Trauma Training Course Research Articles

Tertiary Trauma Survey on Emergency Department Observational Units: A Systematic Literature Review.

In today's competitive world with a fast-paced lifestyle, trauma is on the rise and is globally recognized as the leading cause of mortality, morbidity, and disability.Despite the development of major trauma centers and the introduction of advanced trauma training courses and management guidelines, there remains a substantial risk of missed or delayed diagnosis of injuries with potentially life-changing physical, emotional, and financial implications. The proportion of such incidents is potentially higher in busy emergency departments and developing countries with fewer dedicated major trauma centers or where focused emergency and trauma training and skills development is still in its infancy. In the last decade, tertiary trauma surveys have been recognized as an important re-assessment protocol in reducing such missed injuries or delayed diagnoses in patients involved in major trauma. This naturally leads to the presumption that tertiary trauma surveys could also play an important role in observational medicine. This also brings into question whether a standardized tertiary trauma survey of major trauma patients on emergency observation units could reduce missed injuries, especially in low-income countries with fewer resources and trauma expertise. Thus, the purpose of this systematic literature review is to explore the potential role of tertiary trauma survey as a tool to reducing missed or delayed diagnosis in the emergency observation units and its applicability and feasibility in less-developed healthcare systems and in low- and middle-income countries. A broad-based systematic literature review was conducted to include electronic databases, grey literature, reference lists, and bibliographies using the keywords: tertiary trauma survey, major trauma, observational medicine, emergency observation units, clinical decision unit, adult, missed injuries, and delayed diagnosis. Over 19,000 citations were identified on initial search. Following a review of abstracts, application of inclusion and exclusion criteria, and review of the full article, 19 publications were finally selected for the purpose of this systematic literature review. Current evidence shows a general trend that tertiary trauma surveys performed 24 hours after admission playan important role in identifying injuries missed at the time of initial primary and secondary survey, and its implementation in observational medicine could prove beneficial, especially in resource-depleted healthcare systems.

Non-technical skills and teamwork in trauma: from the emergency department to the operating room.

Management of a trauma patient is a challenging process. Swift and accurate clinical assessment is required and time-sensitive decisions and life-saving procedures must be performed in an unstable patient. This requires a coordinated response by both the emergency room (ER) and operating room (OR) teams. However, a team of experts does not necessarily make an expert team. Root cause analysis of adverse events in surgery has shown that failures in coordination, planning, task management and particularly communication are the main causes for medical errors. While most research is focused on the ER trauma team, the trauma OR team also deserves attention. In fact, OR team dynamics may resemble more the ER team than the elective OR team. ER and OR trauma teams assemble on short notice, and their members, who are from different specialties and backgrounds, may not train regularly together or even know each other beforehand. And yet, they have to perform high-risk procedures and make high stake decisions, in a time-sensitive manner. The airline industry has long recognized the role of team training and non-technical skills (NTS) in reducing hazards. The implementation of the so called crew resource management or crisis resource management (CRM) has significantly made airline travel safer and the transposition to the medical context, with specific training in non-technical skills, has also brought great benefits. In fact, it is clear that adoption of non-technical skills (NTS) in healthcare has led to an increase in patient safety. In this narrative review we recapitulate some of the key non-technical skills and their relevance in trauma, with a focus on both the emergency department (ER) and the operating room (OR) teams, as well as on the transition of care from one to the other. Also, we explore the use of debriefing the team, as well as the roles of NTS training in both undergraduate and postgraduate settings. We review some of the existing trauma training courses and their roles in developing NTS. Finally, we briefly address the challenges posed by the development of trauma hybrid operating rooms.

The effect of micro-learning on trauma care knowledge and learning satisfaction in nursing students

