Trauma Training Research Articles

Knowledge and awareness of emergency department residents and physicians regarding the management of dentofacial traumatic injuries: a cross-sectional study

BackgroundMajority of patients with Dento-Facial Traumatic Injuries (DFTI) seek initial care at an Emergency Department (ED). The timely management of DFTI is of utmost importance in determining long-term prognosis of the tooth and the patient’s overall quality of life. Thus, knowledge and awareness of ED residents & physicians regarding the management of DFTI is crucial for better patient outcomes. Numerous studies have investigated the knowledge of ED specialists regarding initial management of dental trauma, however, scientific evidence in this domain is scarce in our region.ObjectiveThe aim of this study was to evaluate the knowledge and awareness of ED residents and physicians regarding diagnosis and management of DFTI using a web-based survey on REDCap.MethodsAn observational cross-sectional study was conducted among the ED residents and physicians of private and public hospitals in Karachi, Pakistan. Data was collected through a web-based questionnaire, sent via email to the participants. The survey comprised of questions assessing their knowledge regarding the diagnosis and management of various dental and maxillofacial injuries. Responses from the participants were graded as low, moderate or high knowledge levels according to a pre-determined criteria. Pearson’s chi-square test was applied to determine the association between knowledge scores.ResultsThe total response rate was 47.6%. Out of 116 participants, 49 (42%) responses were received from physicians and 67 (58%) from residents. The overall knowledge level of participants was low (46.6%) and there was no significant difference in the knowledge level between residents and physicians (p = 0.157). Participants who had received formal training in dental trauma (p = 0.038) and those with more years of clinical experience (p = 0.004) had higher knowledge scores, that were statistically significant.ConclusionsThe knowledge and awareness of ED residents and physicians in dental trauma management was generally low. Specialized training courses are required to provide timely and adequate management of traumatic dental injuries in order to improve patient-related outcomes.

Variations in Trauma Education Practices Across Emergency Medicine Residencies: Insights from a National Survey of Program Directors.

Care of the acutely injured trauma patient is integral to the practice of emergency medicine. It is currently unknown how most emergency medicine residencies structure their residents' trauma experience and little guidance for competency assessment is provided by the Residency Review Committee. Our study aimed to determine current emergency medicine residency practices in trauma resuscitation. We conducted a cross-sectional survey of members of the Council of Residency Directors in Emergency Medicine (CORD) listserv in April 2023. Frequency with percentage of item responses is reported and differences across trauma levels assessed via Fisher's exact test (α = 0.05). Fifty-seven program directors responded to the survey (21.9%), the majority of whom operate at Level I facilities. Significantly more Level II/ III centers send residents to other sites for trauma experience compared to Level I (p = 0.000). Residents participate in all key procedures (eg, airway management, central venous access) when managing traumas except thoracotomy where participation was notably lower and statistically different across levels (p = 0.000). Lastly, program directors were very confident their residents can lead traumas independently and few acknowledged citations for deficiency in trauma training. Trauma training and confirmation of competency is critical among EM residents who may serve as the sole lead in rural emergency departments. This study demonstrates that there is considerable variability in how residency programs structure trauma education, particularly with regards to the exposure to invasive procedures and the opportunity to lead trauma resuscitations. As the American Board of Emergency Medicine has introduced requirements for program directors to attest specifically to the competence of residents to lead trauma resuscitations, standardized and validated tools should be adopted to support this attestation and ensure competence regardless of the program hospital's trauma level.

School Social Workers’ Reports of Differences in Policies and Practices in Trauma-Informed and Non-Trauma-Informed Schools

This study explored trauma-informed schools from the perspective of social workers, documenting the reported practices and policies associated with trauma-informed approaches in U.S. schools. Survey data from 538 school social workers were analyzed to investigate the differences in policies and practices between schools identified as trauma informed and not. Logistic regression analyses examined whether the presence of specific school practices and policies was associated with the identification of a school as trauma informed. Of a wide array of programs and policies that may be present in trauma-informed schools, only the presence of trauma training and resources for secondary traumatic stress were key predictors of social workers’ identification of a school as trauma informed. The implementation of trauma training has long been the primary focus of trauma-informed approaches in schools. Should commitment to trauma-informed approaches endure, we recommend moving beyond training and secondary traumatic stress resources to deepen the field’s focus on implementing trauma-informed practices and policies at all organizational levels. We also recommend that future research looks carefully at how some school safety and trauma-informed approaches may be incompatible and the extent to which trauma-informed approaches improve or detract from children’s educational experiences and outcomes.

