the course content, and their view on its clinical relevance. Three hundred eighty-two surgeons from 16 countries completed an online course. Three hundred seventy-nine of them responded to the post-course survey. The mean age was 36, with 64% females and 36% males. The course consisted of 9.9h of academic content, including 5h of video lectures and 4.9h of live discussions. Ninety-seven percent of the participants were practicing general and acute care surgeons, and only 2% were exclusively dedicated to trauma surgery. Sixty-one percent of participants highly valued real-time interaction with faculty, and 95% believed their trauma surgical skills would improve. Additionally, 93% of the participants were satisfied or very satisfied with the e-learning experience. The use of video-based instructional materials has revolutionized surgical education. With online courses in trauma surgery, surgeons can now improve their skills and better prepare themselves to handle severe trauma cases. This innovative approach to surgical education has proven to be very effective and can potentially enhance patients' quality of care.

In-service education in trauma care for intensive care unit nurses: An exploratory multiple case study

AimThis study explores the perceptions of intensive care units (ICUs) nurses with different educational backgrounds regarding their abilities in trauma care and the in-service education they receive to support it. BackgroundThe advanced care of patients with traumatic injuries in ICU environments requires skilled and knowledgeable nurses, who need continuing and in-service education to provide the best care. Therefore, it is essential to understand the competencies and educational support these nurses may need in the ICUs to ensure safe and effective care delivery. DesignAn exploratory multiple case study design was used, comprising three hospitals located in two different regions of Saudi Arabia. MethodsThe study was conducted between October 2021 and March 2022. A total of forty ICU clinical staff, twelve managers, nine leaders and seven clinical educators participated in semi-structured interviews, which were complemented by a review of available documents on the trauma care in-service education syllabi, competencies and protocols. Interview data were analysed according to the Framework analysis approach, while documents were reviewed using qualitative content analysis. FindingsThe data analysis revealed two interrelated categories relevant to trauma care: (i) care practice and (ii) education practice. The trauma care practice category highlighted the limited competencies and education in trauma care, as well as the perceived challenges and educational needs of nurses. The education practice category described the staff learning behaviours, supervision practices and in-service education systems in the participants’ settings. ConclusionsThe study concludes that there is a lack of trauma care education at the examined sites. It suggests the need for further research to develop a theoretical foundation for trauma care education that can meet ICU nurses’ educational needs while this being feasible to implement in the specific ICU context and practice.

Disparities in trauma care education: An observational study of the ATLS course within a national trauma system

BackgroundDisparities in trauma systems, including gaps between trauma center levels, affect patient outcomes. Advanced Trauma Life Support (ATLS) is a standard method of care that improves the performance of lower-level trauma systems. We sought to study potential gaps in ATLS education within a national trauma system. MethodsThis prospective observational study examined the characteristics of 588 surgical board residents and fellows taking the ATLS course. The course is required for board certification in adult trauma specialties (general surgery, emergency medicine, and anesthesiology), pediatric trauma specialties (pediatric emergency medicine and pediatric surgery), and trauma consulting specialties (all other surgical board specialties). We compared the differences in course accessibility and success rates within a national trauma system which includes seven level 1 trauma centers (L1TC) and twenty-three non-level 1 hospitals (NL1H). ResultsResident and fellow students were 53% male, 46% employed in L1TC, and 86% were in the final stages of their specialty program. Only 32% were enrolled in adult trauma specialty programs. Students from L1TC had a 10% higher ATLS course pass rate than NL1H (p = 0.003). Trauma center level was associated with higher odds to pass the ATLS course, even after adjustment to other variables (OR = 1.925 [95% CI = 1.151 to 3.219]). Compared to NL1H, the course was two-three times more accessible to students from L1TC and 9% more accessible to adult trauma specialty programs (p = 0.035). The course was more accessible to students at early levels of training in NL1H (p < 0.001). Female students and trauma consulting specialties enrolled in L1TC programs were more likely to pass the course (OR = 2.557 [95% CI = 1.242 to 5.264] and 2.578 [95% CI = 1.385 to 4.800], respectively). ConclusionsPassing the ATLS course is affected by trauma center level, independent of other student factors. Educational disparities between L1TC and NL1H include ATLS course access for core trauma residency programs at early training stages. Some gaps are more pronounced among consulting trauma specialties and female surgeons. Educational resources should be planned to favor lower-level trauma centers, specialties dealing in trauma care, and residents early in their postgraduate training.