BackgroundDespite the fact that there are few formal trauma training courses for nurses, they play an important role in the care of trauma patients. This study aims to investigate the effect of micro-learning on the knowledge of managing trauma patients and learning satisfaction in nursing students.MethodsThe convenience sampling method was used to enroll 30 final-year nursing students from Alborz University of Medical Sciences in this quasi experimental One-group pretest -posttest design. The educational content was created and repeated 4 times over the course of 36 days using a micro-learning approach through whiteboard animations, video casts, and live videos. MCQ scenario-based exam was used to assess participants’ knowledge of trauma in three phases: pretest, immediately following the intervention, and one month after the end of the educational program. An e-learning satisfaction psychometric questionnaire was used to measure satisfaction.ResultsThe mean knowledge score 1 month after the intervention did not differ significantly from the score immediately after the intervention (p = 1), but there was a significant relationship between the mean knowledge score immediately after the intervention and before that (p = 0.047). Demographic variables and knowledge of trauma management did not differ statistically significant. The majority of students were pleased with how the course was implemented (5.64).ConclusionThe use of micro-learning has a positive effect on the promotion and retention of knowledge of trauma care, as well as increasing nursing students’ satisfaction. Micro-learning is proposed as a new educational approach that can be used as a complementary or as a stand-alone method to convey important educational concepts and increase learner satisfaction.

Delphi Method Consensus-Based Identification of Primary Trauma Care Skills Required for General Surgeons in Japan

Purpose: General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons.Methods: An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants.Results: There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1<sup>st</sup> round, 85 specialists participated (response rate: 72.6%). In the 2<sup>nd</sup> round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons.Conclusion: A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.

Clinical Practices Following Train-The-Trainer Trauma Course Completion in Uganda: A Parallel-Convergent Mixed-Methods Study

BackgroundDespite the growth of trauma training courses worldwide, evidence for their impact on clinical practice in low- and middle-income countries (LMICs) is sparse. We investigated trauma practices by trained providers in Uganda using clinical observation, surveys, and interviews.MethodsUgandan providers participated in the Kampala Advanced Trauma Course (KATC) from 2018 to 2019. Between July and September of 2019, we directly evaluated guideline-concordant behaviors in KATC-exposed facilities using a structured real-time observation tool. We conducted 27 semi-structured interviews with course-trained providers to elucidate experiences of trauma care and factors that impact adoption of guideline-concordant behaviors. We assessed perceptions of trauma resource availability through a validated survey.ResultsOf 23 resuscitations, 83% were managed without course-trained providers. Frontline providers inconsistently performed universally applicable assessments: pulse checks (61%), pulse oximetry (39%), lung auscultation (52%), blood pressure (65%), pupil examination (52%). We did not observe skill transference between trained and untrained providers. In interviews, respondents found KATC personally transformative but not sufficient for facility-wide improvement due to issues with retention, lack of trained peers, and resource shortages. Resource perception surveys similarly demonstrated profound resource shortages and variation across facilities.ConclusionsTrained providers view short-term trauma training interventions positively, but these courses may lack long-term impact due to barriers to adopting best practices. Trauma courses should include more frontline providers, target skill transference and retention, and increase the proportion of trained providers at each facility to promote communities of practice. Essential supplies and infrastructure in facilities must be consistent for providers to practice what they have learned.

Trauma training in low- and middle-income countries: A scoping review of ATLS alternatives.

IntroductionTrauma training for front-line providers is a critical component of injury mitigation and trauma systems strengthening. Although the Advanced Trauma Life Support (ATLS) course is standard in much of the world, cost and administrative barriers are prohibitive to deploying the course in many low and middle income countries (LMICs). The purpose of this study was to identify alternative trauma training courses used in LMICs by scoping review and compare their effectiveness.MethodsSeveral peer-reviewed and grey literature databases were searched for relevant articles describing trauma training courses for front-line medical providers in LMICs. Studies were included if: performed in a LMIC; utilized a general trauma training course other than ATLS; trainees were hospital-based medical providers; study included some type of outcome measure.ResultsA total of 34 manuscripts met inclusion criteria. The majority of courses were novel, hospital-initiated courses and ranged in length from 1 day to 1 week. Physicians were the most common target audience, followed by medical students and nurses. Courses were taught in 24 different countries throughout the Middle East, Asia, Latin America and Africa. Comparison of pre- and post-test knowledge was the most common metric used and nearly all courses demonstrated a statistically significant knowledge gain. One study demonstrated a reduction in mortality for injured patients after course implementation. The majority of courses were a collaboration between universities in a high income country and local faculty/practitioners in the LMIC where the course was taught. Reported cost per participant ranged from $10 to $232 USD.ConclusionsSeveral trauma courses are currently being utilized in LMICs effectively with increases in knowledge gained and at a lower reported cost than ATLS. More research is needed to link trauma training courses to patient outcomes.