Gamification in the Design of Virtual Patients for Swedish Military Medics to Support Trauma Training: Interaction Analysis and Semistructured Interview Study.

This study explores gamification in the design of virtual patients (VPs) to enhance the training of Swedish military medics in trauma care. The challenges related to prehospital trauma care faced on the battlefield require tailored educational tools that support military medics' education and training. The aim of the study is to investigate how to design VPs with game elements for Swedish military medics to support learning in military trauma care. By understanding the reasoning and perceptions of military medics when interacting with VPs, this study aims to provide insights and recommendations for designing VPs with game elements that are specifically tailored to their needs. The study involved 14 Swedish military medics of the Home Guard-National Security Forces participating in a tactical combat care course. Participants interacted with 3 different VP cases designed to simulate military trauma scenarios. Data were collected through think-aloud sessions and semistructured interviews. The data were analyzed using interaction analysis, structured by the unawareness, problem identification, explanation, and alternative strategies or solutions (uPEA) framework, and reflexive thematic analysis to explore participants' reasoning processes and perceptions and identify possible game elements to inform the VP design. Mapping the military medics' reasoning to the uPEA framework revealed that study participants became more creative after making a mistake followed by feedback and after receiving a prompt to make a new decision. The thematic analysis revealed 6 themes: motivation, "keep on trying"; agency in interaction with VPs; realistic tactical experience; confidence, "I know that the knowledge I have works"; social influence on motivation; and personalized learning. Participants suggested that game elements such as scoring; badges; virtual goods; progress bars; performance tables; content unlocking; hints; challenge; control; imposed choice; narrative; avatars; sensation; randomness; difficulty adapting; competition; leaderboards; social pressure; progression; and renovation can promote engagement, motivation, and support confidence in decision-making. Gamification in the design of VPs represents a promising approach to military medical training, offering a platform for medics to practice medical and tactical decision-making in a risk-free environment. The insights gained by the study may encourage designing VPs with game elements, as well as including possibly wrong decisions, their consequences, and relevant feedback, that may support military medics' reflections and decision-making.

Pathway to Trauma-Informed Rehabilitation Counseling: Vocational Rehabilitation Counselors’ Training Experiences and Use of Trauma-Relevant Knowledge in Daily Practice

The compelling evidence regarding the prevalence and profound impacts of traumatic experiences on individuals with disabilities underscores the need to establish trauma-informed service environments within vocational rehabilitation (VR). In an initial endeavor towards cultivating trauma-informed service, this study investigates the VR counselors’ professional training experiences in the topical areas of trauma. Further, the applicability of the Technology Acceptance Model (TAM 2) is examined in elucidating the utilization of trauma knowledge by VR counselors in their practices. A needs assessment focusing on trauma training was distributed to 169 VR counselors to measure their trauma-related training history and utilization of trauma knowledge in practices. Path analysis was employed to examine the relationship between training experience and the actual use of trauma knowledge in counseling based on the TAM 2 framework. Participants reported having 9.71 hours of post-graduate training. Path analysis suggested adding three additional paths to the original research model, explaining how post-graduate training leads to the use of trauma knowledge in VR service through perceived ease of use, usefulness, attitude toward using, and behavioral intention. The profession of rehabilitation counseling needs to incorporate more trauma-related training into its practice, education, and research to better serve individuals with disabilities and improve the effectiveness of services.

Enhancing trauma care in Ukraine amid conflict: A successful implementation of the modified advanced trauma life support course in an active war zone.

Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill-equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals. A consortium, including the International Medical Corps, Harvard Humanitarian Initiative, and others, responded to a request from the Ukrainian Ministry of Health. The ATLS curriculum, translated into Ukrainian, guided the training, with US-based instructors sent to Ukraine for teaching. Despite logistical challenges, such as missile attacks and curfews, the courses ran in multiple Ukrainian cities over 3months. Course effectiveness was evaluated through pre- and post-course knowledge tests, self-efficacy surveys, and satisfaction assessments. Ten ATLS courses trained 213 Ukrainian healthcare providers across five deployments. Significant improvements in knowledge scores (p<0.05) and enhanced self-reported confidence in trauma management were observed. Notably, no casualties were reported among instructors or students, highlighting program safety despite security challenges. Our study demonstrates successful ATLS course implementation in an active war zone, filling a critical gap in trauma education in Ukraine. Despite challenges, the program significantly enhanced participants' trauma care knowledge and confidence. Collaboration between international and local partners was pivotal. This model can serve as a valuable framework for trauma education globally, improving outcomes in conflict zones and resource-limited settings.

