Primary Trauma Care Course Report Champasak College of Health and Sciences Pakse, Lao PDR Monday, 17th – Friday, 28th of June, 2019 Executive Summary The content of this report covers the 8-day Primary Trauma Care course from June 17th-June 28th, 2019 at the Champasak College of Health and Sciences in Pakse, Lao PDR. These trainings were organized and conducted by the University of Health Sciences (UHS) and Health Leadership International (HLI) with the approval and support of the Ministry of Health, Lao PDR. The majority of funding for these PTC Instructor 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 8-day training of trainers from emergency room physicians, anesthesiologists, ICU intensivists, and emergency room staff from 8 Provinces and 16 Districts from the Southern Provinces of Laos. The HLI Executive Team which includes 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 Training Course in Pakse, Laos The course participants were selected by Dr. Khamxay Detleuxay and approved by the MoH for participation in the PTC training. Participants were emergency medical providers including EM physicians, IUC intensivist, anesthesiologists, and key ER staff. 1 Training Sessions: Course 1: June 17th-18th, 2019 This training had 18 participants from nine districts in Khammouane Province and 12 participants from six districts in Bolikhamxay Province. Each province had two returning PTC provincial trainers who completed the 2-1-2 PTC course in November 2018 and now serve as Guest Faculty for this training. Course 2: June 20th-21st, 2019 This training had 10 participants from five districts in Xaysomboun Province and 26 participants from thirteen districts in Savannakhet Province. Each province had two returning PTC trainers who completed the 2-1-2 PTC course in November 2018 and now serve as Guest Faculty for this training. Course 3: June 24th- 25th, 2019 This training course had trainees from the Southern Provinces of Champasack, Attapeu, and Sekong. There were a total of 31 trainees and six returning trainers who had completed the PTC 2-1-2 course in November, 2018. Course 4: June 27th- 28th, 2019 This training had 16 participants, 14 from seven districts of Salavan province, two trainees from CHS Champasak, and two returning PTC Trainers. The goal of the training in 2019 is to train two providers from each of the district hospitals in 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 from the November 2018 training 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. Thephandith Phommachanh, 2nd year Resident Emergency Medicine, University of Health Sciences Lao PDR Course Coordinator: Dr. Steve Dunning – Health Leadership International , HLI Medical Director of PTC 2 Dr. Khamsay Detleuxay and Dr. Steve Dunning Course Financial Director: Dr. Steve Dunning – Health Leadership International Course Director - Dr. Khamsay Detleuxay MD with HLI Faculty, UHS 1st and 2nd year Emergency Medicine Residents, and PTC Trainers from Khammouane and Bolikhamxay District. All PTC materials had been translated into Laotian by HLI and were provided to all the attendees. PTC Training Staff PTC Director – Khamsay Detleuxay, MD Emergency Medicine Residents – UHS Bounthavy Chanthalanouvong, MD, Year 2 Anong Phengmailorkham, MD, Year 2 Bounkong Keokhamhong, MD, Year 2 Thepbandith Phommachanh, MD, Year 2 Sonephet Sorbounya, MD, Year 1 Southakone Xayyavong, MD, Year 1 Vilaivanh Ousouphanh, MD, Year 1 Nopphanaphone Sichanto, MD, Year 1 HLI Training Staff – Steve Dunning, MD – Internal Medicine, ATLS, Lao Speaker 3 Khamph Southisombath, MD– Family Medicine, Lao Speaker Rick Arnold, MD – Internal Medicine, Thai Speaker Health Leadership International Faculty with PTC Director, Dr. Khamsay Detleuxay and Director General, Ministry of Health, Department