Trauma Management Training Research Articles

A multicountry health partnership programme to establish sustainable trauma training in east, central, and southern African countries using a cascading trauma management course model

BackgroundInjury accounts for 267 000 deaths annually in the nine College of Surgeons of East, Central, and Southern Africa (COSECSA-ASESA) countries, and the introduction of a sustainable standardised trauma training programme across all cadres is essential. We have delivered a primary trauma care (PTC) programme that encompasses both a “provider” and “training the trainers” course using a “cascading training model” across nine COSECSA countries. The first “primary course” in each country is delivered by a team of UK instructors, followed by “cascading courses” to more rural regions led by newly qualified local instructors, with mentorship provided by UK instructors. This study examines the programme's effectiveness in terms of knowledge, clinical confidence, and cost-effectiveness. MethodsWe collected pre-training and post-training data from 1030 candidates (119 clinical officers, 540 doctors, 260 nurses, and 111 medical students) trained over 28 courses (nine primary and 19 cascading courses) between Dec 5, 2012, and Dec 19, 2013. Knowledge was assessed with a validated PTC multiple choice questionnaire and clinical confidence ratings of eight trauma scenarios, measured against covariants of sex, age, clinical experience, job roles, country, and health institution's workload. FindingsPost-training, a significant improvement was noted across all cadres in knowledge (19% [95% CI 18·0–19·5]; p<0·05) and clinical confidence (22% [20·3–22·3]; p<0·05). Non-doctors showed a greater improvement in knowledge (22% vs 16%; p<0·05) and confidence (24% vs 20%; p<0·05) than doctors. Candidates attending cascading courses also showed larger improvements in knowledge (21% vs 15%; p<0·002) and clinical confidence (23% vs 19%; p<0·002) than their primary course counterparts. Multivariate regression analysis showed that attending cascading courses (Coef=4·83, p<0·05), being a nurse (Coef=3·89, p=0·007) or a clinical officer (Coef=4·11, p=0·015), and attending a course in Kenya (Coef=9·55, p<0·002) or Tanzania (Coef=9·40, p<0·002) were strong predictors to improvement in multiple choice questionnaire performance. However, improvement in clinical confidence was affected by the job-role of the clinical officer (Coef=6·49, p=0·002) and attending a course in Kenya (Coef=16·12, p<0·02) or Tanzania (Coef=7·01, p<0·05). Cascading courses were on average £2000 less expensive than primary care courses. InterpretationTo the best of our knowledge, this is the largest series in the literature on multicountry trauma management training in sub-Saharan Africa. Our study supports the concept of cascading courses as an educationally and cost-effective method in delivering vital trauma training in low-resource settings led by local clinicians. FundingHealth Partnership Scheme through the UK Department for International Development (DFID).

A Checklist for Trauma and Emergency Anesthesia

Death from traumatic injury is the leading cause of death in children and adults younger than 45 years of age. For adults older than 45 years of age, trauma is the third leading cause of death, the primary causes being cardiovascular events and malignancies. Despite this huge burden, the Anesthesiology Residency Review Committee of the Accreditation Council for Graduate Medical Education has as a requirement that residents in anesthesiology programs only manage 20 trauma cases during their residency. The requirement does not define what constitutes “trauma” and does not specify the educational objective for their experience providing care to patients who have sustained trauma. Once they finish training, anesthesiologists will be involved in the management of patients who have sustained traumatic injuries. If they work in a rural area, they may not be challenged with the kind of penetrating injuries common in an urban level I trauma center. However, trauma is ubiquitous, and rural medical centers see severe trauma from motor vehicle crashes, from farming or manufacturing mishaps, and from natural accidents. Because residency may impart limited training in management of trauma, we propose that anesthesiologists use a standardized “trauma and emergency checklist” to facilitate the care they provide these patients and (hopefully) improve outcomes. Checklists have been shown to decrease patient morbidity and mortality by assuring that the health care provider does not overlook some important aspect of care. Checklists are used when preparing an anesthetic workstation at the beginning of the day. The algorithms promulgated by the Advanced Trauma Life Support and Advanced Cardiac Life Support courses are checklists. Even trauma surgeons in the military, who have a great deal of experience in managing patients who sustain blast injury, use checklists. Military surgeons use checklists to manage trauma for the same reason that anesthesiologists use checklists when checking an anesthesia workstation, or that an airline pilot uses a checklist before every takeoff and landing. The checklist assures that critical steps are not missed. Checklists are easy. Missing critical steps can be deadly. Checklists have been shown to decrease inpatient complications and death. 1 Standardized checklists can be especially useful during emergencies. 2,3 A trauma and emergency anesthesia checklist can serve as a template of care for the initial phase of operative anesthesia, as well as resuscitation. The goal of this manuscript is not to provide a definitive checklist. The definitive checklist, if it ever exists, should be created, and vetted, by a learned society within the trauma anesthesiology community. Our goal for this manuscript is to initiate a discussion about what should be on a trauma anesthesia checklist, providing a nidus for a definitive document (Fig. 1).

