Primary Trauma Care · Primary Trauma Care Course Report Champasak Provincial Hospital Pakse, Lao...
21
Primary Trauma Care Course Report Champasak Provincial Hospital Pakse, Lao PDR Monday, 5 th November – Friday 9 th , November, 2018 Executive Summary The content of this report covers the 5-day PTC 2-1-2 course that was held at the Champasak Provincial Hospital, in Pakse, Lao PDR. This PTC 2-1-2 training followed the training at the College of Health Sciences in Luang Prabang for the Northern Provinces. These trainings were sponsored and organized by the University of Health Sciences (UHS) and Health Leadership International (HLI) with the support of the Ministry of Health, Lao PDR. The funding for these PTC trainings was provided under a grant from the U.S. Department of State to Health Leadership International. The Primary Trauma Care Foundation has endorsed the delivery of their life saving PTC training course in the Lao PDR. The Lao PDR Ministry of Health joins over seventy countries who are providing PTC, the trauma and disability training for “front-line health workers on how to deliver emergency medical care with only basic equipment.” The goal of PTC in the Lao PDR is to save lives, prevent disabilities and give medical providers at all levels of health care the medical knowledge and skills to make a difference in the trauma statistics in their nation. The goal of this medical collaboration in the Lao PDR is to train key emergency medicine providers at UHS and at the Provincial and District level in the hopes of spreading the PTC model throughout the Lao PDR. Key Staff Involved in Planning and Coordinating Dr. Khamsay Detleuxay, the Director of the ICU at Mahosot Hospital and the Director of the Emergency Medicine Residency at UHS is the Director of the Primary Trauma Care training to be conducted in the Lao PDR at both the Provincial and District levels. Dr. Khamsay provided medical leadership for course preparation, organization, and invitation of attendees for the 5-day training of trainers in the Northern and Southern Provinces. The HLI Executive Team including Reba McIntyre PhD, Cam McIntyre MD, Steve Dunning MD, and Khampho Thammavangxay Ohno, MPH, PA-C worked with key Lao PDR leaders over many months to plan, coordinate, staff, equip and fund these PTC trainings. Course Participants for 2-1-2 Instructor’s Course in Luang Prabang The course participants were selected by Dr. Khamxay Detleuxay and approved by the MoH and UHS and the Provincial Hospital leadership for participation in this 2-1-2 training of trainers for PTC. Each of the nine provinces in Southern Lao was asked to choose two high level provider participants for this training. 1
Transcript of Primary Trauma Care · Primary Trauma Care Course Report Champasak Provincial Hospital Pakse, Lao...
Primary Trauma CareCourse Report
Champasak Provincial HospitalPakse, Lao PDR
Monday, 5th November – Friday 9th, November, 2018
Executive Summary
The content of this report covers the 5-day PTC 2-1-2 course that was held at the Champasak Provincial Hospital, in Pakse, Lao PDR. This PTC 2-1-2 training followed thetraining at the College of Health Sciences in Luang Prabang for the Northern Provinces.
These trainings were sponsored and organized by the University of Health Sciences (UHS) and Health Leadership International (HLI) with the support of the Ministry of Health, Lao PDR. The funding for these PTC trainings was provided under a grant fromthe U.S. Department of State to Health Leadership International.
The Primary Trauma Care Foundation has endorsed the delivery of their life saving PTCtraining course in the Lao PDR. The Lao PDR Ministry of Health joins over seventy countries who are providing PTC, the trauma and disability training for “front-line health workers on how to deliver emergency medical care with only basic equipment.”The goal of PTC in the Lao PDR is to save lives, prevent disabilities and give medical providers at all levels of health care the medical knowledge and skills to make a difference in the trauma statistics in their nation.
The goal of this medical collaboration in the Lao PDR is to train key emergency medicine providers at UHS and at the Provincial and District level in the hopes of spreading the PTC model throughout the Lao PDR.
