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.

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

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

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.

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

Course participants from Champasak Province along with UHS and HLI Faculty

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.

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

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

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. This training was the roll out of PTC in the Southern Provinces. The North training is tentatively planned to take place in November of 2019.

There was positive feedback and support from the MoH , UHS, 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. This training was funded by a generous grant to HLI from the US Department of State.

MoH, Lao PDR U. S. Department of State

Dr. Niranh Phoumindr MD, Director General; MoH Department of Health Processional Studies Dr. Phouthone Vangkonevilay - President of UHS Dr. Alongkone Phengsavanh – Vice Dean Dr. Thavone Chanthasone – Vice Dean Dr. Molina Choummanivong Vice Director, International Relations Dr. Celine Jacobs - Health Frontiers Suzie Nui MD- PTC Foundation –PTC coordinator

Appendix A: Course Participants, Week 1:June 17-18th, 20th-21st, 2019 Total Number Participants – (66)

No NAME IN ENGLISH DISTRICT Age GENDER BOLIKHAMXAY PROVINCE 1 Dr. Phoungeun Vongsavanh Thaphabat 40 F 2 Dr. Laiphone Meksavanh Thaphabat 28 F

3 Dr. Somying Duangdala Borikhan 30 F 4 Dr. Khamphet Vongsengduean Borikhan 28 F 5 Dr. Onkham Luebunhien Khamkerd 27 F 6 Dr. Latthakone Vonghachack Khamkerd 28 M 7 Dr. Ketdaphone Santivong Pakkading 35 F 8 Dr. Sivilay Sengounheuang Pakkading 26 M 9 Dr. Phadsaphone Khensy Viengthong 29 M 10 Dr. Xangxiong Yiaker Viengthong 29 M 11 Dr. Vongphet Chalernsouk Xaichamphone 35 M 12 Dr. Kaysone Pongsangkeo Xaichamphone 37 F KHAMMOUANE PROVINCE 13 Dr. He Khounxayavongsa Mahaxai 39 F 14 Dr. Maichan Vansikham Mahaxai 29 F 15 Dr. Anoulack Mounthalad Nongbok 28 F 16 Dr. Vannipha Kettalath Nongbok 31 F 17 Dr. Phetsamone Salinthone Hinbune 29 F 18 Dr. Khamchan Keomanyvong Hinbune 31 F 19 Dr. Eo Keovilai Yommalat 30 F 20 Dr. Khounthavisouk Phaouthai Yommalat 29 M 21 Mrs. Norlathai Kalikeoduangsone Bualapha 26 F 22 Dr. Sengdeuane Soulignaseng Bualapha 31 M 23 Dr. Vanpanomphone Xaysana Nakai 35 F 24 Dr. Phoupham Sengchanma Nakai 34 F 25 Dr. Khamsavay Matnivong Sebangphai 27 M 26 Dr. Phoukham Ounlasan Sebangphai 29 M 27 Dr. Inphone Sonsamphanh Xaibuathong 57 M 28 Dr. Koungnang Souvandala Xaibuathong 27 F 29 Dr. Phonevinai Inthavong Khunkham 32 F 30 Dr. Thienkham Boudthavong Khunkham 29 F XAYSOMBOUN PROVINCE 31 Dr. Tony TANTHAVONG Longcheng 33 M 32 Dr. Solaya YODTITTAM Longcheng 30 F 33 Dr. Khamsyxiong ZEBOULENG Longxan 38 M 34 Dr. Touher YIAPAO Longxan 32 M 35 Dr. Bounma SYBOUNTHAN Thathom 29 M 36 Dr. Amphone MAHAXAI Thathom 28 M 37 Dr. Zany HERCHALERN Hom 40 M 38 Dr. Vanhnythor PHIALOUNG Hom 30 M SAVANNAKHET PROVINCE 39 Dr. Tounmany DUANGKHAMKHAI Atsaphone 34 F 40 Dr. Khanxai BOUDDAVONG Atsaphone 46 M 41 Dr. Khampone SYSOMBATH Outhumphone 48 F 42 Dr. Oulayvanh SOUVANNASING Outhumphone 21 F 43 Dr. Inpong THEPPHAVONGSA Xonabuly 49 M 44 Dr. Souksavanh PHENGPASEUTH Xonabuly 31 M 45 Dr. Thongchan KHATTHAMAN Xayphouthong 30 F 46 Dr. Sabaiphone NAMMAVONG Xayphouthong 29 F 47 Dr. Khanephaphone THAVISOUK Phalanxay 35 M 48 Dr. Vannusith SIVONGDAO Phalanxay 35 M 49 Dr. Saengthong KEOKAISONE Thapangthong 38 M 50 Dr. Toui YOTVONGSENG Thapangthong 31 M 51 Dr. Pavee CHANTHAVONG Phin 28 M