265 Qualitative Assessment of a Pilot Trauma Training Program for Community Health Responders in Rural Nepal

265 Qualitative Assessment of a Pilot Trauma Training Program for Community Health Responders in Rural Nepal

Impacting trauma care in resource-limited settings: Lessons learned from Tanzania's web-based trauma registry initiatives.

Trauma significantly impacts Tanzanian healthcare. Lacking standardized hospital-based minimal trauma data sets places further challenges for policymakers. In other resource-limited countries, implementing trauma systems and registries has reduced injury mortalities. In 2013, we introduced an electronic trauma registry, iTRAUMATM at the Tanzanian Muhimbili Orthopedic Institute (MOI) but noted several drawbacks. In 2023, we introduced a robust web-based trauma registry platform. This study assesses the feasibility and utility of implementing the platform at MOI and summarizes challenges, lessons, and results compared to existing systems. This prospective observational study involved clinicians collecting data directly on the platform at the point-of-care, following specific training. Semi-structured interviews with local stakeholders identified challenges and areas for improvement. Data were reported from July to December 2023. Data from 2930 patients showed 59% of injuries were from road traffic collisions (RTCs), with 43% of patients arriving at MOI by non-ambulances. Our findings show that non-ambulance arrivals were associated with higher injury severity (p<0.026), mortalities (p<0.017), and delayed hospital arrival (p<0.004), underscoring the critical role of prompt transport in trauma management. The new platform identified trauma care gaps, with a mean arrival-to-care time of 29.89min, prompting trauma training at MOI to enhance clinician capacities. It also demonstrated superiority over existing systems by improving data completeness, timeliness, and usability. Challenges included gaining support for the platform's functionality, technology integration, and navigating administrative changes. With continued communication, stakeholder acceptance and support were achieved. The web-based platform has become MOI's standard trauma database, demonstrating its feasibility and utility. It overcame the existing challenges of data completeness, timeliness, and usability for policymaking. Positive feedback has prompted plans to expand the platform to other hospitals, benefiting clinical benchmarking and trauma preventive efforts. Ensuring sustainability requires involvement from the Ministry of Health, ongoing training, functionality enhancements, and strengthened global partnerships.

상처 입은 치유자로서의 성장 경험에 관한 자문화기술지

This study is a qualitative study to explore the experiences and growth as a wounded healer. For the study, the counseling experience of a professional counselor was described in a self-cultural technology paper, and the researcher's books, poems, and records were used for the study. The counselor who experienced various traumatic events in his childhood tried to vividly reveal the process of feeling, understanding, and reflecting on clients with confusing and confusing issues. The results of the study are as follows. First, I experienced various traumas in the absence of a safety net for my parents, which led to specialized trauma training. Second, in the process of writing and studying psychology, I began to find the feelings that were suppressed and lost existence. Third, as a wounded healer, I met various clients, discovered that the patterns of wounds were similar, and experienced healing and growth through this. In other words, the solidarity of wounds allowed me to experience existential empathy as a sublime beyond an individual's professional growth. These results are expected to be meaningful in vividly conveying the counselor's reflection and growth as a wounded healer.

Emergency Response Competencies Strengthened by Sustainable Education: First Aid Training Program for Teachers

The primary aim of this study is to assess the knowledge, attitudes, and skills of primary school teachers regarding the management of musculoskeletal trauma through first aid interventions and to determine the effectiveness of a sustainable training program. The preparedness of 138 teachers who received first aid training for trauma intervention and the impact of these trainings on health practices were examined by pre- and post-tests. It was determined that 87% of the teachers participating in the study had not received emergency trauma training before. Pre-training test results showed that the participants had a low level of awareness. However, the increase in mean scores from 6 to 16 and the decrease in standard deviation after the training revealed a significant increase in teachers’ knowledge, attitudes, and skills. These results suggest that emergency trauma training programs significantly increase teachers’ ability to respond to emergencies and emphasize the importance of sustainable first aid training. Analyses based on gender and branch revealed that post-training test scores were similar and all teachers showed high performance. The findings emphasize the need for systematic and comprehensive emergency trauma training programs for all teachers and the importance of these programs for sustainable health and safety practices.