Trauma education and training for healthcare providers: a scoping review

Background: Every six seconds, someone in the world dies because of injury. Trauma is a major public health problem and leads to significant mortality and morbidity worldwide. Healthcare provider training can affect patient outcomes; therefore, it is useful to examine the efficacy of trauma training programmes. This scoping review aimed to determine the impact of trauma training or education on healthcare providers' confidence. Method: Ovid MEDLINE, Ovid Embase, Ovid Emcare, CINAHL, Scopus, Google Scholar and Trove were systematically searched on 7 August 2021, and a methodology adopted to ensure the scoping review was comprehensive. Results: A total of 749 articles were retrieved, of which 15 were eligible for the scoping review. After the articles were analysed, two themes—knowledge and experience—were identified. Knowledge improved from attending courses. However, knowledge retention fell over time. Participants reported that their confidence improved after attending courses, but an inverted correlation was observed between experience and knowledge. Conclusion: Trauma training courses improve the confidence of healthcare providers. However, these courses should be conducted regularly and trainees observed to assess their confidence. Further studies should be conducted to evaluate the effect of these courses on practitioner confidence.

Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews

ObjectivePatients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. MethodsParticipants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants’ perception of any change in their skills as a result of the course. ResultsThe self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001). ConclusionExperienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.

Scoping Evidence Review on Training and Skills Assessment for Open Emergency Surgery

Scope evidence on technical performance metrics for open emergency surgery. Identify surgical performance metrics and procedures used in trauma training courses. Structured literature searches of electronic databases were conducted from January 2010 to December 2019 to identify systematic reviews of tools to measure surgical skills employed in vascular or trauma surgery evaluation and training. Faculty of Shock Trauma Anesthesiology Research Center, University of Maryland School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland and Implementation Science, King's College, London. The evidence from 21 systematic reviews including over 54,000 subjects enrolled into over 840 eligible studies, identified that the Objective Structured Assessment of Technical Skill was used for elective surgery not for emergency trauma and vascular control surgery procedures. The Individual Procedure Score (IPS), used to evaluate emergency trauma procedures performed before and after training, distinguished performance of residents from experts and practicing surgeons. IPS predicted surgeons who make critical errors and need remediation interventions. No metrics showed Kirkpatrick's Level 4 evidence of technical skills training benefit to emergency surgery outcomes. Expert benchmarks, errors, complication rates, task completion time, task-specific checklists, global rating scales, Objective Structured Assessment of Technical Skills, and IPS were found to identify surgeons, at all levels of seniority, who are in need of remediation of technical skills for open surgical hemorrhage control. Large-scale, multicenter studies are needed to evaluate any benefit of trauma technical skills training on patient outcomes.

Efficacy evaluation of China trauma care training program

Objective To understand the current situation of trauma and evaluate the training effect and influencing factors of China Trauma Care Training (CTCT) by investigating the trainees who participated in the course. Methods A total of 1660 trainees who participated in training from May 2017 to May 2018 were selected as the subjects of this study. Through questionnaires, the general information (gender, occupation, professional title, discipline source, length of time engaged in trauma treatment), the situation of trauma in their hospitals (hospital level, trauma mode, number of severe trauma cases each year), the recommended model of trauma treatment, learning methods of trauma knowledge, and the trauma training interval were obtained. The trainees took tests before and after the training, and the test results were used to evaluate the training effect and analyze the influencing factors. Results (1) There were 1 230 males (74.10%), 1 356 physicians (81.93%), 1 247 with intermediate title or lower levels (75.12%), 756 from emergency department/emergency surgery (45.54%), and 899 who were engaged in trauma for more than five years (54.16%). (2) There were 1 068 trainees from tertiary hospitals (64.34%). The main mode of severe trauma in hospitals was emergency+ consultation+ triage (1 198 trainees, 72.17%). A total of 1014 trainees treated less than 200 severe trauma patients each year (61.08%). A total of 1210 trainees recommended emergency/emergency surgery (72.89%) and 350 trainees recommended trauma surgery/trauma hospital (21.08%) as the main mode of treatment. (3) There were various approaches to acquire trauma knowledge, including 1 029 person-times (61.99%) through department internal guidelines, 924 person-times (55.66%) through case discussion, 879 person-times (52.95%) through self-teaching, 767 person-times (46.20%) through lectures, 382 person-times (23.01%) through trauma courses and 285 person-times through further studies at home and abroad (17.17%). A total of 951 trainees recommended 1-2 years as the training interval (57.3%). (4) The average test score before training was (67.5±14.5)points, which were influenced by the hospital level, discipline source, title of trainees, length of time engaged in trauma treatment, and amount of severe trauma cases each year in their hospitals. The hospital level and discipline source were the main effect factors. (5) The average test score after training was (83.8±11.6)points, which was significantly higher than that before training (P<0.01), and the scores of trainees in different subgroups were all improved. The main factors influencing the test score included hospital level, number of severe trauma cases each year, discipline source, professional title, number of severe trauma cases each year treated in the hospital. The major effect factor was the amount of severe trauma cases each year. Conclusions The main mode of trauma in hospitals involved in this study is multi-disciplinary consultation+ decentralized treatment . Few trainees have received systematic trauma training, and their trauma knowledge level and the test scores before training is influenced by hospital level, the case number of severe trauma treatment, discipline source, and trainees’qualifications. After the standardized and standardized trauma training course CTCT , the scores of students from different backgrounds have been significantly improved, and the gap between students has been significantly narrowed. Key words: Wounds and injuries; Questionaires; Trauma training

