Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study

Kivlehan, Sean M; Allen, Amy; Viun, Olha; Makarov, Dmitry A.; Schnorr, Daniel; Patel, Sonny S.; Ryzhenko, S.A.; Pham, Phuong; Erickson, Timothy

doi:10.1136/bmjopen-2021-050871

Cited by 4 publications

(5 citation statements)

References 9 publications

(11 reference statements)

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“…Limited data have emerged from the war in Ukraine on the roles and effects of early care trauma systems. Our results align with those of Kivlehan et al who reported significant improvements in knowledge and confidence among Ukrainian participants in a 5-day WHO-ICRC Basic Emergency Care course carried out in 2022 13…”

Section: Discussionsupporting

confidence: 92%

“…Our results align with those of Kivlehan et al who reported significant improvements in knowledge and confidence among Ukrainian participants in a 5-day WHO-ICRC Basic Emergency Care course carried out in 2022. 13 Epstein et al compared some of the lessons learnt from the US 'Global War on Terror' to the work of their group in supporting surgical care services in Ukraine. 14 Riley has examined the potential lessons from the war for largescale NATO led medical operations 15 and Zasiekina has explored the impact of Post Traumatic Stress Disorder at community level.…”

Section: Open Accessmentioning

confidence: 99%

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Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

Bury,

Fitzpatrick,

Heron

et al. 2023

BMJ Open

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ObjectivesTo design, develop, deliver and assess a training initiative on haemorrhage control for emergency medical services (EMS) staff in Ukraine, in an active wartime setting.DesignUsing the Medical Research Council framework for complex interventions, a training programme was designed and developed in a collaboration between Irish and Ukrainian colleagues and delivered by experienced prehospital clinicians/educators. Feedback was gathered from participants.SettingThe Russian invasion of Ukraine has caused large numbers of trauma patients with limited access to advanced prehospital emergency care. Ukrainian authorities requested support in delivering such care.ParticipantsUkrainian EMS nominated clinical staff as trainees, in partnership with an educational institution in Kyiv.InterventionOne day provider and train-the-trainer courses were developed and delivered, focused on early delivery of tranexamic acid (TXA), using intraosseous access (IO) in victims of wartime trauma.Outcome measuresSafe organisation and delivery of courses, assessed knowledge and skills competence and self-reported satisfaction and pre/post confidence/competence.ResultsTwo provider and one train-the-trainer courses and four equipment supply exercises were delivered for 89 EMS staff (doctors, nurses, paramedics); none had prior experience of IO or prehospital delivery of TXA. All participants were assessed as competent as providers and/or trainers. High levels of satisfaction and significantly improved self-assessed confidence and competence were reported.ConclusionRapid design and delivery of a training programme focused on an identified need for advanced care of trauma patients in a wartime setting has been possible. Training and immediate access to appropriate equipment was demonstrated. Evidence of frequency of use and safe, effective interventions has not been collected; such data are important for evaluation but difficult to collect in this setting. A high level of demand for this training now exists.

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Section: Discussionsupporting

confidence: 92%

Section: Open Accessmentioning

confidence: 99%

Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

Bury,

Fitzpatrick,

Heron

et al. 2023

BMJ Open

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“…For the first time, the armed conflict in Ukraine generated a paper included in the GEMLR. Kivlehan et al 68 . implemented the World Health Organization Basic Emergency Care (BEC) course for the first time in a European context and during an active humanitarian conflict and demonstrated improvement in emergency care knowledge and skill performance.…”

Section: Discussionmentioning

confidence: 99%

Global Emergency Medicine: A Scoping Review of the Literature from 2022

Hexom,

Quao,

Bandolin

et al. 2023

Academic Emergency Medicine

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ObjectiveThe objective was to identify the highest quality global emergency medicine (GEM) research published in 2022. The top articles are compiled in a comprehensive list of all the year's GEM articles and narrative summaries are performed on those included.MethodsA systematic PubMed search was conducted to identify all GEM articles published in 2022 and included a manual supplemental screen of 11 organizational websites for gray literature (GRAY). A team of trained reviewers and editors screened all identified titles and abstracts, based on three case definition categories: disaster and humanitarian response (DHR), emergency care in resource‐limited settings (ECRLS), and emergency medicine development (EMD). Articles meeting these definitions were independently scored by two reviewers using rubrics for original research (OR), review (RE) articles, and GRAY. Articles that scored in the top 5% from each category as well as the overall top 5% of articles were included for narrative summary.ResultsThe 2022 search identified 58,510 articles in the main review, of which 524 articles screened in for scoring, respectively, 30% and 18% increases from last year. After duplicates were removed, 36 articles were included for narrative summary. The GRAY search identified 7755 articles, of which 33 were scored and one was included for narrative summary. ECRLS remained the largest category (27; 73%), followed by DHR (7; 19%) and EMD (3; 8%). OR articles remained more common than RE articles (64% vs. 36%).ConclusionsThe waning of the COVID‐19 pandemic has not affected the continued growth in GEM literature. Articles related to prehospital care, mental health and resilience among patients and health care workers, streamlining pediatric infectious disease care, and disaster preparedness were featured in this year's review. The continued lack of EMD studies despite the global growth of GEM highlights a need for more scholarly dissemination of best practices.

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“…In addition to the pilot BEC programs in Zambia, Tanzania, and Uganda, additional iterations have been implemented in emergency facilities in Nigeria, Sierra Leone, Ukraine, and Kiribati and adapted for each clinical context [30][31][32][33]. In these cases, knowledge acquisition was similarly measured by comparing pre-and post-course assessments.…”

Section: Plos Onementioning

confidence: 99%

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

Epps

Ramachandran

et al. 2023

PLoS ONE

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Background Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia. Methods A six-month emergency care curriculum consisting of BEC content, standardized WHO clinical documentation forms, African Federation of Emergency Medicine (AFEM) didactics, and clinical mentorship by visiting emergency medicine (EM) faculty was designed and implemented using IS frameworks at Redemption Hospital, a low-resource public referral hospital in Monrovia, the capital of Liberia. Healthcare worker performance on validated knowledge-based exams during pre- and post-intervention testing, post-course surveys, and patient outcomes were used to evaluate the program. Results Nine visiting EM physicians provided 1400 hours of clinical mentorship and 560 hours of didactic training to fifty-six Redemption Hospital staff over six-months. Median test scores improved 20.0% (p<0.001) among the forty-three healthcare workers who took both the pre- and post-intervention tests. Participants reported increased confidence in caring for medical and trauma patients and comfort performing emergency care tasks on post-course surveys. Emergency unit (EU)/Isolation unit (IU) mortality decreased during the six-month implementation period, albeit non-significantly. Course satisfaction was high across multiple domains. Discussion This study builds on prior research supporting WHO efforts to improve emergency care globally. BEC implementation over a six-month timeframe using IS principles is an effective alternative strategy for facilities in resource-constrained environments wishing to strengthen emergency care delivery.

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Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study

Cited by 4 publications

References 9 publications

Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders

Global Emergency Medicine: A Scoping Review of the Literature from 2022

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

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