Trauma advanced practice provider education: the current state of trauma advanced practice provider postgraduate education in the United States

BackgroundPostgraduate education for advanced practice providers (APPs) is a rapidly evolving field and includes residencies and fellowships designed to help narrow the gap between physicians and APPs. The current state...

Identifying and addressing mentorship gaps in European trauma and emergency surgical training. Results from the Young European Society of Trauma and Emergency Surgery (yESTES) mentorship survey.

European training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES). Utilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship. Findings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring. Our survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community.

Resuscitation following trauma & role of trauma training programmes in emergency settings: A literature review & survey.

Background & objectives Traumatic injuries, especially in low- and middle- income countries (LMICs), present significant challenges in patient resuscitation and healthcare delivery. This study explores the role of trauma training programmes in improving patient outcomes and reducing preventable trauma-related deaths. Methods A dual approach was adopted, first a literature review of trauma training in LMICs over the past decade, along with a situational assessment survey. For the review of literature, we searched the PubMed database to identify key challenges and innovative practices in trauma training programmes in LMIC's. The survey, conducted among healthcare professionals in various LMICs, collected direct insights into the challenges and the status of trauma training programmes in these countries. Results The literature review analysed 68 articles, with a significant focus on the African subcontinent (36 studies), underscoring the region's emphasis on research on trauma training programmes. These studies mainly targeted physicians, clinicians, postgraduate trainees in surgical or anaesthesia fields and medical students (86.8%), highlighting innovations like simulation-based training and the cascading training model. In our survey, we received 34 responses from healthcare professionals in India, Belarus, Azerbaijan, Nepal and Pakistan. Around 52.9 per cent reported the absence of established trauma training programmes in their settings. The majority of respondents advocated for hands-on, simulation-based training (94.1%) and emphasised the need for structured training programmes (85.3%), feedback sessions (70.6%) and updated protocols (61.8%). This combined data underlined the critical gaps and potential improvements in trauma training programmes and resuscitation practices in LMICs. Interpretation & conclusions Effective trauma care in LMICs requires the establishment of comprehensive, tailored training programmes. Key interventions should include subsidization of pre-existing trauma courses and the adoption of World Health Organization Guidelines for essential trauma care, implementation of trauma quality improvement and review processes and the incorporation of focused assessment with sonography in trauma (FAST) in emergency departments. These steps are crucial for equipping healthcare workers with vital skills and knowledge, fostering a culture of continuous learning and improvement in the realm of trauma care.

Consensus recommendations for acute trauma care & outcomes in LMICs from the transdisciplinary research, advocacy & implementation network for trauma in India.

Background & objectives Injuries profoundly impact global health, with substantial deaths and disabilities, especially in low- and middle-income countries (LMICs). This paper presents strategic consensus from the Transdisciplinary Research, Advocacy, and Implementation Network for Trauma in India (TRAIN Trauma India) symposium, advocating for enhanced, system-level trauma care to address this challenge. Methods Five working groups conducted separate literature reviews on pre-hospital trauma care, in-hospital trauma resuscitation and training, trauma systems, trauma registries, and India's Towards Improving Trauma Care Outcomes (TITCO) registry. Using a Delphi approach, the TRAIN Trauma India Symposium generated consensus statements and recommendations for interventions to streamline trauma care and reduce preventable trauma mortality in India and LMICs. Experts prioritized interventions based on cost and difficulty. Results An expert panel agreed on four pre-hospital consensus statements, eight hospital resuscitation consensus statements, six system-level consensus statements, and six trauma registry consensus statements. The expert panel recommended six pre-hospital interventions, four hospital resuscitation interventions, nine system-level interventions, and seven trauma registry interventions applicable to the Indian context. Of these, 14 interventions were ranked as low cost/low difficulty, five high cost/low difficulty, five low cost/high difficulty, and three high cost/high difficulty. Interpretation & conclusions This consensus underscores the urgent need for integrated and efficient trauma systems to reduce preventable mortality, emphasizing the importance of comprehensive care that includes community engagement and robust pre-hospital and acute hospital trauma care pathways. It highlights the critical role of inclusive, system-wide approaches, from enhancing pre-hospital care and in-hospital resuscitation to implementing effective trauma registries to improve outcomes and streamline care across contexts.

Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war.