Design, implementation and long-term follow-up of a context specific trauma training course in Uganda: Lessons learned and future directions

BackgroundThe Kampala Advanced Trauma Course (KATC) was developed in 2007 due to a locally identified need for an advanced trauma training curriculum for the resource-constrained setting. We describe the design, implementation and evaluation of the course. MethodsThe course has been delivered to over 1,000 interns rotating through surgery at Mulago National Referral Hospital. Participants from 2013 to 2016 were surveyed after completion of the course. ResultsThe KATC was developed with local faculty and includes didactic and simulation modules. Over 50% of survey respondents reported feeling confident performing and teaching 7 of 11 course skills and felt the most relevant skill was airway management(30.2%). Participants felt least confident managing head trauma(26.4%). Lack of equipment(52.8%) was identified as the most common barrier to providing trauma care. ConclusionsProviders are confident with most skill sets after taking the KATC. Minimal dependence on instructors from high-income countries has kept the course sustainable and maximized local relevance.

Road Accidents Management and Emergency Medicine Care.

Background: Traffic accident is when only material damage is caused to the vehicle, track or environment, and there are no casualties. Traffic disaster is such an event in which, besides the material damage, there are human casualties. Traffic disaster is such an event in which, besides the material damage, there are human casualties.&#x0D; Aim: Provision of emergency medical care in all phases of the management of injured persons in traffic accidents with basic and abnormal trauma support in order to reduce: morbidity, validity and mortality and increasing the quality of EMS.&#x0D; Materials and methods: Samples of the survey were only injured in traffic accidents and the main causes were; age, sex, place of residence, seasons, weekdays and months, sleepwalking, drug use, alcohol consumption, and medical assessment, poor quality of roads, speed overtaking, car testing, illness, mobile phone use, eating in the car, radio CD player.&#x0D; Results: The research material was obtained from the UCCK - Clinic Clinic in Pristina archive for January - December 2015 and January - October 2016. Research samples were only injured in traffic accidents. In Kosovo, the Emergency Clinic for January-December was 55.294 / 9.32% and 66 injured / 0.11%. Over 3 400 people die in the world's streets every day and tens of millions of people are injured.&#x0D; Conclusions: EMS should be equipped with medical staff, medicines, medical equippment, concrete materials, ambulances with the aim of providing basic and advanced care to the nearest hospital. Educate and train emergency medical professionals with basic and advanced trauma training courses, especially the hospital and prehospital level, and be incorporated as a first class subject at all levels of school.

Biological Response to Stress During Battlefield Trauma Training: Live Tissue Versus High-Fidelity Patient Simulator.