of Health Processional Studies, Dr. Niranh Phoumindr. PTC Course Administration Team A collaborative team of HLI and UHS worked together to provide the administration and evaluation tasks that supported this PTC training course. Course Administrator – Southida Vilayvieng, MD, Ministry of Health UHS Administrator - Thepbandith Phommachanh, MD 4 PTC Course Participants for Week 1: June 17-18th, June 20th-21st, 2019 See Appendix A for a list of course participants, which includes names, districts, age, and gender Course participants from Khammouane and Bolikhamxay Province along with UHS and HLI Faculty. 5 Course participants from Savannakhet and Xaysomboun Province along with UHS and HLI Faculty PTC Course Participants for Week 2: June 24th-25th, June 27th-28th, 2019 See Appendix B for a list of course participants, which includes names, districts, age, and gender. Course participants from Attapeu and Xekong Province along with UHS and HLI Faculty 6 Course participants from Champasak Province along with UHS and HLI Faculty 7 Course participants from Salavan Province along with UHS and HLI Faculty The PTC Program The PTC Program was taught entirely in the Lao language. There was a total of four courses, each course consisting of a two day training, over a span of two weeks. The trainings were taught by 2nd and 1st year EM residents with HLI faculty serving as consultants/co-teachers. The two day training course consisted of four skill stations, four workshop stations and eight scenario stations to provide an intense hands-on trauma training. See Appendix C for the course schedule and content. 8 PTC Course Evaluation, Training Feedback, Training Outcomes Summary of Pre and Post MCQ WEEK 1: June 17th-18th, June 20th-21st, 2019 WEEK 2: June 24th-25th, June 27th-28th, 2019 9 Bolikhamxay Province Champasak Province Mean % Pretest 48% Mean % Pretest 54% Mean % Posttest 83% Mean % Posttest 74% % of Mean Improvement 35% % of Mean Improvement 20% Khammouane Province Attapeu Province Mean % Pretest 53% Mean % Pretest 53% Mean % Posttest 78% Mean % Posttest 74% % of Mean Improvement 25% % of Mean Improvement 21% Xaysomboun Province Sekong Province Mean % Pretest 37% Mean % Pretest 58% Mean % Posttest 74% Mean % Posttest 87% % of Mean Improvement 37% % of Mean Improvement 29% Savannakhet Province Salavan Province Mean % Pretest 51% Mean % Pretest 47% Mean % Posttest 81% Mean % Posttest 82% % of Mean Improvement 30% % of Mean Improvement 35% Summary Pre and Post Confidence Matrix – Course 1 -4 Scenarios A B C D E F G H 5 yo 30 yo 25 yo 60 yo 50 yo man 20 yo 2 yo child 50 yo man with pregnant male female unconscious male who with a cyanosed from pelvic woman with with with a fixed is major a tension fx with knife 40% dilated pupil conscious hemorrhag pneumothorax femur fx in abd burns but e from a cannot traumatic move his amputation legs of his leg Course 1: Khammouane/Bolikhamxay Pre 1.6 1.9 1.8 2.2 1.9 1.9 1.7 1.7 Post 4.6 4.5 4.3 4.5 4.4 4.3 4.2 4.4 Course 2: Savannakhet/Xaysomboun Pre 1.7 2.1 2.0 2.8 2.5 2.5 2.3 2.2 Post 4.1 4.0 4.1 4.2 4.0 4.3 3.8 4.3 Course 3: Champasak/Attapeu/Sekong Pre 1.7 2.8 2.1 2.7 2.2 2.4 1.9 2.3 10 Post 4.3 4.4 4.6 4.4 4.4 4.4 4.4 4.5 Course 4: Salavan Pre 1.4 2.1 1.9 2.2 1.8 2.1 1.8 1.6 Post 3.9 3.9 4 4.4 3.7 3.9 3.8 4.1 Course Evaluation The PTC training for the Southern Provinces 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. Participant skill and knowledge improved as shown by MCQ results and higher confidence matrix scores in managing trauma patients. Recommendations and Conclusion UHS and HLI will continue to strengthen the Laotian medical edits of the PTC curriculum and skill scenarios. UHS and HLI have received approval for the future roll-out of the district hospital PTC trainings in 2019.