Development of a Comprehensive Trauma Training Curriculum for the Resource-Limited Environment

Anderson, Geoffrey A.; Kayima, Peter; Ilcisin, Lenka; Benitez, Noralis Portal; Albutt, Katherine; Briggs, Susan M.; Nehra, Deepika

doi:10.1016/j.jsurg.2018.02.014

Cited by 20 publications

(32 citation statements)

References 25 publications

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“…International surgeons handling the workload and local surgeons ready for private practice will result in a temporary management of hospital capacities only. NGO have surely understood this point, but the implementation was not successful everywhere [23,24]. A well-equipped hospital with low surgical expertise probably is not as effective as a low equipped hospital with well trained staff.…”

Section: Discussionmentioning

confidence: 99%

No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Wichlas

Hofmann

Moursy

et al. 2021

Arch Orthop Trauma Surg

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Introduction In low-income countries (LIC), international surgeons face the fact that there are patients they cannot treat. The goal of this study was to identify and analyze patients lost to treatment. Material and methods We analyzed retrospectively the data of 282 trauma victims from a non-governmental organizational (NGO) hospital in Sierra Leone, Africa. During a 3-month period (10.10.2015–08.01.2016), these patients had 367 injuries and underwent 263 orthopedic surgeries. Despite a clear indication, some patients did not receive surgical treatment. We identified these injuries and the reason why they could not be operated. The anatomic region of the injury was evaluated and if they had a bone or soft tissue defect or were infected. Results We identified 95 (25.89%) injuries in 70 patients (47 males; 23 females) that were not be operated. The reasons were lack of specific implants (no implant group; N = 33), no treatment strategy for the injury (no solution group; N = 29), and patients that were lost (lost patient group; N = 33), almost equally distributed by 1/3. In the no implant group were mainly closed fractures and fractures of the pelvis and the proximal femur. The implants needed were locking plates (N = 19), proximal femoral nails (N = 8), and implants for pelvic surgery (N = 6). In the no solution group were nearly all bone (P < 0.0000), soft tissue defects (P < 0.00001) and infections (P = 0.00003) compared to the rest and more open fractures (P < 0.00001). In the lost patients group, most fractures were closed (24 out of 33, P = 0.033). These fractures were mostly not urgent and were postponed repeatedly. Conclusion One quarter of the patients did not receive the surgical treatment needed. Besides acquisition of implants, surgical skills and expertise could be a solution for this issue. Nevertheless, these skills must be passed to local surgeons.

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Section: Discussionmentioning

confidence: 99%

No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Wichlas

Hofmann

Moursy

et al. 2021

Arch Orthop Trauma Surg

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“…All five included studies were published between June 2005 and December 2020 and were undertaken in four different, low-or middle-income countries: Uganda, Pakistan, Brazil and Ghana. Three studies [18][19][20] were non-randomized cross-sectional studies and one was a randomized prospective crossover study [21]. Jacobs et al [22] had an unspecified study design and no raw outcome data.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Jacobs et al [22] had an unspecified study design and no raw outcome data. All studies evaluated different courses: the Mulago Operative Trauma Resuscitation Course (M-OTR) [18], Surgical Techniques and Repairs in Trauma for the Low-resource Environment (STaRTLE) [19], Emergency Vascular Surgery Course for Non-Vascular Surgeons (EVSC) [20], Advanced Trauma Life Support (ATLS) surgical skills station [21] and the Advanced Trauma Operative Management (ATOM) course [22]. A detailed description of each course is provided in Table 2.…”

Section: Study Characteristicsmentioning

confidence: 99%

Are Trauma Surgery Simulation Courses Beneficial in Low- and Middle-Income Countries—A Systematic Review and Meta-Analysis

et al. 2021

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Despite trauma-related injuries being a leading cause of death worldwide, low- and middle-income countries (LMICs) lack the infrastructure and resources required to offer immediate surgical care, further perpetuating the risk of morbidity and mortality. In high-income countries, trauma surgery simulation courses are routinely delivered to surgeons, teaching the fundamental skills of operative trauma. This study aimed to assess whether similar courses are beneficial in LMICs and how they can be improved. We performed a systematic review and meta-analysis using MEDLINE, Embase and Google Scholar, analysing studies evaluating trauma surgery simulation in LMICs. The outcomes measured included clinical knowledge improvement, participant confidence and general course-feedback. The review was carried out in-line with PRISMA guidelines. Five studies were included, summating a population of 172 participants. In three studies, meta-analysis showed an overall significant weighted mean improvement of knowledge post-course by 22.91% (95%CI 19.53, 26.29; p < 0.00001; I2 = 0%). One study reported a significant increase in participant confidence for 20/22 of operative skills taught (p < 0.04). We conclude that these courses are beneficial in LMICs; however, further research is necessary to establish the optimum course design, and whether patient outcomes are improved following their implementation. Collaboration between international trauma institutions is essential for closing the educational resource inequality gap between higher- and lower-income countries.

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“…For example, to date, over one million clinicians in 80 countries have received Advanced Trauma Life Support (ATLS) course trainings [ 9 ]. Based on models of care from high-income countries, standard ALS courses have not been adapted to low-resource clinical settings (with few exceptions) [ 6 , [10] , [11] , [12] , [13] , [14] ].…”

Section: Introductionmentioning

confidence: 99%

Advanced life support courses in Africa: Certification, availability and perceptions

Friedman

Werner

Geduld

et al. 2020

African Journal of Emergency Medicine

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Background Advanced life support (ALS) short training courses are in demand across Africa, though overwhelmingly designed and priced for non-African contexts. The continental expansion of emergency care is driving wider penetration of these courses, but their relevance and accessibility is not known. We surveyed clinicians within emergency settings to describe ALS courses' prevalence and perceived value in Africa. Methods We conducted a cross-sectional quantitative analysis of 235 clinicians' responses to the African Federation for Emergency Medicine's online needs assessment for an open-access ALS course in Africa. Participants responded to multiple-choice and open answer questions assessing demographics, ALS course certification and availability, perceptions of ALS courses, and barriers and facilitators to undertaking such courses. Results 235 clinicians working in 23 African nations responded. Most clinicians reported ALS course completion within the past three years (73%) and in-country access to ALS courses (76%). Most believed the content adequately met their region's needs (60%). Price and course availability were the most common barriers to taking an ALS course. The most common courses were cardiac and paediatric-focused, and the most common reasons to take a course included general career development, personal interest, and departmental requirements. Conclusion One-quarter of emergency care clinicians lack access to ALS courses in twenty-three African nations. Most clinicians believe that ALS courses have value in their clinical settings and meet the needs of their region. Our findings illustrate the need for an affordable, widely available ALS course tailored to lower-resource African settings that could reach rural and peri-urban clinicians.

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Development of a Comprehensive Trauma Training Curriculum for the Resource-Limited Environment

Cited by 20 publications

References 25 publications

No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

No implant, no solution, lost cases to surgery: orthopedic trauma triage for surgery in an NGO hospital in Sierra Leone

Are Trauma Surgery Simulation Courses Beneficial in Low- and Middle-Income Countries—A Systematic Review and Meta-Analysis

Advanced life support courses in Africa: Certification, availability and perceptions

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