Tactical Combat Casualty Care (TCCC) training imposes psychophysiological stress on medics. It is unclear whether these stress levels vary with the training modalities selected. It is also unclear how stress levels could have an impact on medical performance and skill uptake. We conducted a pilot study to compare the effects of live tissue (LT) with a high-fidelity patient simulator (SIM) on the level of stress elicited, performance, and skill uptake during battlefield trauma training course in an operating room (OR) and in a simulated battlefield scenario (field). In the report, we studied the effects of training modalities and their changes on stress levels by measuring different biomarkers (salivary amylase, plasma catecholamines, and neuropeptide Y) at various time points during the trauma training course. We found that the training resulted in significant psychophysiological stress as indicated by elevated levels of various biomarkers relative to baseline immediately after both OR and field assessment (p < 0.05). Compared with pre-OR levels, the LT training in the OR resulted in significant increases in the plasma levels of epinephrine, norepinephrine, and neuropeptide (p = 0.013, 0.023, 0.004, respectively), whereas the SIM training in the OR resulted in significant increases in the plasma levels of norepinephrine and neuropeptide (p = 0.003 and 0.008). Compared with pre-field levels, we found significant increases in plasma epinephrine concentration in the SIM group (p = 0.016), plasma norepinephrine concentration in the LT group (p = 0.015), and plasma neuropeptide Y concentration in both LT (p = 0.006) and SIM groups (p = 0.029). No differences in the changes of biomarker levels were found between LT and SIM groups in the OR and field. Compared with pre-field levels, the testing on the same modality as that in the OR in the simulated battlefield resulted in significant increases in norepinephrine and neuropeptide levels (p = 0.013 and 0.015), whereas the testing on different modalities resulted in significant increases in amylase, epinephrine, and neuropeptide levels (p = 0.016, 0.05, 0.018, respectively). There was a significantly larger increase in plasma norepinephrine concentration (p = 0.031) and a trend toward a greater increase in the salivary amylase level (p = 0.052) when the field testing involved a different modality than the OR compared with when OR and field testing involved the same modality. Although most of the biomarkers returned to baseline levels after 24 h, plasma norepinephrine levels remained significantly higher regardless of whether field testing occurred on the same or different modality compared with OR (p = 0.040 and 0.002). TCCC training led to significant increase in psychophysiological stress, as indicated by elevated levels of various biomarkers. The training modalities did not result in any differences in stress levels, whereas the switch in training modalities appeared to elicit greater stress as evidenced by changes in specific biomarkers (amylase and norepinephrine). A comparative study with a larger sample size is warranted.

本邦における医師・救急救命士・看護師の骨髄内輸液路確保手技の比較(Comparison of intraosseous routes insertion between doctors, EMTs, and nurses in Japan: training course using chicken bones)

要旨【目的】骨髄内輸液路（以下，骨髄路）確保は，小児の心停止や重症患者に対して有用であるが，本邦で施行可能な職種は医師のみである。医師，救急救命士（以下，救命士），看護師の職種ごとの骨髄路確保成功率と手技時間を比較検討した。【方法】用手で行う骨髄針（以下，MAN–IO）と，電動式骨髄穿刺キット（以下，EZ–IO）を用いて，各挿入方法ビデオを閲覧後，鶏肉の大腿骨に挿入した。外傷コース受講生291名の全手技をビデオで撮影し，成功率，施行時間を測定した。【結果】248名が解析対象となった。成功率は職種間で有意差を認めなかった（MAN–IO 1回目：医師60.9% vs. 救命士68.1% vs. 看護師61.1%，p=0.53；EZ–IO 1回目：医師80.4% vs. 救命士78.7% vs. 看護師75.9%，p=0.80）。成功時の穿刺時間も職種間で有意差を認めなかった（MAN–IO：医師12.5s vs. 救命士11.5s vs. 看護師13.4s，p=0.49；EZ–IO：医師5.34s vs. 救命士5.25s vs. 看護師4.84s，p=0.58）。【結語】救命士や看護師も，医師と同等に骨髄路確保ができることが示された。本邦の救命士の輸液路確保手技として，骨髄路確保は有用と考えられる。

Using an Individual Procedure Score Before and After the Advanced Surgical Skills Exposure for Trauma Course Training to Benchmark a Hemorrhage-Control Performance Metric