200 Online Trauma Care Learning Helped Young Myanmar Doctors Managing War-Wounded

Abstract Aim Myanmar military's brutal crackdowns on pro-democracy protestors after Feb-2021 coup resulted in a staggering number of death and wounded. An on-line trauma care series was launched in March 2021 for general practitioners and young medical graduates with limited trauma care experience. Method A pilot study was conducted to assess the effectiveness of online learning and address the demands of the medical personnel in the frontline areas. Pre- and post-assessments were sent out via anonymised Google forms and analysed. Results Among 106 participants, 65% graduated between 2011 and 2020. 46% worked in a hospital setting before the coup while 19.2% were GPs. Trauma first aid (70.8%), wound ballistics (68.8%) and ATLS updates (62.5%) were the most demanded topics. Average confidences grew in managing all 4 components (24.3% to 85.4% in Trauma First Aid, 23.5% to 72.9% in Trauma Wound Management, 12.5% to 81.3% in Wound Ballistics and 27.2% to 85.5% in Red Cross Wound scoring). Conclusions This pilot study highlighted an urgent demand for training and education in trauma care among young Myanmar doctors. With ongoing public hospital closures due to civil disobedience movement, care of war-wounded would still be largely dependent on makeshift casualty care chain in community setting.

Trauma on Farms in the Republic of Ireland

BackgroundFarming is the most dangerous occupation in high-income countries worldwide. However, there is a lack of descriptive literature in this area. Injuries on farms are increasing, at a time when the cohort of trauma patients generally has become older and more medically complex. Farmers continue to work late in life when other industry workers would be retired. This study describes major trauma occurring on farms in the Republic of Ireland, the demographics of patients and treatments they received. MethodsData was gathered from the National Office of Clinical Audit Major Trauma Audit (MTA) 2014 to 2016. Patients were included and excluded based on Trauma Audit and Research Network(TARN) inclusion criteria. ResultsThere were 430 patients included in this study. The median age was 54.5 years (range 1-93). There were 6.3%(n=27) paediatric patients, and 27%(n=116) over 65-year olds. Patients had predominantly low Charlson Comorbidity Index scores (median 0). Patients >65 years had more comorbidities (p<0.001). The median ISS was 9(IQR 9-17). The most common mechanism of injury was blow from animal (n=126,29%) followed by low fall (n=115,27%). Summer was the most common season of injury (n=128,30%) and most patients presented to a hospital between 8am-12am(n=412,96%). There were 11 patients (2.6%) who died after arrival to hospital – most commonly due to head injury (n=5,45%).The median length of stay was six days; older patients stayed longer than younger patients (6 vs 12 days,p<0.001). The most common body area injured was limbs (n=139,32%), followed by chest (n=89,21%), spine (n=67,16%) and head injuries (n=64,15%). There were 84 patients (19.5%) who underwent operative intervention, and 77(18%) required intensive care unit (ICU) admission. Farm trauma patients were more likely to arrive by helicopter than other MTA patients. ConclusionsA substantial proportion of trauma on Irish farms involves older men who have co-morbidities and complexity of medical need. Farm trauma occurs in rural and remote locations with longer journey times to trauma centres and trauma units–this has implications for trauma care education and mode of EMS transport. Older patients who suffer trauma on farms require longer hospital stays and may not return to independent living.

Multi-Lingual and Multi-Institutional Pre-Hospital Trauma Care Education for Both Trained and Untrained First Responders: Global Trauma Care Solution in Sight

Vyas, Dinseh MD; Wright, Joseph K.; Lung, John; Nileshwar, Anitha MD; Rao, Amrut MD; Vijayan, Sandeep MD; Shetty, Deviprasad MD; Joshi, Adhokshak MD Author Information

Developing trauma care education in low, middle-income countries: Sequential Trauma Education Programs, challenges, and lessons learned

Background: As one of the leading causes of death and disability in the world, human trauma and injury disproportionately affects individuals in developing countries. During initial program development, senior MOHP physicians stated there was a critical need for a portable and flexible educational course on the clinical care of injured patients. To meet the need for improved trauma care in Egypt, the Sequential Trauma Emergency/Education ProgramS (STEPS) course was created through the collaborative effort of Egyptian and US expert physicians. The objective of course development was to create a high-quality, modular, adaptable, and sustainable trauma care course that could be readily adopted by a lower- or middle-income country. Methods: We describes the course development from 2006 to 2015, highlighting the challenges and solutions of creating a successful, flexible and sustainable in-country trauma care training program that suits low and middle-income countries. Results: STEPS was developed at the University of Maryland, based in part on World Health Organization's Emergency and Trauma Care materials, and introduced to the Egyptian Ministry of Health and Population and Ain Shams University in May 2006. The program is designed to adapt low cost and limited resources with maintaining high fidelity and unified standard. In 2008, the course transitioned completely to the leadership of Egyptian academic physicians. To date, more than 700 physicians from 8 countries have taken the course through the Ministry of Health and Population or public/governmental universities. For the first time the course will be held in Sudan on January 2016. Conclusion: STEPS has rapidly become a desired trauma care training program proved by sustainability based on 7 years of course conduct. Success of this collaborative educational program is demonstrated by the numbers of physicians trained, and program continuance after transitioning to in-country leadership and trainers.

Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas

ABSTRACT Introduction and objectives Injuries and noncommunicable diseases account for greater than 73% deaths and 76% disability adjusted life years (DALYs) in Latin America, where trauma care is challenging especially when resources are scarce. Education and training is a basic step in trauma systems development, which was shown to improve survival. Except for urban areas, trauma courses are unavailable and unaffordable in the Latin region. The aim of this study is to evaluate the feasibility of implementation of a basic trauma education course (BTC) for resource-limited areas adopted and promulgated by the Panamerican Trauma Society (PTS) since 2011. Materials and methods Basic trauma education course was administered in Paraguay, Medellin, Chile, and Panama during the PTS congresses (2011-2013). The two-day course was based on the patient's pathway system, addressing the management of the patient through various echelon of care from rural health centers to local provincial hospital and tertiary treatment facilities. It contained 20 hours of didactic lectures and hands on skill labs on basic trauma resuscitation, stabilization, and transport, as well as trauma system-oriented teaching (triage, EMS, kinematics, trauma registries). Panamerican Trauma Society international and national instructors administered the courses. Course logistics and coordination were carried out by international and local coordinators and by trauma league medical students. Pre and post (30 multiple-choice questions) tests were used to assess participants. Paired t-test was used to compare scores. Results Fifty-four students (rural physicians, EMS providers, students, nurses, and administrators) participated. Pre and posttest score comparison showed significant improvement 74% vs 85% respectively, p-value &lt; 0.0001. Conclusion A tailored trauma course and evaluation can be feasible in educating local providers. The PTS can promulgate the application of BTCs that may serve as a model for continuing trauma care education in developing countries. Course follow-up evaluation is pending. How to cite this article Mata LV, Mora FE, Quiodettis M, Fischer J, Machain GM, Salamea JC, Rodas EB, Aboutanos MB. Panamerican Trauma Society Basic Trauma Education Course Administration in Resource-limited Areas. Panam J Trauma Crit Care Emerg Surg 2016;5(2):83-87.

Prehospital trauma care education for first responders in Rajasthan, India: a multi-institutional study

trainer (CVC), interpret a chest radiograph, relay “bad news” to the patient/family (BN) and place a tube thoracostomy in a partial task trainer (TT). To assess performance, check lists (CL) in all four tasks and global rating scales (GR) in the two procedural tasks were created. A midlevel surgical resident and an attending surgeon/anesthesiologist assessed each trainee. Spearman’s and intraclass correlation coefficient were used to compare agreement between assessments.

Prehospital trauma care education for first responders in India

BackgroundA major factor contributing to global trauma mortality and morbidity is the lack of effective prehospital trauma services in developing settings. We developed a 2-d training course for nondoctor first responders featuring high-fidelity simulation and video-assisted debriefing, self-directed learning videos, and native language instruction. Materials and methodsA pilot session was conducted in Jodhpur, Rajasthan. Eighteen local instructors were recruited to train 48 layperson first responders in 10 essential subjects. Didactic sessions of 15–20 min consisting of self-directed learning videos were followed by 30–40 min skill sessions featuring high-fidelity simulation, and concluded with 15–20 min video-debriefing periods. Changes in competence were evaluated using pretraining and posttraining surveys. ResultsResults demonstrated that statistically significant competence increases in all areas of trauma management assessed: airway (t[46] = 7.30, P < 0.000), hemorrhage (t[46] = 9.96, P < 0.000), fractures (t[46] = 9.22, P < 0.000), cervical spine injury (t[46] = 12.12, P = 0.000), chest injury (t[46] = 7.84, P < 0.000), IV line placement (t[46] = 4.36, P < 0.000), extrication (t[46] = 2.81, P < 0.005), scene assessment (t[46] = 7.06, P < 0.000), triage (t[46] = 5.92, P < 0.000), and communication (t[46] = 5.56, P < 0.000). Highest increases in competence were observed in cervical spine injury and hemorrhage management, with lowest increases in IV line placement and extrication. ConclusionsResults suggest this approach may be effective in imparting prehospital trauma management concepts to layperson first responders. This study highlights an innovative educational avenue through which trauma management capacity can be enhanced in developing settings.

