Abstract
Background
Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middle-income countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country.
Methods
From 2007 to 2009, an educational program for trauma, “Better and Systematic Team Training,” (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization’s “Guidelines for Essential Trauma Care.” Data on human and physical resources, infrastructure, trauma administrative functions, and quality-improvement activities before and at 2-year follow-up were compared for all 27 government hospitals.
Results
A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana.
Conclusions
Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.
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References
Lozano R, Naghavi M, Foreman K et al (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128
WHO (2009) The global status report on road safety. World Health Organization, Geneva
Jurkovich GJ (1999) Systematic review of trauma system effectiveness based on registry comparisons. J Trauma 47(3 Suppl):S46
Cooper DJ, McDermott FT, Cordner SM et al (1998) Quality assessment of the management of road traffic fatalities at a level I trauma center compared with other hospitals in Victoria, Australia. Consultative Committee on Road Traffic Fatalities in Victoria. J Trauma 45:772–779
Petrie D, Lane P, Stewart TC (1996) An evaluation of patient outcomes comparing trauma team activated versus trauma team not activated using TRISS analysis. Trauma and Injury Severity Score. J Trauma 41:870–873
Gerardo CJ, Glickman SW, Vaslef SN et al (2011) The rapid impact on mortality rates of a dedicated care team including trauma and emergency physicians at an academic medical center. J Emerg Med 40:586–591
WHO (2010) Strengthening the care for the injured: Success stories and lessons learned from around the world. World Health Organization, Geneva
MVA (2008) Annual report 2008. Motor Vehicle Accident Fund, Botswana
Mock C, Arafat R, Chadbunchachai W et al (2008) What World Health Assembly Resolution 60.22 means to those who care for the injured. World J Surg 32:1636–1642
Wisborg T, Brattebo G, Brinchmann-Hansen A et al (2008) Effects of nationwide training of multiprofessional trauma teams in norwegian hospitals. J Trauma 64(6):1613–1618
Mock C, Lormand JD, Goosen J et al (2004) Guidelines for essential trauma care. World Health Organization, Geneva
Hanche-Olsen TP, Alemu L, Viste A et al (2012) Trauma care in Africa: a status report from Botswana, guided by the World Health Organization’s “Guidelines for Essential Trauma Care”. World J Surg 36:2371–2383
Caruso N (2011) Development of emergency medicine in Botswana. Afr J Emerg Med 1:108–112
Wisborg T, Brattebo G (2008) Keeping the spirit high: why trauma team training is (sometimes) implemented. Acta Anaesthesiol Scand 52:437–441
Georgiou A, Lockey DJ (2010) The performance and assessment of hospital trauma teams. Scand J Trauma Resusc Emerg Med 18:66
Hjortdahl M, Ringen AH, Naess AC et al (2009) Leadership is the essential non-technical skill in the trauma team–results of a qualitative study. Scand J Trauma Resusc Emerg Med 2009:1748
Bergman S, Deckelbaum D, Lett R et al (2008) Assessing the impact of the trauma team training program in Tanzania. J Trauma 65:879–883
Driscoll PA, Vincent CA (1992) Organizing an efficient trauma team. Injury 23:107–110
Rutledge R (1995) The goals, development, and use of trauma registries and trauma data sources in decision making in injury. Surg Clin North Am 75:305–326
Moore L, Clark DE (2008) The value of trauma registries. Injury 39:686–695
Mehmood A, Razzak JA, Kabir S et al (2013) Development and pilot implementation of a locally developed Trauma Registry: lessons learnt in a low-income country. BMC Emerg Med 2013:134
Kobusingye OC, Lett RR (2000) Hospital-based trauma registries in Uganda. J Trauma 48:498–502
Wilkinson D, McDougall R (2007) Primary trauma care. Anaesthesia 62(Suppl):161–164
Ersdal HL, Vossius C, Bayo E et al (2013) A one-day “Helping Babies Breathe” course improves simulated performance but not clinical management of neonates. Resuscitation 84:1422–1427
Driscoll PA, Vincent CA (1992) Variation in trauma resuscitation and its effect on patient outcome. Injury 23:111–115
Henderson KI, Coats TJ, Hassan TB et al (2008) Audit of time to emergency trauma laparotomy. Br J Surg 87:472–476
Mock CN, Jurkovich GJ, nii-Amon-Kotei D et al (1998) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 44:804–812
Acknowledgments
The Laerdal Foundation for Acute Medicine provided financial support for this project.
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Appendix: Definitions
Appendix: Definitions
Trauma guidelines: Guidelines that define the trauma patient, local trauma care structure, activation criteria for trauma teams, roles for team members, qualifications for team leader, available resources, and transfer policies.
Trauma manual Written in-hospital practice, guidelines for initial triage, assessment, and treatment of injuries aimed at standardizing care given to trauma victims.
Trauma committee Organizational structure aimed at developing and implementing trauma care strategies at the individual hospital.
Trauma registry Separate local registry for trauma cases, regardless of whether they are adjusted for severity.
System for trauma audit System for identifying cases of preventable trauma deaths or suboptimal care, designing corrective plans, and monitoring the process.
Plan for trauma education Trauma-specific systematic educational efforts.
Trauma simulations Team organization and training activities in the emergency room using simulations.
Posters in the trauma room Posters on the wall in the emergency room guiding systematic trauma care.
Defined trauma team Team organization with preassigned roles and adapted to local resources.
Alarm criteria Predefined criteria (e.g., trauma mechanism, physiologic status, and anatomic injuries) that activate a team response.
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Hanche-Olsen, T.P., Alemu, L., Viste, A. et al. Evaluation of Training Program for Surgical Trauma Teams in Botswana. World J Surg 39, 658–668 (2015). https://doi.org/10.1007/s00268-014-2873-8
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DOI: https://doi.org/10.1007/s00268-014-2873-8