Medical Crew Research Articles

Safety of Air Medical Transport of Patients With COVID-19 by Personnel Utilizing Routine Personal Protective Equipment

BackgroundAir medical transport of patients with known or suspected COVID-19 likely represents a high-risk exposure to crewmembers as aircraft cabins are quite small resulting in very close personal contact. The actual risk to medical crewmembers is not known.MethodsWe conducted an IRB-exempt, retrospective study of air medical transport of patients with known or suspected COVID-19 by eight programs in the Four Corners Region to determine the number of symptomatic COVID-19 among air medical crew members compared to total exposure time. All programs utilized similar routine PPE including N-95 masks and eye protection. Total exposure time was considered from time of first patient contact until hand-off at a receiving hospital.ResultsThere were 616 air transports: 62% by fixed-wing and 38% by rotor-wing aircraft between March 15th and September 6th 2020. 407 patients (66%) were confirmed COVID+ and 209 (34%) were under investigation. Patient contact time ranged from 38 to 432 minutes with an average of 140 minutes. The total exposure time for medical crew was 2,924 hours; exposure time to confirmed COVID+ patients was 2008 hours. Only 30% of patients were intubated, the remainder had no oxygen (8%), low flow nasal cannula (42%), mask (11%), high-flow nasal cannula (4.5%) and CPAP or BPAP (3.5%). Two flight crew out of 108 developed COVID that was presumed related to work.ConclusionsAir Medical Transport of patients with known or suspected COVID-19 utilizing routine PPE is remarkably safe for medical crew members, even when patients are not intubated. This has implications for healthcare personnel in any setting that involves care of patients with COVID-19 in similarly confined spaces.

A Fuzzy Memetic Moth Flame Optimization Algorithm for Composing Medical Crews with Equity and Efficiency

A Fuzzy Memetic Moth Flame Optimization Algorithm for Composing Medical Crews with Equity and Efficiency

Examination of Primary Bougie Use in Air Medical Intubations

<h3>Introduction</h3> Use of a bougie during emergency rapid sequence intubation (RSI) appears to increase first attempt success but may increase time to a definitive airway. This analysis was performed to explore primary use of a bougie during air medical RSI. <h3>Methods</h3> For this analysis, patients undergoing RSI by air medical crews were identified from a large air medical database. First attempt success (FAS), and first attempt success without desaturation (FASWD) were used as outcome measures. Patients in whom a bougie was used during the initial intubation attempt were compared to patients undergoing intubation without the bougie. Propensity scores for bougie use were calculated and multiple logistic regression used to calculate odds ratios for both outcome measures. <h3>Results</h3> A total of 11,836 air medical RSI patients were identified. Patients in whom a bougie was used on the first attempt had more difficult airway predictors. Logistic regression analysis with propensity adjusted odds ratios revealed no associations between use of a bougie on first attempt and FAS (adjusted OR 0.92, 95% CI 0.80-1.05, p=0.212). However, FASWD rates were statistically significantly lower with use of a bougie on first attempt after adjusting for age, gender, trauma, and presence of difficult airway criteria (adjusted OR 0.85, 95% CI 0.75-0.96, p=0.009). <h3>Conclusion</h3> Primary use of the bougie during intubation resulted in similar rates of first pass success when compared to non-bougie group. Primary bougie use may be associated with a higher rate of desaturation during first attempt intubation. Limitations include the potential for selection bias not addressed by the statistical models. Further examination to explore the effects of bougie use related to desaturation is recommended.

Job stressors and job satisfaction in emergency medical services crew members in Slovakia

Job stressors and job satisfaction in emergency medical services crew members in Slovakia

The Impacts of COVID-19 on Oman’s National Health Security

The COVID-19 has had a massive impact on the Oman national health security system, putting the officials and medical crews under sustained pressure and challenges to cope with this crisis. We need to improve the national health security system to achieve health equity and to protect us all from the threat of COVID-19 and future pandemics. This study addresses the impact of COVID-19 on Oman national health security system. The study focuses on three objectives to determine the relationship between COVID-19 and national health security in Oman, to investigate the impact of COVID-19 on national health security, and to identify the role of government in mitigating the impacts of COVID-19 on national health security. The study applies a qualitative method approach and was conducted in two parts using questionnaire surveys and interviews. The study has found that, having a strong relationship between COVID-19 and national health security, the COVID-19 has had impacts on Oman national health security system and the role of the government in mitigating the impacts is very important. The purpose of the study is to generate recommendation to Oman national health security system to pave the way to a robust and resilient national health security system.