Developing Sustainable Trauma Care Education in Egypt: Sequential Trauma Education Program, Steps to Success

As one of the leading causes of death and disability in the world, human trauma and injury disproportionately affects individuals in developing countries. To meet the need for improved trauma care in Egypt, the Sequential Trauma Emergency/Education ProgramS (STEPS) course was created through the collaborative effort of U.S. and Egyptian physicians. The objective of course development was to create a high-quality, modular, adaptable, and sustainable trauma care course that could be readily adopted by a lower- or middle-income country. We describe the development, transition, and host nation sustainability of a trauma care training course between a high-income Western nation and a lower-middle-income Middle Eastern/Northern African country, including the number of physicians trained and the challenges to program development and sustainability. STEPS was developed at the University of Maryland, based in part on World Health Organization's Emergency and Trauma Care materials, and introduced to the Egyptian Ministry of Health and Population and Ain Shams University in May 2006. To date, 639 physicians from multiple specialties have taken the 4-day course through the Ministry of Health and Population or public/governmental universities. In 2008, the course transitioned completely to the leadership of Egyptian academic physicians. Multiple Egyptian medical schools and the Egyptian Emergency Medicine Board now require STEPS or its equivalent for physicians in training. Success of this collaborative educational program is demonstrated by the numbers of physicians trained, the adoption of STEPS by the Egyptian Emergency Medicine Board, and program continuance after transitioning to in-country leadership and trainers.

Trauma care systems in Saudi Arabia: an agenda for action.

Saudi Arabia is undergoing a rapid population growth that along with improved socioeconomics has led many individuals to own a car or even a number of cars per family, resulting in a greater number of vehicles on the roads. The reduced focus on good public transportation systems and the dependence on cars for transportation have created a diversity of drivers who are unfamiliar with the local driving rules and lack the basic skills for safe driving. This is in addition to some young drivers who frequently violate traffic laws and tend to speed most of the time. This unplanned expansion in road traffic has resulted in more car accidents, injuries, disabilities, and deaths. Accompanying that is an increased socioeconomic burden, depletion of human resources, emotional and psychological stress on families, and a strain on healthcare facilities. If this continues without prompt intervention, it will lead to increased insurance premiums and may become unmanageable. To minimize this impact, a national or regional multidisciplinary trauma system has to be developed and implemented. A trauma system is a preplanned, comprehensive, and coordinated regional injury response network that includes all facilities with the capability to care for the injured. Essential components of the system include trauma prevention, prehospital care, hospital care, rehabilitation, system administration, trauma care education and training, trauma care evaluation and quality improvement, along with the participation of society. Research has documented a significant decrease in morbidity and mortality from trauma after the implementation of such systems, depending on their efficiency. The purpose of this review is to discuss the problem of road traffic accidents in this country and address the trauma care system as an effective solution.

An Overview of New Zealand's Trauma System

Patterns of trauma and trauma systems in New Zealand are similar to those in Australia. Both countries have geographical considerations, terrain and distance, that can cause delay to definitive care. There are only 7 hospitals in New Zealand that currently manage major trauma patients, and consequently, trauma patients are often hospitalized some distance from their homes. The prehospital services are provided by one major provider throughout the country, with a high level of volunteers providing these services in the rural areas. New Zealand has a national no-fault accident insurance system, the Accident Compensation Corporation, which funds all trauma-related healthcare from the roadside to rehabilitation. This insurance system provides 24-hour no-fault personal injury insurance coverage. The Accident Compensation Corporation provides bulk funding to hospitals for resources to manage the care of trauma patients. Case managers are assigned for major trauma patients. This national system also has a rehabilitation focus. The actual funds are managed by the hospitals, and this allows hospital staff to provide optimum care for trauma patients. New Zealand works closely with Australia in the development of a national trauma registry, research, and education in trauma care for patients in Australasia (the islands of the southern Pacific Ocean, including Australia, New Zealand, and New Guinea).