Trauma‐related Preventable Deaths in Berlin 2010: Need to Change Prehospital Management Strategies and Trauma Management Education

Fatal trauma is one of the leading causes of death in Western industrialized countries. The aim of the present study was to determine the preventability of traumatic deaths, analyze the medical measures related to preventable deaths, detect management failures, and reveal specific injury patterns in order to avoid traumatic deaths in Berlin. In this prospective observational study all autopsied, direct trauma fatalities in Berlin in 2010 were included with systematic data acquisition, including police files, medical records, death certificates, and autopsy records. An interdisciplinary expert board judged the preventability of traumatic death according to the classification of non-preventable (NP), potentially preventable (PP), and definitively preventable (DP) fatalities. Of the fatalities recorded, 84.9 % (n = 224) were classified as NP, 9.8 % (n = 26) as PP, and 5.3 % (n = 14) as DP. The incidence of severe traumatic brain injury (sTBI) was significantly lower in PP/DP than in NP, and the incidence of fatal exsanguinations was significantly higher. Most PP and NP deaths occurred in the prehospital setting. Notably, no PP or DP was recorded for fatalities treated by a HEMS crew. Causes of DP deaths consisted of tension pneumothorax, unrecognized trauma, exsanguinations, asphyxia, and occult bleeding with a false negative computed tomography scan. The trauma mortality in Berlin, compared to worldwide published data, is low. Nevertheless, 15.2 % (n = 40) of traumatic deaths were classified as preventable. Compulsory training in trauma management might further reduce trauma-related mortality. The main focus should remain on prevention programs, as the majority of the fatalities occurred as a result of non-survivable injuries.

Training in trauma management

Considerable improvements have occurred in the care of injured patients since the times of World War I and II. This has been brought about not only by technological advances but also due to improved training of doctors and nurses in providing trauma care. Important elements of combat trauma training are realism, human-specific injuries and treatments, volume of trauma exposure, and team building. In all modern armies training is imparted using human simulators and mannequins, human cadavers, occasionally live animals but more often using animal tissues. Worldwide trauma training courses are mandatory for both paramedics and medical officers. There is a need to set up an organised system of trauma training in India and we, in the Armed Forces have to capitalize on the wealth of combat and non-combat trauma experience, in setting up such courses.

Izazovi u unapredjenju zbrinjavanja povredjenih u Republici Srbiji

There are many problems that trauma care system in Serbia is facing today. Few of them are: 1) Lack of categorization of trauma centers; 2) Diversity in managing of trauma patients among institutions; 3) There is no trauma management training, 4) Inappropriate cooperation between pre hospital trauma care and hospital trauma care; 5) There is no standard in managing of trauma patients as well as procedures. To improve trauma care quality throughout the country we must learn from the experiences of other countries. The aim of this paper was to report representative data about organization, management, stuff and equipment of ambulance and emergency services in Serbia. We analyzed 12 out of 138 parameters we obtained from the relevant institutions.

Organisation of traumatic head injury management in the Nordic countries

Objective: The aim of this study is to map and evaluate the available resources and the premises of traumatic head injury management in the Nordic countries, before the implementation of...

Essential trauma management training: addressing service delivery needs in active conflict zones in eastern Myanmar

IntroductionAccess to governmental and international nongovernmental sources of health care within eastern Myanmar's conflict regions is virtually nonexistent. Historically, under these circumstances effective care for the victims of trauma, particularly landmine injuries, has been severely deficient. Recognizing this, community-based organizations (CBOs) providing health care in these regions sought to scale up the capacity of indigenous health workers to provide trauma care.Case descriptionThe Trauma Management Program (TMP) was developed by CBOs in cooperation with a United States-based health care NGO. The goal of the TMP is to improve the capacity of local health workers to deliver effective trauma care. From 2000 to the present, international and local health care educators have conducted regular workshops to train indigenous health workers in the management of landmine injuries, penetrating and blunt trauma, shock, wound and infection care, and orthopedics. Health workers have been regularly resupplied with the surgical instruments, supplies and medications needed to provide the care learnt through TMP training workshops.Discussion and EvaluationSince 2000, approximately 300 health workers have received training through the TMP, as part of a CBO-run health system providing care for approximately 250 000 internally displaced persons (IDPs) and war-affected residents. Based on interviews with health workers, trauma registry inputs and photo/video documentation, protocols and procedures taught during training workshops have been implemented effectively in the field. Between June 2005 and June 2007, more than 200 patients were recorded in the trauma patient registry. The majority were victims of weapons-related trauma.ConclusionThis report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries. These health workers are able to provide trauma care for otherwise inaccessible populations in remote and conflicted regions. The principles learnt during the implementation of the TMP might be applied in similar settings.