Extremity tourniquets have proven to be lifesaving in both civilian and military settings and should continue to be used by first responders for trauma patients with life-threatening extremity bleeding. This is especially true in combat scenarios in which both the casualty and the first responder may be confronted by the imminent threat of death from hostile fire as the extremity hemorrhage is being treated. Not every extremity wound, however, needs a tourniquet. One of the most important aspects of controlling life-threatening extremity bleeding with tourniquets is to recognize what magnitude of bleeding requires this intervention and what magnitude of bleeding does not. Multiple studies, both military and civilian, have shown that tourniquets are often applied when they are not medically indicated. Overuse of extremity tourniquets has not caused excess morbidity in either the recent conflicts in Iraq and Afghanistan or in the US urban civilian setting. In the presence of prolonged evacuation, however, applying a tourniquet when it is not medically indicated changes tourniquet application from being a lifesaving intervention to one that may cause an avoidable amputation and the development of an array of metabolic derangements and acute kidney injury collectively called prolonged tourniquet application syndrome. The recent literature was reviewed for papers that documented the complications of tourniquet use resulting from the prolonged casualty evacuation times being seen in the current Russo-Ukrainian war. The literature was also reviewed for the incidence of tourniquet application that was found to not be medically indicated, in both the US civilian setting and from Ukraine. Finally, an in-person meeting of the US/Ukraine Tourniquet Working Group was held in Warsaw, Poland, in December of 2023. Unnecessary loss of extremities and life-threatening episodes of prolonged tourniquet application syndrome are currently occurring in Ukrainian combat forces because of nonindicated tourniquet use combined with the prolonged evacuation time seen in the Russo-Ukrainian war. Specific numbers of the complications experienced as a result of tourniquet use by Ukrainian forces in the current conflict are treated as classified information and are not available, but multiple sources from the Ukrainian military medical personnel and from the US advisors providing medical assistance to Ukraine have all agreed that the problem is substantial. Unnecessary tourniquet morbidity might also occur in US forces in a variety of potential future combat scenarios in which evacuation to surgical care is delayed. Prehospital trauma training programs, including but not limited to tactical combat casualty care, place insufficient emphasis on the need to avoid leaving tourniquets in place when they are not medically indicated. This aspect of training should receive emphasis in future Tactical Combat Casualty Care (TCCC) and civilian first responder curriculum development. An interim ad hoc training solution on this topic is available at the websites noted in this articles. Additional training modalities may follow in the near future. Therapeutic/Care Management; Level V.

[Translated article] Peripheral trauma treated in the paediatric emergency department: Descriptive study

IntroductionPeripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients. Material and methodsWe performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020. ObjectiveTo describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement. ResultsA total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6–11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%). ConclusionsPeripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians’ autonomy in dealing with these more complex injuries.

Dissociation training and symptom identification accuracy among Australian psychologists.

Dissociation is a common but underrecognized sequelae of trauma exposure. We investigated Australian psychologists' training in dissociation, assessment practices, and accuracy in identifying dissociation symptoms. Participants in this cross-sectional study of Australian psychologists (N = 280) were recruited through publicly available email addresses, graduate psychology programs, and social media. Participants estimated the percentages of their clients who had experienced trauma and had dissociative symptoms, their confidence in assessing and treating trauma and dissociation, their training in trauma and dissociation, and their dissociation screening practices. Participants were also asked to identify dissociation symptoms (per the Dissociative Experiences Scale-II and Somatic Dissociation Questionnaire-5) from a list of trauma-related symptoms. Although 99% of participants reported treating trauma-exposed clients, only 59.6% and 41.1% reported formal training in trauma or dissociation during their psychology qualification, respectively. One in five participants correctly identified all psychoform and somatoform symptoms as dissociation. Accurately identifying psychoform dissociation symptoms was associated with confidence in treating dissociation (p = .048) and having informal peer consultation on dissociation (p = .032). Accurately identifying somatoform dissociation was associated with confidence assessing (p = .006) and treating (p = .009) dissociation and having completed professional development on dissociation (p = .047). Most psychologists demonstrated inaccuracies in their knowledge of dissociation, which raises concern that dissociation may not be recognized in clinical practice and thus go untreated. Training on dissociation should be incorporated into psychology curricula, particularly at the graduate level, and accessible, cost-effective professional development programs for practicing clinicians are needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Developing the Open Psychedelic Evaluation Nexus consensus measures for assessment of supervised psilocybin services: An e-Delphi study.