Test with an individual procedure score (IPS) to assess whether an unpreserved cadaver trauma training course, including upper and lower limb vascular exposure, improves correct identification of surgical landmarks, underlying anatomy, and shortens time to vascular control. Prospective study of performance of 3 vascular exposure and control procedures (axillary, brachial, and femoral arteries) using IPS metrics by 2 colocated and trained evaluators before and after training with the Advanced Surgical Skills Exposure for Trauma (ASSET) course. IPS, including identification of anatomical landmarks, incisions, underlying structures, and time to completion of each procedure was compared before and after training using repeated measurement models. Audio-video instrumented cadaver laboratory at University of Maryland School of Medicine. A total of 41 second to sixth year surgical residents from surgical programs throughout Mid-Atlantic States who had not previously taken the ASSET course were enrolled, 40 completed the pre- and post-ASSET performance evaluations. After ASSET training, all components of IPS increased and time shortened for each of the 3 artery exposures. Procedure steps performed correctly increased 57%, anatomical knowledge increased 43% and skin incision to passage of a vessel loop twice around the correct vessel decreased by a mean of 2.5 minutes. An overall vascular trauma readiness index, a comprehensive IPS score for 3 procedures increased 28% with ASSET Training. Improved knowledge of surface landmarks and underlying anatomy is associated with increased IPS, faster procedures, more accurate incision placement, and successful vascular control. Structural recognition during specific procedural steps and anatomical knowledge were key points learned during the ASSET course. Such training may accelerate acquisition of specific trauma surgery skills to compensate for shortened training hours, infrequent exposure to major vascular injuries, or when just-in-time training is necessary. IPS is a benchmark for competence in extremity vascular control.

G86(P) Paediatric advanced trauma skills (pats): a new advanced trauma course for multidisciplinary staff

<h3>Background</h3> Major paediatric trauma is rare and therefore exposure to it is often sporadic and infrequent. Since the designation of major trauma centres (MTC), doctors in these centres are likely to see more paediatric trauma. Advances in paediatric trauma management and are not taught in the more traditional courses such as APLS, ATLS and ETC. This course has been designed for those with an interest in paediatric trauma based in either MTCs or major trauma units (MTU). There are no other similar courses at present in England. <h3>Method</h3> We initially designed a 1-day high fidelity simulation course. Following 8 courses, it became clear there was a need to cover advanced trauma skills. PATS was subsequently developed as a 2-day course covering essential advanced skills. It is run with senior multidisciplinary faculty from emergency medicine, pre-hospital care, paediatric emergency medicine, surgeons, anaesthetists and paediatric intensive care. This high-fidelity simulation course incorporates technical and non-technical skills. The candidates completed anonymous pre- and post-questionnaires. <h3>Results</h3> Of the 10 candidates who have attended the 2 courses, many had requested at the start of the course for more experience with complex trauma scenarios, procedures and leading the team. Despite 70% of the candidates having been involved in other trauma training courses and feeling confident in managing an injured child prior to this course, 90% found the course positively challenging and 100% reported that this course had met their expectations. All candidates had identified human factors as their main learning, in particular communication and team leadership. Other key themes identified were an increased confidence with specific procedures and management protocols. Practicing more procedures during scenarios was requested. Candidates had commented on the benefits of having a mixed seniority of the candidate group (senior trainees and consultants) and the faculty. <h3>Discussion</h3> The feedback has been overwhelmingly positive. Evaluation demonstrated the importance of this course for multi-grade and multidisciplinary staff seeing paediatric trauma. Future courses will invite staff from all disciplines exposed to paediatric trauma and will address the request for more practical procedures.

Combating terror: a new paradigm in student trauma education.

Other than the Advanced Trauma Life Support course, usually run for postgraduate trainees, there are few trauma courses available for medical students. It has been shown that trauma teaching for medical students is sadly lacking within the undergraduate curriculum. We stated that students following formal teaching, even just theory and some practice in basic skills significantly improved their management of trauma patients. Hadassah-Hebrew University in Israel runs an annual 2-week trauma course for final-year medical students. The focus is on hands-on practice in resuscitation, diagnosis, procedures, and decision making. After engaging a combination of instructional and interactive teaching methods including practice on simulated injuries that students must assess and treat through the 2 weeks, the course culminates in a disaster drill where students work alongside the emergency services to rescue, assess, treat, and transfer patients. The course is evaluated with a written precourse and postcourse test, an Objective Structured Clinical Examination and detailed feedback from the drill. We analyzed student feedback at the end of each course during a 6-year period from 2007 to 2012. Correct answers for the posttest results were higher each year with good reliability as assessed by Chronbach's α and with significant variation from pretest scores assessed using paired-samples t tests. Best scores were achieved in knowledge acquisition and practical skills gained. Students were also asked whether the course contributed to self-preparedness in treating trauma patients, and this consistently achieved high scores. We believe that students benefit substantially from the course and gain lasting skills and confidence in trauma management, decision making, and organizational skills. The course provides students with the opportunity to learn and ingrain trauma principles along Advanced Trauma Life Support guidelines and prepares them for practice as safe doctors. We advocate the global implementation of a student trauma training course as a mandatory educational initiative and propose our course format as a model for similar courses.