The Case for the Role of Advanced Simulators in Trauma Management Training Was Not Made

The Case for the Role of Advanced Simulators in Trauma Management Training Was Not Made

The Case for the Role of Advanced Simulators in Trauma Management Training Was Not Made

The Case for the Role of Advanced Simulators in Trauma Management Training Was Not Made

A Virtual Learning Environment for Team Training in Trauma Management

A Virtual Learning Environment for Team Training in Trauma Management

Advanced Trauma Life Support System (ATLS) in a Peripheral Hospital.

Dear Editor, It was Dr James Stynor, an American Orthopaedic Surgeon who introduced a structural trauma management training programme, following the death of his wife and serious injury to his 3 children in an air crash in 1970s. This approach is now regarded as gold standard in early trauma, initial assessment and resuscitation. The basic philosophy of the ATLS is to treat lethal injury first, then reassess and treat again. Component steps of ATLS are:- Elements of primary survey are: Airway with cervical spine control Breathing and ventilation Circulation with control of haemorrhage Dysfunction of the central nervous system Exposure in a controlled environment Secondary survey: Head to toe examination of the undressed stable patient The ATLS approach focuses on the second or early death group where death is preventable [1]. At least one in five and possibly as many as one in three, trauma deaths in hospital are preventable [2]. We have adopted ATLS with modification as required for our hospital setting (Table 1). Pre-hospital trauma life support (PHTLS) is essential component of ATLS in which Regimental Medical Officers (RMOs), Nursing Assistants (NAs) and Battlefield Nursing Assistants (BFNAs) are trained in Combat Survival Skills. We have done away with the system of receiving the casualties in Ml Room and shifting them to the ward. We receive our casualties directly in the acute ward, where Nursing officer/NA on duty does the primary survey and sends information quickly to Duty Medical Officer (DMO) and surgical team. In primary survey they carryout ABCD of the ATLS. Doctors do the re-primary survey and secondary survey. In documentation, investigations and required X-rays are carried out in the acute ward itself. Focused abdominal sonogram for trauma (FAST) is done in the ward with portable ultrasound by the surgeon [3]. Triage of mass casualties is carried out by the surgeon. In this small peripheral 49 bedded hospital with limited staff and equipment we have managed 372 battle casualties successfully with no mortality in 2 years. Table 1 Advanced Trauma life Support System (ATLS) Protocol 169 MH Our experience with ATLS is wonderful. It is recommended that all large hospitals should have a trauma wing to handle polytrauma cases and follow ATLS to prevent early deaths. It is also recommended that the concept of PHTLS be taught to all officers of other Arms and Services during their training to enable them to ensure better Combat Survival Skills of their troops.

Trauma care in China: challenge and development

The People's Republic of China has significantly improved the general health of its people by a concerted effort in primary health care but trauma care and its prevention remains a problem. This paper provides an overview of the strengths and weaknesses of the trauma-care system in China and proposes a strategy for its future development. This includes public-health legislation, the integration of military and civilian practice to provide comprehensive care from the scene of the incident through to rehabilitation, medical audit, the introduction of postgraduate trauma-management training courses and international academic exchanges.

A method to measure the value of formal training in trauma management: comparison between ATLS and induction courses

The change in knowledge resulting from formal training in trauma management on two different courses was examined. Seventy-four doctors and a control group were included in this prospective study over a 2-year period. They represented participants on two Advanced Trauma Life Support (ATLS) courses and four induction courses for junior doctors in Accident and Emergency (A&E) departments. The results indicate substantial benefits from both types of training. The ATLS course participants achieved better scores. Steps in constructing a simple test for the evaluation of courses are described. Standardization of approach is recommended. Assessment and audit of training in trauma management is feasible with limited resources. It may eventually be possible to measure individual clinician's proficiency against a standard scale.