Voter initiatives in Oregon and Colorado authorize legal frameworks for supervised psilocybin services, but no measures monitor safety or outcomes. To develop core measures of best practices. A three-phase e-Delphi process recruited 36 experts with 5 or more years' experience facilitating psilocybin experiences in various contexts (e.g., ceremonial settings, indigenous practices, clinical trials), or other pertinent psilocybin expertise. Phase I, an on-line survey with qualitative, open-ended text responses, generated potential measures to assess processes, outcomes, and structure reflecting high quality psilocybin services. In Phase II, experts used seven-point Likert scales to rate the importance and feasibility of the Phase I measures. Measures were priority ranked. Qualitative interviews and analysis in Phase III refined top-rated measures. Experts (n = 36; 53% female; 71% white; 56% heterosexual) reported currently providing psilocybin services (64%) for a mean of 15.2 [SD 13.1] years, experience with indigenous psychedelic practices (67%), and/or conducting clinical trials (36%). Thematic analysis of Phase I responses yielded 55 candidate process measures (e.g., preparatory hours with client, total dose of psilocybin administered, documentation of touch/sexual boundaries), outcome measures (e.g., adverse events, well-being, anxiety/depression symptoms), and structure measures (e.g., facilitator training in trauma informed care, referral capacity for medical/psychiatric issues). In Phase II and III, experts prioritized a core set of 11 process, 11 outcome, and 17 structure measures that balanced importance and feasibility. Service providers and policy makers should consider standardizing core measures developed in this study to monitor the safety, quality, and outcomes of community-based psilocybin services.

Implementation of structured trauma training for first-year surgical residents in Ethiopia: a novel pilot program in a low income country.

Curricula for surgical residents should include training in trauma care; however, such training is absent in many low income countries. At the largest surgical training institution in Ethiopia, a trauma training program was developed, integrated into the existing surgical curriculum, and implemented. This study was conducted to evaluate the trainees' response to the new program. Over a 5-month period, 35 first-year surgical residents participated in weekly trauma care training sessions. The program included journal clubs, practical sessions, didactic sessions, and case-based discussions. Six months after the conclusion of the training, changes in knowledge, attitude, and practices were evaluated through a self-report survey. For knowledge-based items, the survey data revealed reported improvements in 83.8% to 96.8% of students. Furthermore, 90.3% to 93.5% of participants indicated improvements in practice, while 96.7% exhibited a change in attitude. Respondents reported that attending didactic courses improved their presentation skills and facilitated the acquisition of knowledge. They suggested the inclusion of additional practical sessions. Training structures that are simple to implement are crucial for residency programs with limited resources. Such programs can be developed using existing academic staff and can aid residents in delivering improved care to trauma patients.

Effectiveness of a specific trauma training on war-related truncal injury management: A pre-post study

BackgroundNon-Compressible Torso Hemorrhage (NCTH) is the leading cause of preventable death in combat casualty care. To enhance the French military surgeons' preparedness, the French Military Health Service designed the Advanced Course for Deployment Surgery (ACDS) in 2008. This study evaluates behavioral changes in war surgery practice since its implementation. MethodsData were extracted from the OPEX® registry, which recorded all surgical activity during deployment from 2003 to 2021. All patients treated in French Role 2 or 3 Medical Treatment Facilities (MTFs) deployed in Afghanistan, Mali, or Chad requiring emergency surgery for NCTH were included. The mechanism of injury, severity, and surgical procedures were noted. Surgical care produced before (Control group) and after the implementation of the ACDS course (ACDS group) were compared. ResultsWe included 189 trauma patients; 99 in the ACDS group and 90 in the Control group. Most injuries were combat-related (88 % of the ACDS and 82 % of the Control group). The ACDS group had more polytrauma (42% vs. 27 %; p= 0.034) and more e-FAST detailed patients (35% vs. 21 %; p= 0.044). Basics in surgical trauma care were similar between both groups, with a tendency in the ACDS group toward less digestive diversion (n= 6 [6 %] vs. n= 12 [13 %]; p= 0.128), more temporary closure with abdominal packing (n= 17 [17 %] vs. n= 10 [11 %]; p= 0.327), and less re-operation for bleeding (n= 0 [0 %] vs. n= 5 [6 %]; p= 0.046). ConclusionThe French model of war trauma course succeeded in keeping specialized surgeons aware of the basics of damage control surgery. The main improvements were better use of preoperative imaging and better management of seriously injured patients.