System of Helicopter Emergency Medical Services in Nepal: A Study at Nepal Mediciti Hospital

ObjectiveNepalis have benefited from helicopter emergency medical services (HEMS) since 2013. Helicopters are coordinated from private companies for medical transport. There are no helicopters dedicated solely for emergency medical services. Private helicopter companies and hospitals collaborate to transfer patients. Mountainous terrain, traffic infrastructure problems, and distance to rural facilities designate HEMS as the preferred method for transferring patients in Nepal. This article discusses the 2 methods used to fly patients between facilities and from scene calls. The first and preferred method is when patients received medical support from trained personnel en route to the appropriate facility. This method allows for quicker access to a physician with appropriate care throughout a transfer. The second method used occurs when patients were flown with no medical team or trained care onboard the helicopter. Regardless of the method used, HEMS has proven to be beneficial because it limits out-of-hospital time, alleviates patient load from overwhelmed hospitals, and delivers patients to critical care facilities out of reach by ground emergency medical services. The aim of this study was to interpret the current system of helicopter emergency medical services in Nepal and to determine the difference in patient outcomes when transferred with care onboard and without. MethodsThis was a retrospective study of patients who were transferred by helicopter to Mediciti Hospital in Nepal from November 2017 to December 15, 2019. ResultsDuring the study, a total of 425 patients were transferred by helicopter. Two hundred forty-three (57.18%) patients were moved with the support of the medical team onboard. One hundred eighty-two (42.82%) were flown without medical support. Of the 243 patients, 173 (71.19%) were medical, and 70 (28.81%) had suffered traumatic injuries. From the 182 nonsupported patients, 115 (63.19%) were medical, and 67 (36.81%) were traumatic. One hundred eighty (74.07%) of the patients with medical support went to the intensive care unit (ICU). Forty-two (23.07%) without medical support went to the ICU. Ninety-one (50.55%) patients who received support went to the ICU and stayed for 1 to 5 days. Thirty-eight (90.48%) patients with no medical support en route stayed 1 to 5 days in the ICU. Of the 243 patients who received medical support en route, 69 died (28.4%) during the course of treatment in the hospital. Of the 182 who were flown without medical care during transport, 6 (3.33%) died. ConclusionHEMS effectiveness and usefulness are rapidly growing in Nepal. Having trained medics onboard delivering care can be beneficial. When patients are critically ill, it is preferred to fly them via helicopter with a medical crew onboard.

Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland

ObjectiveWe aimed to investigate the medical characteristics of helicopter hoist operations (HHO) in HEMS missions.MethodsWe designed a retrospective study evaluating all HHO and other human external cargo (HEC) missions performed by Swiss Air-Rescue (Rega) between January 1, 2010, and December 31, 2019.ResultsDuring the study period, 9,963 (88.7 %) HEMS missions with HHO and HEC were conducted during the day, and 1,265 (11.3 %) at night. Of the victims with time-critical injuries (NACA ≥ 4), 21.1 % (n = 400) reached the hospital within 60 min during the day, and 9.1 % (n = 18) at night. Nighttime missions, a trauma diagnosis, intubation on-site, and NACA Score ≥ 4 were independently and highly significantly associated with longer mission times (p < 0.001). The greatest proportion of patients who needed hoist or HEC operations in the course of the HEMS mission during the daytime sustained moderate injuries (NACA 3, n = 3,731, 37.5 %) while practicing recreational activities (n = 5,492, 55.1 %). In daytime HHO missions, the most common medical interventions performed were insertion of a peripheral intravenous access (n = 3,857, 38.7 %) and administration of analgesia (n = 3,121, 31.3 %).ConclusionsNearly 20 % of patients who needed to be evacuated by a hoist were severely injured, and complex and lifesaving medical interventions were necessary before the HHO procedure. Therefore, only adequately trained and experienced medical crew members should accompany HHO missions.