Trauma Education and Care in the Jungle of Ecuador, Where There is no Advanced Trauma Life Support

The advanced trauma life support course is not available or affordable to rural areas in low-income countries. A trauma continuing education course was created to educate physicians of rural hospitals in the jungles of Ecuador. A basic trauma care course was designed based on local resources and location of injury, including rudimentary health posts in the jungle, rural hospitals, and definitive referral centers. Course effectiveness was evaluated by a comparison of test scores before and after the course. A multiple choice questionnaire was given. Comparison to previous test scores was also performed. Paired Student's t test was used for statistical analysis. An objective structured clinical examination (OSCE), based on the course design, was administered. Twenty-six rural physicians participated in the course. Mean test scores significantly improved from pretest to post-test (72% to 79%; p = 0.032). Knowledge deficiencies in prehospital care, extremity injury care, and patient evaluation adjuncts significantly improved from 23% to 87%, 23% to 100%, and 31% to 100%, respectively. Test results after the course showed improvements in all major categories tested. Twelve of the 26 participants were repeat test takers from a course provided 2 years earlier. These participants showed improved pretest scores compared with their highest previous test score (76.8% versus 68.5%; p = 0.0496). Compared with first-time test takers, these participants showed improved pretest (76.8% versus 68.4%) as well as post-test (81% versus 76%) scores. Twenty-five of the 26 physicians participated in the OSCE, with a pass rate of 76%. The OSCE identified various strengths and deficiencies based on patient location and available resources. In rudimentary health posts, management was adequate for hemorrhage control (65%), immobilization (77%), and early transfer to rural hospitals (92%). Prehospital communication was inadequate (53%). Rural hospital management was adequate for primary evaluation (60%) and resuscitation (74%) but poor in secondary patient evaluation (53%), adjuncts (25%), and transfer to definitive referral centers (11%). OSCE scores differed from multiple choice questionnaire test results. Where there is no advanced trauma life support, a tailored trauma course and evaluation can be effective in educating local providers. A well-designed competency evaluation (multiple choice questionnaire and OSCE) is helpful in identifying deficient local aspects of trauma care. The course design and evaluation methods may serve as a model for continuing trauma care education in developing countries.

Effect of an Intensive Trauma Care Education Curriculum on Emergency Medicine Residents' Performance on Standardized Tests of Trauma Care Knowledge

Effect of an Intensive Trauma Care Education Curriculum on Emergency Medicine Residents' Performance on Standardized Tests of Trauma Care Knowledge

General surgeons and the Advanced Trauma Life Support course: is it time to refocus?

The aim of this study was to assess Advanced Trauma Life Support (ATLS) training status of general surgeons, its perceived utility, and its relation to clinical trauma practice. A national sample of 1300 general surgeons was surveyed by mail about trauma training, ATLS status, trauma call, and confidence in clinical trauma care abilities. Response rate was 61%. Respondents most commonly (67%) felt they learned a great deal about trauma care in residency training; 13% responded similarly regarding ATLS. Course participation within 4 years of the survey was reported by 33% of respondents. Nearly 75% of those not taking the course cited primary reasons related to relevance (30%), redundancy (29%), and credentialing (15%). Inaccessibility, inconvenience, and cost were lesser factors. Of those expressing extreme confidence with trauma resuscitation, 40% had taken ATLS; 15% of those expressing a lesser degree of confidence had taken ATLS. The ATLS course represents a standard of initial trauma care education in which only one-third of surgeons report current participation. Many view ATLS as not relevant or useful, yet take trauma call. To ensure standard education and patient care, an ATLS course curriculum specifically geared to the general surgeon should be developed and made a mandatory component of residency training or a requirement for board certification and trauma call credentialing.

Care for victims of urban violence and the education of trauma and critical care surgeons. A troubled partnership?

This article reviews the current status of trauma care education and its relationship to critical care education. The critical linkage of both of these endeavors with urban hospitals oriented to indigent care is stressed. Within the specialty of surgery, the recent progress toward resolution of conflicts that have threatened trauma and critical care education programs is reviewed. The partnership between the trauma programs of urban hospitals will be strengthened by this resolution.

Evaluation of pediatric trauma care in Ontario.

Three hundred sixty-seven consecutive pediatric trauma deaths which occurred in Ontario between 1985 and 1987 were analyzed from the coroners' records. Injuries were classified as survivable or unsurvivable, and a preventable death rate of 20% was identified. Rural preventable deaths occurred mainly before arrival at hospital, but 55% of urban preventable deaths occurred in hospitals. The causes of death in children with survivable injury suggest that the institution of prehospital resuscitation and improvement in trauma care education for physicians might reduce mortality. The high incidence of unsurvivable injury suggests that injury prevention will be more cost effective in the long term.