Key Staff Involved in Planning and Coordinating
Dr. Khamsay Detleuxay, the Director of the ICU at Mahosot Hospital and the Director of the Emergency Medicine Residency at UHS is the Director of the Primary Trauma Care training to be conducted in the Lao PDR at both the Provincial and District levels. Dr. Khamsay provided medical leadership for course preparation, organization, and invitation of attendees for the 5-day training of trainers in the Northern and Southern Provinces.
The HLI Executive Team including Reba McIntyre PhD, Cam McIntyre MD, Steve Dunning MD, and Khampho Thammavangxay Ohno, MPH, PA-C worked with key Lao PDR leaders over many months to plan, coordinate, staff, equip and fund these PTC trainings.
Course Participants for 2-1-2 Instructor’s Course in Luang Prabang
The course participants were selected by Dr. Khamxay Detleuxay and approved by theMoH and UHS and the Provincial Hospital leadership for participation in this 2-1-2 training of trainers for PTC. Each of the nine provinces in Southern Lao was asked to choose two high level provider participants for this training.
1
These participants for this 2-1-2 Instructor’s Course were trained to be key leaders/instructors in the PTC training in each of their provinces in late 2019. The goalof the trainings in 2019 will be to train two providers from each of the district hospitalsin each province. The overall goal nationwide is to provide PTC training to two providers from all of the 139 district hospitals in the Lao PDR in 2019. Both the Emergency Medicine Residents and Provincial trained PTC instructors will be faculty in this nationwide training program.
PTC Course Leadership Course Director: Dr. Khamsay Detleuxay; PTC Director, Director of ICU Mahosot Hospital, and Director of EM Residency at UHS
Course Coordinator: Dr. Steve Dunning – Health Leadership International HLI Medical Director of PTC
Dr. Khamsay and Dr. Steve
Course Financial Director: Dr. Cam McIntyre – Health Leadership International
PTC Faculty – Clinical Training Team
The clinical training team consists of a team of highly skilled emergency medicine practitioners from UHS and HLI under the leadership of Dr. Khamsay Detleuxay MD. His goal has been to create a competent core training team utilizing Emergency Medicine residents at UHS as PTC trainers. The eight residents trained in February 2018 were the faculty along with HLI faculty at the Provincial Hospital level in the Northern and Southern Provinces.
Course Director - Dr. Khamsay Detleuxay MD with four UHS Emergency Medicine 2nd Year Residents
Four Emergency Medicine 2nd year residents were the core PTC trained leaders for this training conducted in Laotian. All PTC materials had been translated into Laotianby HLI and were provided to the attendees representing the eight Provincial Hospitalsfrom the Southern Provinces.
PTC Training Staff
PTC Director – Khamsay Detleuxay, MD
2
2 nd Year EM Residents – UHS
Thepbandith PHOMMACHANH MDBunkong KEOKHAMHONG MDAnong PHENGMAILORKHAM MDBunthavy CHANTHALANOUVONG MD
2nd Year Emergency Medicine Residents – UHS with Dr. Khamsay and Dr. Khamph ( HLI )
HLI Clinical Staff – Steve Dunning, MD – Internal Medicine, ATLS, Lao SpeakerCam McIntyre, MD – Family Medicine, ATLSRick Arnold, MD – Internal Medicine, Thai SpeakerKhamph Southisombath, MD – Family Medicine, Lao SpeakerAlicia Quella, PhD, PA-C – Emergency Medicine, Epidemiology, ATLS
PTC Course Administration Team
A collaborative team of HLI and UHS worked together to provide the administration and evaluation tasks that supported this PTC 2-1-2 training of trainers course.
Course Administrator – Champasack - Dr. Alicia Quella PhDUHS Administrator - Dr. Sompasong Kanthavong MD
3
PTC Instructor’s Course Participants for Day 1, 2 & 3
The Southern Provinces represented were Borikhamxay, Khammuan, Appapeu, Savannaket, Xaysomboun, Saravan, Xekong, and Champasack. See Appendix A for a list of the 2-1-2 course participants which included degree, specialty, gender and age.