Crew Resource Management Training for Surgical Teams, A Fragmented Landscape

Medical Crew Resource Management (CRM) training courses are designed to increase patient safety by reducing the effects of human errors. These training courses are most popular in surgery and a wide range of medical CRM training courses for surgical teams is now available. However, the effects of these CRM training courses on patient outcomes are inconclusive. Although surgical teams feel the need to be trained in team collaboration skills, they are often puzzled about what criteria to apply when choosing a medical CRM training course. This study aimed to compare CRM training courses on didactic components and simulation-exercises to explore if these courses are interchangeable. In this qualitative study, semi-structured interviews were conducted among 10 main CRM training providers of surgical teams in the Netherlands. Although a large variety was found in the content of CRM training courses, the most substantial differences were found in the simulation-exercises. Nine out of 10 trainers stated that standard simulation-exercises would be a step forward to ensure quality in CRM trainings. According to the trainers, the implementation of medical CRM can reduce human errors and as a result, preventable patient complications. They suggested a quality standard for CRM trainers in the medical field to ensure the quality of medical team training as a way to reach this. Medical CRM training courses are diverse and noninterchangeable. Trainers expect that if CRM becomes part of surgical training and is embedded in operating theatre culture, it could be of great value for patients and professionals.

Care Flight: A Pioneer in the West Celebrates 40 Proud Years of Responding “When It Matters Most”

Northern Nevada and northeastern California offer some of the world's most breathtaking scenery including the Sierra Nevada mountain range, which is home to Lake Tahoe (the largest Alpine Lake in North America), a dozen ski resorts, and mountains rising more than 14,000 feet covered by dense, inaccessible wilderness forests including Desolation Wilderness and the Pacific Crest Trail. This natural playground offers activities for every season, including snowmobiling, skiing, scuba diving, hiking, biking, rock climbing, and camping. It is home to more than 500,000 residents and attracts over 4 million visitors a year. The vast and remote open desert of Nevada with rolling foothills and rugged terrain is home to wild mustangs, rattle snakes, mule deer, eagles, hawks, and big horn sheep. Rural Nevada is dotted with frontier communities that have limited-capability hospitals and clinics. These towns, along with the region's urban communities are well served by Care Flight, the 35th helicopter emergency medical services (HEMS) in the country and the first in the western United States when it began 40 years ago. The pioneering spirit and skilled medical and aviation crews, coupled with a helicopter and aviation technology that allowed them to land almost anywhere, day or night, made Care Flight an invaluable part of critical care transport services throughout the western United States and continues to this day. Temple Fletcher, CCEMTP, CMTE, SMTA, EMS Instructor, Sierra Nevada Critical Incident Stress Management Network and a peer support coordinator. Temple retired from Care Flight after over 30 years of service in management and on the flight line. She is proud to have been raised in an air medical family with high moral values of customer service, patient advocacy, and safety that the original founders instilled in the program and its staff. She would like to acknowledge the following Care Flight alumni for their support and encouragement: Jane Miller, Maggie Tole, Pam Altringer, Sandy Hutton, and Mark Mennie (photographer).

Theoretical model of “ship paramedic” psychogram

In the light of the Decree of the President of the Russian Federation “On the strategy of the Arctic zone of the Russian Federation...” an increase in the volume of ship traffic along the Northern Sea Route is expected. With the increase of ship traffic the absolute number of cases when it is necessary to render the first aid to injured ship crew members will also increase. According to the Russian legislation, ship's crew medical officer is not to be provided if total number of people on the vessel is less than 40 people. At the same time the evacuation arm over considerable length of the Northern Sea Route is from several hundreds to thousands kilometers and weather conditions in those latitudes are harsh and changeable for the most part of the year. In such circumstances quick evacuation of a casualty to a specialized institution by air ambulance or ground transport and timely arrival of a trained and properly equipped medical crew to a ship are extremely difficult. Besides, the actual volume of the medical aid which the injured on the ship can need goes far beyond the concept “first aid” and includes both the procedures and manipulations, related to the concepts of “emergency” and (or) “prehospital care” and medical care. According to the international normative-legal acts, the function of first aid rendering to victims on a ship of civil fleet within the framework of a ship role is entrusted to a crew member who has no profile medical education, but who passed and successfully passed qualification examinations on the course of rendering aid and medical care to victims on the ship. It is known that passing the qualification exam by specialty and putting the obtained knowledge and skills into practice in conditions of emergency on a vessel are characterized by different context and require different competences, personal qualities and skills from a person. Up to the present time the Russian Federation has not developed a professiogram – a reference point for assessing the degree of expressed properties and qualities in applicants for maritime specialties. The article touches upon the problem of semantic content of the notion “ship's paramedic” and offers a theoretical model of its psihogram.

Evidence Supporting the Management of Medical Conditions During Long-Duration Spaceflight: Protocol for a Scoping Review.

