Primary Trauma Care Course Report Luangprabang College of Health and Sciences Luangprabang, Lao PDR Monday, 11th – Friday, 22nd of November 2019 Executive Summary The content of this report covers the 8-day Primary Trauma Care course from November 11th- November 22nd, 2019 at the Luangprabang College of Health and Sciences in Luangrabang, 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.A. Department of State though 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 Vice -Director of 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-days PTC training of trainers from the nine Provinces and 66 Districts from the Northern Provinces of Lao PDR. 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 Luangprabang, Lao PDR 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 emergency medicine physicians, IUC intensivists, anesthesiologists, and key emergency room staff. 1 Training Sessions: Course 1: November 11th-12th, 2019 This training had 15 participants from eight districts in XiengKhouang Province and 12 participants from six districts in Luangprabang Province. Each province had one-two returning PTC provincial trainers who completed the 2-1-2 PTC course in November 2018 and served as Provincial faculty for this training. Course 2: November 14th-15th, 2019 This training had 14 participants from seven districts in Xayaburi Province and 18 participants from nine districts in Vientiane Province. The two remaining districts from Vientiane Province will complete the 2-day PTC training in 1/2020. Two returning PTC trainers who completed the 2-1-2 PTC course in November 2018 served as Provincial faculty for this training. Course 3: November 18th-19th, 2019 This training course had trainees from fourteen districts from the Northern Provinces of Bokeo, Luang Namtha, and Phongsaly. There were a total of 38 trainees and four returning provincial trainers who had completed the PTC 2-1-2 course in November, 2018. Course 4: November 21st-22nd, 2019 This training had 36 participants, 18 from the districts of Huaphan Province, 12 from the districts of Oudomxay, and 6 from the districts of Luangprabang who were unable to make it to the prior training. In addition, there were 4 returning provincial trainers from Huapan and Oudomxay. 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 served as faculty in this nationwide training program. All PTC materials have been translated into Laotian by HLI and were provided to all the attendees. PTC Course Leadership Course Director: Dr. Khamsay Detleuxay; PTC Director, Vice-Director of Mahosot Hospital, and Director of EM Residency at UHS Course Coordinator: Dr. Steve Dunning – Health Leadership International , HLI Medical Director of PTC Course Financial Director: Dr. Cam McIntyre– Health Leadership International Dr. Khamsay Detleuxay and Dr. Steve Dunning 2 UHS Faculty, HLI Faculty, and Co-trainers from the Northern Provinces of Bokeo and Luang Namtha. PTC Training Staff PTC Director – Khamsay Detleuxay, MD Emergency Medicine Residents – UHS Anouphet Nhengtavan, MD, Year 3 Mouavang Xiapao, MD, Year 3 Pouifai Houangsavanh, MD, Year 3 Bounlom Santisouk, MD, Year 2 Kingchan Khammavong, MD , Year 2 Chanthao Chue Fue, MD, Year 2 Somphone Oulaychanh, MD Year 2 Khamsay Inthavong, MD Year 2 HLI Training Staff – Steve Dunning, MD – Internal Medicine, ATLS, Lao Speaker Khamph Southisombath, MD– Family Medicine, Lao Speaker Rick Arnold, MD – Internal Medicine, Thai Speaker 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 3 PTC Course Participants: There were a total of 131 participants, 33 females and 98 male participants. Participants were Emergency Medicine Physicians, ICU intensivists, General Surgeons and key ER staff. Participants were from 65 districts of the 9 Northern Provinces of Lao PDR (XiengKhouang, Luangprabang, Vientiane, Xayaburi, Luang Namtha, Bokeo, Phongsaly, Huapan, and Oudomxay). PTC Course Participants for Week 1: November 11th-12th, November 14th-15th 2019 See Appendix A for a list of course participants, which includes names, districts, age, and gender Course participants from XiengKhouang Province along with UHS and HLI Faculty 4 Course participants from Xayaburi and Vientiane Province along with UHS and HLI Faculty PTC Course Participants for Week 2: November 18th-19th, November 21st-22nd, 2019 See Appendix B for a list of course participants, which includes names, districts, age, and gender. Course participants from Bokeo, Phongsaly, and Luang Namtha Province along with UHS and HLI Faculty 5 Course participants from Oudomxay Province along with UHS and HLI Faculty Course participants from Huapan Province along with UHS and HLI Faculty The PTC Program The PTC Program was taught entirely in the Lao language. There were a total of four courses, each course consisting of a two-day training, over a span of two weeks. The trainings were taught by 3rd and 2nd 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. 6 See Appendix C for the course schedule and content. 7 8 PTC Course Evaluation, Training Feedback, Training Outcomes Summary of Pre and Post MCQ WEEK 1: November 11th-12th, 14th-15th 2019 WEEK 2: November 18-19th, 21st-22nd, 2019 XiengKhouang Province (N=11) Luang Namtha Province (N=8) Mean % Pretest 50% Mean % Pretest 60% Mean % Posttest 82% Mean % Posttest 89% % of Mean Improvement 31% % of Mean Improvement 29% Luangprabang Province (N=22) Bokeo Province (N=8) Mean % Pretest 54% Mean % Pretest 52% Mean % Posttest 82% Mean % Posttest 86% % of Mean Improvement 28% % of Mean Improvement 34% Vientiane Province (N=22) Phongsaly Province (N=12) Mean % Pretest 50% Mean % Pretest 57% Mean % Posttest 74% Mean % Posttest 85% % of Mean Improvement 24% % of Mean Improvement 28% Xayaburi Province (N=18) Huapan Province (N=18) Mean % Pretest 54% Mean % Pretest 52% Mean % Posttest 87% Mean % Posttest 79% % of Mean Improvement 31% % of Mean Improvement 27% Oudomxay Province (N=12) Mean % Pretest 57% Mean % Posttest 83% % of Mean Improvement 25% 9 Summary Pre and Post Confidence Matrix – Course 1 -4 Scenarios A B C D E F G H Average 5 yo 30 yo 25 yo 60 yo 50 yo man 20 yo 2 yo child 50 yo man with pregnant male femal unconscio male with a cyanosed pelvic woman with e with us with a who is major from a fx with knife in 40% fixed conscio hemorrha tension femur fx abd burns dilated us but ge from a pneumoth pupil cannot traumatic orax move amputati his legs on of his leg Course 1: XiengKhouang/Luangprabang Pre 1.9 2.2 1.8 2.4 2.2 2.2 2.0 2.1 2.1 Post 3.6 3.9 3.9 4.0 3.9 4.0 3.4 3.9 3.8 Course 2: Vientiane/Xayaburi Pre 1.8 2.3 2.3 2.3 2.1 2.4 2.0 1.8 2.1 Post 4.2 4.3 4.4 4.4 4.2 4.4 4.2 4.5 4.3 Course 3: Phongsaly/Luang Namtha/Bokeo/+ 2 districts Vientiane Pre 2.1 2.3 2.3 2.4 2.4 2.8 2.4 2.3 2.4 Post 4.0 4.1 4.1 4.3 4.4 4.1 3.8 4.6 4.2 Course 4: Oudomxay/Huapan Pre 1.9 2.1 2.1 2.3 2.1 2.2 1.9 1.9 2.1 Post 4.3 4.1 4.2 4.4 4.2 4.2 4.0 4.3 4.2 Course Evaluation The PTC training for the Northern Provinces was very successful.