4
The First 2-Day PTC Program – Day 1 and 2
The PTC Program was taught predominantly in Laotian. The course was supported with translation only to strengthen clarity in the clinical presentations by a team of translators – Dr. Khamsay, Dr. Khamp and Dr. Steve. Four skill stations were set-up for the intense hands-on trauma training for this course. See Appendix B for the course schedule and content for the 2-day PTC (Instructor Course) (Day 1 and Day 2). During Day 1 and Day 2 participants were in four groups rotating through the skill stations.
The Instructor PTC Program – Day 3
See Appendix C for the Instructor’s Course schedule.
The Provincial PTC attendees discussed teaching methods during day three of the 2-1-2 PTC Instructors training. The attendees learned how to teach a PTC skill, deliver a PTC course, run a scenario group, and run a discussion group.
New Provincial Trainers received PTC training bags for the roll-out of PTC training intheir nine Northern Provinces. Following the 3-day instructor training attendees received a certificate recognizing them as certified trainers of PTC. These MD’s will be leading the PTC roll-out in 2019 for training district hospital staff in their home provinces.
The Second 2-Day PTC Program
See Appendix D for the course schedule for the second 2-Day PTC program.
Photo of PTC Course 2 - Day 4 and 5 Attendees and Faculty at Luangprabang CHS
The course 2 participants were health providers from
The second 2-day PTC training was taught by the new Provincial PTC trainers from the nine different provinces as the key faculty. They were coached by UHS and HLIPTC faculty. See Appendix E for the schedule of the 2-day PTC course.
PTC Course Evaluation, Training Feedback, Training Outcomes
PTC Course 1 – 16 Provincial Hospital Training of Trainers Attendees – Day 1 & 2 PTC Course 2 - 16 Pakse Attendees – Day 4 & 5PTC Instructor Methods Course – Day 3
Summary of Pre and Post MCQ – Course 1 and Course 2
Multiple Course ExamCourse 1Mean % Pretest 60%Mean % Postest 83%% of Mean Improvement 23%Course 2Mean % Pretest 65%Mean % Postest 79%% of Mean Improvement 14%
Pre and Post Confidence Matrix
Scenarios
A B C D E F G H
Course1
Pre 2.4 3.2 2.9 3.3 2.7 3.2 3.3 2.9Post 3.4 4.1 4.4 4.0 3.5 4.4 3.9 4.6Course
2Pre 2.2 3.0 2.7 2.8 2.5 3.1 3.1 2.5Post 3.63 3.88 3.63 3.62 3.81 3.50 3.56 3.75
PTC Course EvaluationCourse 1
Teach a PTC Skill
Deliver a PTC Skill
Run a Trauma Scenario
Run a Disscussion Group
3.9 3.8 4.2 4.1
Course 2
Pre 2.2 3.0 2.7 2.8 2.5 3.1 3.1 2.5Post 3.6 4.1 4.4 4.4 3.6 4.2 3.8 4.5
PTC Course Evaluation for Day 3 Course 1
Teach a PTC Skill
Deliver a PTC Skill
Run a Trauma Scenario
Run a Disscussion Group
3.9 3.8 4.2 4.1
Course Evaluation
The PTC training in Luang Prabang was very successful. The trainees stated the
course was an excellent trauma model for all levels of healthcare providers. They
valued the ABCDE approach and the hands-on skill and knowledge small group
sessions.
At the end of the Day -3 Instructor Course participants rated the six sessions as
good to very good for the usefulness of the content. They also rated their ability
to teach this course in the 4 to 5 range. (1-5 scale) The overall impact of the three
day training showed a high level of trainee confidence to roll-out the nationwide
PTC training in the Provinces.
Participant skill and knowledge improved as shown by MCQ results and higher
confidence matrix scores in managing trauma patients.
Recommendations and Conclusion
A recommendation is to simplify both the administrative and evaluation PTC
material in the upcoming district PTC trainings in 2019. Also, UHS and HLI will
continue to strengthen the Laotian medical edits of the PTC curriculum and skill
scenarios.
The recommendation of MoH, UHS and HLI is to move forward with a planned PTC
2-1-2 training in Vientiane in February 2019 of the second cohort of Emergency
Medicine residents. Also UHS and HLI have received approval for the future roll-
out of the district hospital PTC trainings in 2019 in both the North and the South.