BackgroundFuture long-duration space exploration missions, such as traveling to Mars, will create an increase in communication time delays and disruptions and remove the viability of emergency returns to Earth for timely medical treatment. Thus, higher levels of medical autonomy are necessary. Crew selection is proposed as the first line of defense to minimize medical risk for future missions; however, the second proposed line of defense is medical preparedness and crew member autonomy. In an effort to develop a decision support system, the Canadian Space Agency mandated a team of scientists from Thales Research and Technology Canada (Québec, QC) and Université Laval (Québec, QC) to create an evidence-based medical condition database linking mission-critical human conditions with key causal factors, diagnostic and treatment information, and probable outcomes.ObjectiveTo complement this database, we are currently conducting a scoping review to better understand the depth and breadth of evidence about managing medical conditions in space.MethodsThis scoping review will adhere to quality standards for scoping reviews, employing Levac, Colquhoun, and O’Brien's 6-stage methodology; the reported results will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. In stage 1, we identified the research question in collaboration with the Canadian Space Agency (CSA), the main knowledge user. We prioritized 10 medical conditions: (1) acute coronary syndrome, (2) atrial fibrillation, (3) eye penetration, (4) herniated disk, (5) nephrolithiasis, (6) pulmonary embolism, (7) retinal detachment, (8) sepsis, (9) stroke, and (10) spaceflight associated neuro-ocular syndrome. In stage 2, with the help of an information specialist from Cochrane Canada Francophone, papers were identified through searches of the following databases: ARC, Embase, IeeeXplore, Medline Ovid, PsychINFO, and Web of Science. In stage 3, studies will be selected and assessed using a 3-step process and emerging, refined exclusion criteria. In stage 4, the data will be charted in a table based on parameters required by the CSA and developed using Google spreadsheets for shared access. In stage 5, evidence-based descriptive summaries will be produced for each condition, as well as descriptive analyses of collected data. Finally, in stage 6, the findings will be shared with the CSA to guide the completion of this project.ResultsThis study was planned in December 2018. Stage 1 has been completed. The initial database search strategy with all target conditions combined identified a total of 10,403 citations to review through title and abstract screening and after duplicate removal. We plan to complete stages 2-6 by the beginning of 2021.ConclusionsThis scoping review will map the literature on the management of 10 priority medical conditions in space. It will also enable us to identify knowledge gaps that must be addressed in future research, ensuring successful and medically safe future missions as humankind embarks upon new frontiers of space exploration.International Registered Report Identifier (IRRID)DERR1-10.2196/24323

Work-related factors, cognitive skills, unsafe behavior and safety incident involvement among emergency medical services crew members: relationships and indirect effects

Objectives. This study examines relationships between work-related factors – stress and fatigue, cognitive skills – situation awareness and cognitive flexibility, unsafe behavior and safety incident involvement among emergency medical services (EMS) crew members, and whether cognitive skills and unsafe behavior together indirectly affect the relationship between work-related factors and safety incident involvement. Methods. A sample of 131 EMS crew members working in ground ambulances (physicians, paramedics, ambulance drivers) completed self-report questionnaires. Results. The correlation analysis showed significant positive interrelationships between work-related factors, unsafe behavior and safety incident involvement, and that cognitive skills were significantly negatively related to these variables. The multiple indirect effects analysis revealed significant indirect effects of both work-related factors on safety incident involvement through situation awareness and unsafe behavior, but not through cognitive flexibility. Conclusion. In terms of reducing the number of EMS provider and patient safety incidents, the findings suggest the importance of reducing stress and fatigue in EMS crew members, improving their cognitive skills, in particular situation awareness, and supporting their safety compliance behavior.

Safety of air medical transport of patients with COVID-19 by personnel using routine personal protective equipment.