Training the trainers in emergency medicine: an advanced trauma training course in Rwanda's medical simulation center.

Medical simulation is an integral tool for training medical students and physicians in all specialties, including emergency medicine. We describe a model program for advanced trauma training utilizing the medical simulation and skills center in Rwanda, one of the first in Africa for training health care professionals.

Trauma training course: innovative teaching models and methods for training health workers in active conflict zones of Eastern Myanmar.

BackgroundMyanmar has struggled through decades of internal conflict, which has negatively impacted the country’s health outcomes. Recent government changes have brought hope and reduced conflict. The ethnic minority groups have suffered the brunt of the health consequences and reside in regions that lack health infrastructure, resources, and providers. Due to the chronic lack of healthcare providers within conflict areas, health workers (HWs) have been trained in an effort to fill the void. Research has shown that these non-physician clinicians positively impact health outcomes in developing countries. These HWs are supported by community-based organizations in collaboration with foreign non-governmental organizations. Started in 2000, the trauma training course was developed to meet the educational needs of these HWs.MethodsEssential procedures for HWs in conflict zones were identified, and teaching methods were adapted to develop models that were simple, reproducible, cost effective, and able to facilitate effective learning within the limitations of these challenging environments. This paper presents simulation models developed to teach trauma injury evaluation and management in resource-limited settings to HWs.ResultsMaterial and construction of the models described include breathing, chest, cricothyroidotomy, circulation, wound repair, fracture/dislocation, splinting, fasciotomy/amputation, and an animal model. In 2013, a pre/post test and post-training evaluation were completed, which demonstrated an increase in understanding of the material and satisfaction with the training.ConclusionsThe simulation models described engage the HWs in clinical skills practice specific to injury management, which builds upon the HWs existing knowledge and facilitates an increased understanding of life-saving procedures. Through observation of the HW performance and HW feedback, these simulation models have increased the understanding of trauma management. Limitations include lack of a graduated learning system for the HWs, logistics, and time constraints. Despite the barriers faced, we feel that this is a necessary program that has reduced morbidity and mortality due to traumatic injury in the geographic areas that the HWs serve. With the changing political environment in Myanmar and the development of peace agreements between the government and the ethnic minority groups, these HWs can be integrated into Myanmar’s evolving health system.

Evolution of trauma management at a tertiary care hospital: A cohort study

Objective To analyze the characteristics of polytrauma patients and to assess the outcome of trauma care as this specialty has evolved over the years at a university hospital. Methods The study included all polytrauma patients treated between January 1998 and September 2005 at a tertiary care hospital in a megacity. Data of 1009 patients was collected prospectively and analyzed retrospectively. Patients were divided into two groups A and B, based on their presentation before and after the introduction of a formal trauma training course in 2002. The analysis included demographic data, injury severity score, vital signs including hemodynamics and GCS on admission, intubation rates, mortality and complications. Results 435 patients were included in group A (1998–2001) whereas group B (2002–2005) comprised of 574 patients. The proportion of patients with accidental versus intentional injuries was similar in both groups. The mean injury severity score of group A was 11.9 whereas that of group B was 11.7. Almost 50% of patients were transferred from other hospitals. Transferred patients had significantly lower GCS ( p < 0.001), higher ISS ( p < 0.001) and longer ICU stays ( p < 0.001) in both (A and B) patient groups, while in group A mortality was also higher ( p = 0.018). A significantly higher number of patients in group B went into shock. The overall mortality rate was 9.7% for group A which significantly decreased to 5.7% for group B ( p < 0.05). Conclusions This study supports the view that as trauma care evolved at our hospital with the establishment of a formal training program, the mortality rates have significantly decreased.