These are tentatively planned to take place during June and November of 2019, in
the South and North, respectively.
A large number of participants (18) were included in the Instructor course, with all
18 instructing on the subsequent PTC course 2. This may have diluted their
experience as instructors but it was necessary to build a pool of Provincial
instructors for future courses at the District level in 2019.
There was positive feedback and support from the MoH , UHS, Provincial hospitals,
Colleges of Health Sciences and participating faculty and trainees that the PTC
training would help improve significantly trauma care in the Lao PDR.
Acknowledgments and Thanks
HLI wishes to thank the following supporters for the planning, organizing, instructing and funding efforts that made the PTC training possible in November 2018. This training was funded by a generous grant to HLI from the US Department of State.
MoH, Lao PDRU. S. Department of State
Dr. Phouthone Vangkonevilay - President of UHSDr. Ketsomsouk Boubphaphan – Dean of Faculty of MedicineDr. Alongkone Phengsavanh – Vice Dean of Faculty of MedicineDr. Niranh Phoumindr MD, Director General; Department of Health Professional Studies
Dr. Molina Choummanivong Vice Director, International RelationsDr. Celine Jacobs - Health FrontiersSuzie Nui MD- PTC Foundation –PTC coordinator
Appendix A: PTC 2-day Course Participants – All from Champasak Province –
(Total Number of Participants – 16)
Name & Surname Province Degree
Specialty M/F
Age
Dr. Somphone CHANSAMONE Borikhamxay
MD - M 27
Dr. Souksomboun SYSAVANG Borikhamxay
MD SURGEON M 25
Dr. Boungong VONGSINASONE Khammuan MD ANESTHESIA M 57Dr. Kesone BOUNYASONE Khammuan MD IM F 29Dr. Nouphit PHONSAVANH Attapeu MD SURGEON M 39Dr. Somboun THIRAKOUN Attapeu MD SURGEON M 40Dr. Aloundeth PHOUHEUANGHOUNG
Savannaket MD EM M 38
Dr. Souchinda PHANTHAVONGSA Savannaket MD EM M 29Dr. Siphandone KHOUNYOTHA Xaysombou
nMD FM M 32
Dr. Xuaxa HER Xaysomboun
MD FM M 31
Dr. Minaphone MADMANIVONG Saravan MD - F 27Ma. Sakhone DUANGMALALAY Saravan MD ANESTHESIA M 36Dr. Kinglatda PHOUDTHAVONG Xekong MD - M 50Dr. Souphaphone PHONSONGKHAM
Xekong MD - F 28
Dr. Somphith PHANTHALATH Champasack MD SURGEON M 50Dr. Papha PHATHOUMPHANH Champasack MD FM F 27
Schedules for the 2-1-2 PTC Training in Pakse for Southern Provinces of Lao PDR
Appendix B: Course Schedule for the 2-1-2 TrainingDay 1
Time/Minutes
Topic Slides
Lao Lead Pakse
HLI Lead
8:30 / 30 min
Welcome, Intro, MCQ
Dr. Khamsay
Steve
9:00/15 min Local Trauma Perspective
Dr. Khamsay
Steve
9:15/15 min PTC Overview 1-13 Bounkong Alicia/Cam
9:30/30 min Truama ABCD Primary Survey
14-37 Thepbandith
Rick
10:00/10 min
Break / /
10:10/40 min
Airway & Breathing
38-62 Anong Khamph
10:50/35 min
Circulation & Shock
63-85 Bounkong Alicia/Cam
11:25/35 min
Chest Injuries 86-104
Bounthavy Steve
12:00/45 min
Lunch Break /
12:45/80 min
Skills /
/40 min
Basic/Airway Anong Steve
Advanced Airway Bounkong Khamph
/20 min