ObjectiveAir medical transport of patients with known or suspected coronavirus disease 2019 (COVID‐19) likely represents a high‐risk exposure to crew members as aircraft cabins are quite small resulting in close personal contact. The actual risk to medical crew members is not known.MethodsWe conducted an institutional review board‐exempt, retrospective study of air medical transport of patients with known or suspected COVID‐19 by 8 programs in the Four Corners Region to determine the number of symptomatic COVID‐19 among air medical crew members compared to total exposure time. All programs used similar routine personal protective equipment (PPE), including N‐95 masks and eye protection. Total exposure time was considered from time of first patient contact until handoff at a receiving hospital.ResultsThere were 616 air transports: 62% by fixed‐wing and 38% by rotor‐wing aircraft between March 15 and September 6, 2020. Among transported patients, 407 (66%) were confirmed COVID+ and 209 (34%) were under investigation. Patient contact time ranged from 38 to 432 minutes with an average of 140 minutes. The total exposure time for medical crew was 2924 hours; exposure time to confirmed COVID+ patients was 2008 hours. Only 30% of patients were intubated, and the remainder had no oxygen (8%), low‐flow nasal cannula (42%), mask (11%), high‐flow nasal cannula (4.5%), and continuous positive airway pressure or bilevel positive airway pressure (3.5%). Two flight crew members out of 108 developed COVID that was presumed related to work.ConclusionsAir medical transport of patients with known or suspected COVID‐19 using routine PPE is considered effective for protecting medical crew members, even when patients are not intubated. This has implications for health care personnel in any setting that involves care of patients with COVID‐19 in similarly confined spaces.

Влияние типа амортизаторов на устойчивость автосанитарной машины к кренам ее подрессоренной массы

The article presents the results of assessing the stability of the ambulance vehicle to lateral and longitudinal rolls regarding them as parameters affecting the quality of health care to the transported victim. The authors present the results of a road testing aimed at assessing the vehicle resistance to such rolls under conditions of imitation of a seriously ill patient`s delivery to a medical institution. The tests were carried out on ambulances equipped on the basis of Ford Transit vehicles, using various types of damping elements in the suspension, namely, two variants of two-tube hydraulic shock absorbers; one-tube hydro-pneumatic shock absorbers; air suspension. As the estimated parameters, there were used the values of actual angular acceleration of the passenger compartment rolls in comparison with the values admissible for medical indicators. It is shown that from the standpoint of providing the best comfort for the patient and the medical crew of ambulance, it is preferable to use in the vehicle suspension the single-tube hydro-pneumatic shock absorbers, the installation of which is permissible under conditions of operational modernization of the vehicle.

The perception and experience of child abuse among emergency medical crews in Kagawa Prefecture

The perception and experience of child abuse among emergency medical crews in Kagawa Prefecture

Current view on treatment of attention deficit hyperactivity disorder in adolescents

Diagnosis of attention deficit hyperactivity disorder (ADHD) in adolescent patients may be problematic, because of the broad spectrum of symptoms. Population research display heritable character. The function of dopaminergic, adrenergic, and serotoninergic systems is disordered in different ways in patients, who suffer from this disease. Purpose: The aim of this article is to show the actual view on the treatment of attention deficit hyperactivity disorder in teenage patients.. Results: In the treatment of ADHD the most important thing is pedagogical therapy as well as cooperation of parents and medical crew. In some particular cases pharmacologic treatment should also be included in therapeutic process, which is described in this review. Methylphenidate is the most frequent drug used in the treatment and that is why we focused on the complex description of the substance. Conclusions: Teachers and the school responsible for teaching these children must adapt didactic methods to the severity of the disorder. It is valuable to conduct the drug in the therapy of teenagers whose parents ready to cooperate, always with psychiatric supervision. In the process of pharmacotherapy, it is crucial to include breaks, for example during vacations. Psychostimulants are highly addictive substances, which is why many researchers are uncertain about the routine prescription of methylphenidate.

Use of Helmet-Based Noninvasive Ventilation in Air Medical Transport of Coronavirus Disease 2019 Patients

Helmet-based noninvasive ventilation (NIV) is a viable option for the safe transport of potential or known coronavirus disease 2019 patients. Given the most likely modes of transmission through droplets, aerosols, and fomite contact, airway procedures such as endotracheal intubation place air medical crews and other health care providers at high risk for exposure. This, together with data that suggest that a large cohort of coronavirus disease 2019 patients have better outcomes if we can avoid intubating them, creates a need for a safe method of NIV or high-flow oxygen delivery during transport. Commonly used and successful in-hospital regimens for these patients are high-flow nasal cannula and continuous positive airway pressure or bilevel positive airway pressure. In some studies, helmet NIV has been shown to be a viable, if not superior, alternative to these therapies for patients with acute hypoxemic respiratory failure. Furthermore, because it is a sealed and closed space that completely isolates the patient's airway and breathing, it provides a very high degree of protection from exposure to pathogens transmitted through droplets or aerosols. This article discusses practical implementation of helmet NIV in air medical transport.