52 Dr. Somphone INTHIBAN Phin 35 M 53 Dr. Nongneth KHAMBOUNHEUANG Atsaphangthong 37 M 54 Dr. Chansamone BOUTHAVONG Atsaphangthong 39 F 55 Mr. Visanu AKHAPHONG Xaibuly 49 M 56 Dr. Saifone YINGYONG Xaibuly 39 F 57 Dr. Khammeud THOMVILAY Vilabury 32 M 58 Mrs. Somsanit BOUAKHEUA Vilabury 34 F 59 Dr. Mayoula DOUANGDY Xepon 31 F 60 Dr. Xaysavanh BOUN AIENG Xepon 43 M 61 Dr. Youlaxay SIANOTHAI Champhon 30 M 62 Dr. Khonsavan KOE ASA Champhon 53 F 63 Dr. Somvang KHAIKHAMPHITHOUN Nong 30 M 64 Dr. Bounphasy XAYKOSY Nong 39 M 65 Dr. Soukvisone PHOTILAT Songkhone 33 M 66 Dr. Sonethanu SENGBUALOM Songkhone 37 M

Appendix B: Course Participants, Week 1:June 24th-25th, 27th-28th, 2019 Total Number Participants – (47)

No NAME IN ENGLISH DISTRICT Age Sex CHAMPASAK PROVINCE 1 Dr. Phoutthasin Vangkonevilay Champasak 30 M 2 Dr. Ammonexai Luanthammakhanh Champasak 44 M 3 Dr. Anousone Souysavad Pathumphone 27 M 4 Dr. Vonnida Keophithoun Pathumphone 27 F 5 Dr. KeoOudone Phomphithak Phonethong 29 M 6 Dr. Bounmee Khenphakoun Phonethong 31 M 7 Dr. Phouphet Phaxaisombath Bachieng 26 M 8 Dr. Khensawhane Chantalar Bachieng 31 F 9 Dr. Vongdeuan Sonephachanh Sukhuma 28 F 10 Dr. Xonlaty Soysoumontha Sukhuma 32 M 11 Dr. Moukdavan Soudtisan Sanasombune 28 F 12 Dr. Latdavone Douangphoumy Paksong 32 F 13 Dr. Khankham Philadeng Paksong 27 M 14 Dr. Khamphoumy Inthathilath Mounlapamok 30 M 15 Dr. Khamphaibone Phimmasone Mounlapamok 30 F 16 Dr. Kouweth Vongpherngpheng Khong 29 M 17 Mr. Khampaeng Xiayavong Khong 28 M ATTAPEU PROVINCE 18 Dr. Lanthom Pangkanpume Phouvong 26 F 19 Dr. Khomson Vorlachit Phouvong 36 M 20 Dr. Silavone Sidavong Sanamxay 31 M 21 Dr. Khamseuy Sisavath Sanamxay 31 M 22 Dr. Aderng Keobouavanh Xanxay 30 M 23 Dr. Thonechan Louangmany Xanxay 32 F 24 Dr. Bounsomphong Kipkingkeo Samakhixai 30 M Military hos.

25 Mr. Chanthakhan Kommasin Samakhixai 38 M Military hos. SEKONG PROVINCE 26 Dr. Sounthone Khamdyxay Kaleum 29 M 27 Dr. Bidavanh Phakphoumy Kaleum 26 F 28 Dr. Chanthachone Sisoulath Thateng 30 F 29 Dr. Khemphone Wanvilay Thateng 30 F 30 Dr. Sonthana Soulivong Dakcheung 31 F 31 Dr. Thongkham Keomanilay Dakcheung 35 M SALAVAN PROVINCE 32 Dr. Bounloup Phasaisombath Toumlan 32 M 33 Dr. Chansee Ninthakhane Toumlan 32 F 34 Dr. Orlathai Xayabanha Laongam 32 F 35 Dr. Phoukham Phousavanh Laongam 28 M 36 Mr. Inzee Sysana Ta oy 23 M 37 Dr. Thilasak Khenmany Ta oy 36 M 38 Mr. Phichat Xaiyakhanthong Lakhonepheng 28 M 39 Dr. Manosai Inthalangsi Lakhonepheng 30 F 40 Dr. Yom Inthavong Vapy 32 M 41 Mr. Soudalath Chansomphou Vapy 26 M 42 Dr. Viengkham Souliyavong Samoiy 32 M 43 Dr. Xaisanouk Ketthongphanh Samoiy 29 M 44 Mrs. Soumey Sanpaseth Khongsedon 28 F 45 Mr. Soudchay Ninnasopha Khongsedon 48 M 46 Mr. Chanthasone Khammanyvong CHS Champasak 26 M 47 Miss. Khaophone Silisak CHS Champasak 24 F