Cervical Spine/Log Roll
Thepbandith
Cam/Alicia
/20 min
Chest Drains Bounthavey
Rick
14:05/10 min
Break /
14:15/60 min
Abdominal Pelvic Limb trauma
105-141
Thepbandith
Rick
15:05/15 min
Demonstration scenario
All Khamph
15:20/70 min
Scenario Practice
Steve #1 Bounthavy Steve
Khamph #2 Anong Khamph
Alicia/Cam #3 Bounkong
Rick #4 Thepbandith
Rick
16:30/5 min Overview & Summary
Dr. Khamsay
Day 2Time/Minutes
Topic Slides
Lao Lead Pakse
HLI Lead
8:30/45min Head & Spinal Injuries
126-182
Bounkong Cam/Alicia
9:15/30 min Trauma in 183- Anong Khamph
Children &Pregnancy
214
9:45/30 min Burns 215-235
Bounthavy Steve
10:15/15 min
Break
10:30/ 80 min
Workshops
20 min
Analgesia Bounthavy Rick
20 min
Transport Anong Alicia/Cam
20 min
Peds Trauma Thepbandith
Khamph
20 min
Neuro Assessment
Bounkong Steve
12:00/ 30 min
Secondary Survey
236-248
Thepbandith
Rick
12:30/40 min
Lunch Break
13:10/50 min
Disaster Management
Bounthavy Steve
14:00/80 min
Scenarios
/20 min
#5 Steve Bounthavvy
Steve
/20 min
#6 Khamph Anong Khamph
/20 min
#7 Alicia/Cam Bounkong Alicia/Cam
/20 min
#8 Rick Thepbandith
Rick
15:20/10 min
Break
15:30/15 min
Repeat MCQ Khamph
15:45/20 min
Summary, FeedbackEvaluation
Khamsay Steve,Alicia
16:05/15 min
Close, discussionPlanning for Instructor Day
Dr. Khamsay
Steve
16:20/15 min
Certificates Dr. Khamsay
Steve
Appendix C: Course Schedule for Day 3 – Instructor Course 2-1-2 TrainingDay 3
Time/Minutes
Topics Slides Lao Lead Pakse
HLI Lead
8:00/ 15 min Registration, Fill informs
Reba
8:15/15 min Welcome, IntroEducational Philosophy
1-4 Steve
8:30/55 min Session I: CommunicationsSkills
5-10 Thepbandith
Rick
/15 min
Training input
/5 min Explain Feedback
/30 min
Practical Workshop
/5 min Reflection & Summary
9:25/80 min Session 2: InteractiveTeaching
11-25 Anong Khamph
/20 min
Training Input 1: QuestionsIn Lectures
/15 min Practical Workshop
/5 min Reflections
/15 min Training Input 2: PTCWorkshop
/20 min Practical Workshop
/5 min Reflection & Summary
10:45/20 min
Break
11:05/80 min
Session 3: Scenarios
27-34 Bounthavy Steve
/20 min
Training Input: TheTraining Scenario
/15 min
Practical Scenario
/40 min
Practical Workshop
/5 min Reflection &
Summary12:25/ 45 min
Lunch Break
13:10/80 min
Session 4: Skill Stations
35-43 Bounkong Cam
/15 min
Training Input 1: TeachingThe skill with demonstration
/15 min
Running the Skill StationWith demonstration
/5 min
Organization of the skill Stations
/40 min
Practical WorkshopSet up and practiceRole Play Log roll
14:30/35 min
Session 5: How toRun a PTCCourse
45-50 Dr. Khamsay
/15 min
In a new venue
/15 min
Who does what the next day
/5 min
Taking charge of the room And safety
15:05/15 min
Break
15:20/90 min
Section 6: Slides & Lectures
53-58 Bounkong Alicia
/10 min
Training input 1:Using slides effectively
/20 min
Practical Workshop:Speaking with slides on a Laptop
/15 min
Training input 2: PreparingPTC lectures
/40 min
Final Presentations
/5 Final Feedback
min16:50/10 min
Confidence Matrix, EvalsSummary, Certificates