Mechanical ventilation of patients in helicopter emergency medical service transport: an international survey

BackgroundMechanical ventilation in helicopter emergency medical service (HEMS) environments is a procedure which carries a significant risk of complications. Limited data on the quality and performance of mechanical ventilation in HEMS are available in the literature.MethodWe conducted an international survey to evaluate mechanical ventilation infrastructure in HEMS and collect data of transported ventilated patients. From June 20–22, 2019, the participating HEMS bases were asked to provide data via a web-based platform. Vital parameters and ventilation settings of the patients at first patient contact and at handover were compared using non-parametric statistical tests.ResultsOut of 215 invited HEMS bases, 53 responded. Respondents were from Germany, Denmark, United Kingdom, Luxembourg, Austria and Switzerland. Of the HEMS bases, all teams were physician staffed, mainly anesthesiologists (79%), the majority were board certified (92.5%) and trained in intensive care medicine (89%) and had a median (range) experience in HEMS of 9 (0–25) years. HEMS may provide a high level of expertise in mechanical ventilation whereas the majority of ventilators are able to provide pressure controlled ventilation and continuous positive airway pressure modes (77%). Data of 30 ventilated patients with a median (range) age of 54 (21–100) years and 53% male gender were analyzed. Of these, 24 were primary missions and 6 interfacility transports. At handover, oxygen saturation (p < 0.01) and positive end-expiratory pressure (p = 0.04) of the patients were significantly higher compared to first patient contact.ConclusionIn this survey, the management of ventilated HEMS-patients was not associated with ventilation related serious adverse events. Patient conditions, training of medical crew and different technical and environmental resources are likely to influence management. Further studies are necessary to assess safety and process quality of mechanical ventilation in HEMS.Trial registrationThe survey was prospectively registered at Research Registry (researchregistry2925).

The drinkable rock: improvised methods to extract H20 from minerals for resource depleted emergencies on future Mars missions

Once inhabited, medical emergencies will occur on Mars where human survival will depend ultimately on the availability of water. This research aimed to explore the hypothesis that medical crews working in an austere and extreme environments could extract mineral bound water through improvised methods using only items accessible to the crew from the habitat. During a Mars simulation crew members collected surface gypsum, a hydrate mineral, and attempted three improvised methods to extract the mineral bound water through a heating, disaggregation and distillation process. The methods produced differing results however the total extracted mass of water as a percentage of the total sample mass varied from 0.39% to 7.4%. By utilizing items found in the habitat only; the crew were able, through improvised strategies, to achieve a proof of concept by extracting water from minerals during the simulated mission.

Study protocol training for life: a stepped wedge cluster randomized trial about emergency obstetric simulation-based training in a low-income country

BackgroundGlobally perinatal and maternal mortality rates remain unacceptably high. There is increasing evidence that simulation-based training in obstetric emergencies is associated with improvement in clinical outcomes. However, the results are not entirely consistent. The need for continued research in a wide variety of clinical settings to establish what works, where and why was recommended. The aim of this study is to investigate the effectiveness of an emergency obstetric simulation-based training program with medical technical and teamwork skills on maternal and perinatal mortality in a low-income country.MethodsA stepped wedge cluster randomized trial will be conducted at the medium to high-risk labour ward at Mulago Hospital, Kampala, Uganda, with an annual delivery rate of over 23,000. The training will be performed using a train-the-trainers model in which training is cascaded down from master trainers to local facilitators (gynaecologists) to learners (senior house officers). Local facilitators will be trained during a four-day train-the-trainers course with an annual repetition. The senior house officers will be naturally divided in seven clusters and randomized for the moment of training. The training consists of a one-day, monodisciplinary, simulation-based training followed by repetition training sessions. Scenarios are based on the main local causes of maternal and neonatal mortality and focus on both medical technical and crew resource management skills. Kirkpatrick’s classification will be used to evaluate the training program. Primary outcome will be the composite of maternal and neonatal mortality ratios. Secondary outcome will comprise course perception, evaluation of the instructional design of the training, knowledge, technical skills, team performance, percentage of ventouse deliveries, percentage of caesarean sections, and a Weighted Adverse Outcome Score.DiscussionThis stepped wedge cluster randomized trial will investigate the effect of a monodisciplinary simulation-based obstetric training in a low-income country, focusing on both medical technical skills and crew resource management skills, on patient outcome at one of the largest labour wards worldwide. We will use a robust study design which will allow us to better understand the training effects, and difficulties in evaluating training programs in low-income countries.Trial registrationISRCTN98617255, retrospectively registered July 23, 2018.