Vyas Dinesh, Hollis Michael, Abraham Rohit, Rustagi Neeti, Chandra Siddharth, Malhotra Ajai, Rajpurohit Vikas, Purohit Harshada, Pal Ranabir
Department of Surgery, Texas Tech University, Odessa, Texas.
Department of Pediatric Urology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2016 Jun 1;203(1):22-7. doi: 10.1016/j.jss.2016.03.026. Epub 2016 Mar 31.
The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality.
An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels.
Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur.
These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise.
创伤大流行是全球主要的死亡原因之一，在快速发展的经济体中尤为如此。在这些环境中，创伤相关死亡率的一个常见原因可能是机动车保有量迅速增长，而发达国家的国家院前培训却没有相应增加。由此导致的道路交通伤害往往无法及时送达医院进行有效治疗，从而造成可预防的残疾和死亡。本文探讨了一项医疗急救人员培训计划的开展情况，该计划有可能减少这种不必要的发病率和死亡率。
一个强化培训工作坊分为两个递进层次：急性创伤培训（ATT）和广泛创伤培训（BTT）方案。这两个分别为期四小时和两天的方案，能够对最有可能首先接触院前受害者的非专业人员进行大规模教育，如警察、消防员以及出租车和/或救护车司机。在焦特布尔和斋浦尔的三所印度教育机构中，超过750名ATT参与者和168名BTT参与者接受了培训。除了进行培训前和培训后的自我评估以评估对课程主题的临床信心外，学员们还接受了一系列关键创伤主题的理论和实践教育。进行双样本t检验统计分析以比较培训前和培训后的信心水平。
项目开展吸引了来自各种职业背景的人员参加我们的ATT和BTT工作坊。工作坊由来自广泛医学专业的当地医生以及之前接受过ATT培训的警察主持。在ATT和BTT方案的所有课程主题中，临床信心有统计学意义的显著提高（P < 0.0001）。此外，焦特布尔与斋浦尔相比，BTT培训后信心的提高情况相似。
这些结果表明，在快速发展的环境中，不同地理区域的可靠性和可重复性水平令人鼓舞。项目扩展可以使医疗急救人员的培训率呈指数级增长，这有助于遏制快速发展经济体中与创伤相关的死亡率。未来的方向将包括临床能力评估以及进一步递进分化为更高层次的创伤专业知识。