17:00 Finish
Appendix D: PTC 2-day Course Participants
First/Last Name Province Degree
Speciality M/F
Age
Dr. Sengmany Vatsavong 106 militaryhospital
MD - F 30
Dr. Somphavanh Rasvong 106 militaryhospital
MD - M 48
Dr. Bounkham Phalaphone 106 militaryhospital
MD - M 32
Ms. Linda Banhilath 106 militaryhospital
Nurse - F 27
Ms. Omphan Suyaiyu 106 militaryhospital
Nurse - F 40
Mr. Santisouk Keovongsa Champasack hospital
Nurse - M 45
Dr. Oulay Sitthideh Champasack hospital
MD - F 36
Ms. Manivant Singkham Champasack hospital
Nurse - F 36
Ms. Some Keovongsa Champasack hospital
Nurse - F 38
Ms. Olaxone Bounphahuksa Champasack hospital
Nurse - F 36
Dr. Vinitda Phimmasone Champasack hospital
Nurse - F 26
Ms. Sonda Saiyaphoum Champasack hospital
Nurse - F 36
Ms. Viengsavanh Vongsavast Champasack hospital
Nurse - F 38
Dr. Vienglakhone Phayphomkong
College of heath MD - M 29
Ms. Kindalone Souvanavongsa
College of heath MA - F 42
Ms. Malilammone Hanxana College of heath MA - F 25
Appendix E: Course Schedule for Day 4 and 5 – PTC 2 day courseDay 4
Time/Minutes
Topic Slides
Lao Lead Pakse
HLI Lead
8:30 / 30 min
Welcome, Intro, MCQ
Dr. Khamsay
Steve
9:00/15 min Local Trauma Perspective
Dr. Khamsay
Steve
9:15/15 min PTC Overview 1-13 Bounkong Alicia/Cam
9:30/30 min Truama ABCD Primary Survey
14-37 Thepbandith
Rick
10:00/10 min
Break / /
10:10/40 min
Airway & Breathing
38-62 Anong Khamph
10:50/35 min
Circulation & Shock
63-85 Bounkong Alicia/Cam
11:25/35 min
Chest Injuries 86-104
Bounthavy Steve
12:00/45 min
Lunch Break /
12:45/80 min
Skills /
/40 min
Basic/Airway Anong Steve
Advanced Airway Bounkong Khamph
/20 min
Cervical Spine/Log Roll
Thepbandith
Cam/Alicia
/20 min
Chest Drains Bounthavey
Rick
14:05/10 min
Break /
14:15/60 min
Abdominal Pelvic Limb trauma
105-141
Thepbandith
Rick
15:05/15 min
Demonstration scenario
All Khamph
15:20/70 min
Scenario Practice
Steve #1 Bounthavy Steve
Khamph #2 Anong Khamph
Alicia/Cam #3 Bounkong
Rick #4 Thepbandith
Rick
16:30/5 min Overview & Summary
Dr. Khamsay
Day 5
Time/Minutes
Topic Slides
Lao Lead Pakse
HLI Lead Notes
8:30/45min Head & Spinal Injuries
126-182
Bounkong Cam/Alicia
9:15/30 min Trauma in Children &Pregnancy
183-214
Anong Khamph
9:45/30 min Burns 215-235
Bounthavy Steve
10:15/15 min
Break
10:30/ 80 min
Workshops
20 min
Analgesia Bounthavy Rick
20 min
Transport Anong Alicia/Cam
20 min
Peds Trauma Thepbandith
Khamph
20 min
Neuro Assessment
Bounkong Steve
12:00/ 30 min
Secondary Survey
236-248
Thepbandith
Rick
12:30/40 min
Lunch Break
13:10/50 min
Disaster Management
Bounthavy Steve
14:00/80 min
Scenarios
/20 min
#5 Steve Bounthavvy
Steve Green
/20 min
#6 Khamph Anong Khamph Yellow
/20 min
#7 Alicia/Cam Bounkong Alicia/Cam
Red
/20 min
#8 Rick Thepbandith
Rick Blue
15:20/10 min
Break
15:30/15 min
Repeat MCQ Khamph
15:45/20 Summary, Khamsay Steve,
min FeedbackEvaluation
Alicia
16:05/15 min
Close, discussionPlanning for Instructor Day
Dr. Khamsay
Steve
16:20/15 min
Certificates Dr. Khamsay
Steve