Appendix C: Schedules for the Training in Pakse, June 17-28, 2019 DAY ONE: Time/Minutes Topic Slides Lao Lead G1 Lao Lead G2 HLI Lead 8:30 / 30 min Welcome, Intro, Dr. Khamsay Dr. Khamsay Dr. Steve MCQ 9:00/15 min Local Trauma Dr. Khamsay Dr. Khamsay Dr. Steve Perspective 9:15/15 min PTC Overview 1-13 Dr. Khamsay Bounkong Dr. Steve 9:30/30 min Trauma ABCD 14-37 Thepbandith Sonephet Dr. Khamph Primary Survey Province Inst 1 Province Inst 2 10:00/10 min Break 10:10/40 min Airway & 38-62 Anong Nophanaphone Dr. Rick Breathing 10:50/35 min Circulation & 63-85 Vilaivanh Bounkong Dr. Steve Shock 11:25/35 min Chest Injuries 86-104 Southakone Bounthavy Dr. Khamph 12:00/45 min Lunch Break 12:45/80 min Skills /40 min Basic/Airway Vilaivanh Sonephet Dr. Steve Advanced Anong Nophanaphone Dr. Khamsay Airway /20 min Cervical Thepbandith Bounkong Dr. Khamph Spine/Log Roll /20 min Chest Drains Southakone Bounthavy Dr. Rick 14

14:05/10 min Break 14:15/60 min Abdominal 105- Thepbandith Sonephet Dr. Steve Pelvic Limb 141 Vilaivanh Province Inst 2 trauma 15:05/15 min Demonstration All All Dr. Khamph scenario 15:20/60 min Scenario Practice

No. #1 Southakone Bounthavy Dr. Steve Province Inst 1 Province Inst 1 No #2 Anong Nophanaphone Dr. Khamph Province Inst 2 Province Inst 2 No #3 Vilaivanh Bounkong Dr. Rick No #4 Thepbandith Sonephet Dr. Khamsay 16:30/5 min Overview & Dr. Khamsay Dr. Khamph Summary

DAY 2 : Time/Minutes Topic Slides Lao Lead G1 Lao Lead G2 HLI Lead 8:30/45min Head & Spinal 126-182 Vilaivanh Bounkhong Dr. Steve Injuries 9:15/30 min Trauma in 183-214 Anong Nophanaphone Dr. Khamph Children & Province Inst 2 Province Inst 1 Pregnancy 9:45/30 min Burns 215-235 Southakone Bounthavy Dr. Rick 10:15/15 min Break 10:30/ 80 min Workshops / 20 min Analgesia Southakone Bounthavy Dr. Steve Province Inst 1 Province Inst 1 20 min Transport Anong Nophanaphone Dr. Khamph Province Inst 2 Province Inst 2 20 min Peds Trauma Thepbandith Sonephet Dr. Rick 20 min Neuro Vilaivanh Bounkong Dr. Steve Assessment 12:00/ 30 min Secondary 236-248 Thepbandith Sonephet Dr. Rick Survey 12:30/40 min Lunch Break 13:10/50 min Disaster Thepbandith Bounthavy Dr. Khamph Management 14:00/80 min Scenarios /20 min No #5 Southakone Bounthavy Dr. Steve Province Inst 1 Province Inst 1 /20 min No #6 Anong Khamsay Dr. Khamph Province Inst 2 Province Inst 2 /20 min No #7 Vilaivanh Bounkong Dr. Khamsay /20 min No #8 Thepbandith Sonephet Dr. Rick

15:20/10 min Break 15:30/15 min Repeat MCQ Thepbandith Dr. Khamsay Dr. Khamph

15:45/20 min Summary, Dr. Khamsay Dr. Khamph Feedback Evaluation 16:05/15 min Close, Thepbandith Dr. Khamsay Dr. Steve discussion Planning for Instructor Day 16:20/15 min Certificates Dr. Khamsay Dr. Steve