View
2
Download
0
Category
Preview:
Citation preview
Primary Trauma CareCourse Report
Colleges of Health SciencesLuang Prabang, Lao PDR
Monday, 29th October – Friday 2nd, November, 2018
Executive Summary
The content of this report covers the 5-day PTC 2-1-2 course was at the College of Health Sciences in Luang Prabang, Lao PDR. The following week this same training was conducted at the Champasak Provincial Hospital in Pakse for the Southern Provinces.
These trainings were sponsored and organized by the University of Health Sciences (UHS) and Health Leadership International (HLI) with the support of the Ministry of Health, Lao PDR. The funding for these PTC trainings was provided under a grant fromthe U.S. Department of State to Health Leadership International.
The Primary Trauma Care Foundation has endorsed the delivery of their life saving PTCtraining 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 5-day training of trainers in the Northern and Southern Provinces.
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 2-1-2 Instructor’s Course in Luang Prabang
The course participants were selected by Dr. Khamxay Detleuxay and approved by theMoH and UHS and the Provincial Hospital leadership for participation in this 2-1-2 training of trainers for PTC. Each of the nine provinces in Northern Lao was asked to choose two high level provider participants for this training.
1
These participants for this 2-1-2 Instructor’s Course were trained to be key leaders/instructors in the PTC training in each of their provinces in late 2019. The goalof the trainings in 2019 will be to train two providers from each of the district hospitalsin 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 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. Steve Dunning – Health Leadership International HLI Medical Director of PTC
Dr. Khamsay and Dr. Steve
Course Financial Director: Dr. Cam McIntyre – Health Leadership International
PTC Faculty – Clinical Training Team
The clinical training team consists of a team of highly skilled emergency medicine practitioners from UHS and HLI under the leadership of Dr. Khamsay Detleuxay MD. His goal has been to create a competent core training team utilizing Emergency Medicine residents at UHS as PTC trainers. The eight residents trained in February 2018 were the faculty along with HLI faculty at the Provincial Hospital level in the Northern and Southern Provinces.
2
Course Director - Dr. Khamsay Detleuxay MD with four UHS Emergency Medicine 2nd Year Residents
Four Emergency Medicine 2nd year residents were the core PTC trained leaders for this training conducted in Laotian. All PTC materials had been translated into Laotianby HLI and were provided to the attendees representing the nine Provincial Hospitals from the Northern Provinces.
PTC Training Staff
PTC Director – Khamsay Detleuxay, MD
2 nd Year Emergency Medicine Residents – UHSAnouphet Nhengtavan, MDMouavang Xiapao, MDTim Sihanath, MDPhouifai Houangsavanh, MD
HLI Clinical Staff – Steve Dunning, MD – Internal Medicine, ATLS, Lao SpeakerCam McIntyre, MD – Family Medicine, ATLSKhampho Thammovangxay Onho, MPH, PA-C – Family Medicine, Lao SpeakerRick Arnold, MD – Internal Medicine, Thai SpeakerKhamph Southisombath, MD – Family Medicine, Lao SpeakerAlicia Quella, PhD, PA-C – Emergency Medicine, Epidemiology, ATLS
3
HLI Team
PTC Course Administration Team
A collaborative team of HLI and UHS worked together to provide the administration and evaluation tasks that supported this PTC 2-1-2 training of trainers course.
Course Administrator – Luang Prabang - Reba McIntyre PhD, MSW, MPA UHS Administrator - Sompasong Kanthavong, MD Course Statistics – Alicia Quella PhD, PA-CPublicity- Bouatha Keopanya - College of Health Sciences/Luang Prabang - Photography
PTC Instructor’s Course Participants for Day 1, 2 & 3
The Northern Provinces represented were Vientiane, Luangnamtha, Luangprabang, Xiengkhuang, Bokeo, Xayaboury, Huaphan, Oudomxay, and Phongsaly. See Appendix A for a list of the 2-1-2 course participants which included degree, specialty, gender and age.
4
5
The First 2-Day PTC Program – Day 1 and 2
The PTC Program was taught predominantly in Laotian. The course was supported with translation only to strengthen clarity in the clinical presentations by a team of translators – Dr. Khamsay, Dr. Khampho, Dr. Khamp and Dr. Steve. Four skill stations were set-up for the intense hands-on trauma training for this course. See Appendix B for the course schedule and content for the 2-day PTC (Instructor Course) (Day 1 and Day 2). During Day 1 and Day 2 participants were in four groupsrotating through the skill stations.
6
The Instructor PTC Program – Day 3
See Appendix C for the Instructor’s Course schedule.
The Provincial PTC attendees discussed teaching methods during day three of the 2-1-2 PTC Instructors training. The attendees learned how to teach a PTC skill, deliver a PTC course, run a scenario group, and run a discussion group.
7
New Provincial Trainers received PTC training bags for the roll-out of PTC training intheir nine Northern Provinces. Following the 3-day instructor training attendees received a certificate recognizing them as certified trainers of PTC. These MD’s will be leading the PTC roll-out in 2019 for training district hospital staff in their home provinces.
The Second 2-Day PTC Program
See Appendix D for the course schedule for the second 2-Day PTC program.
Photo of PTC Course 2 - Day 4 and 5 Attendees and Faculty at Luangprabang CHS
The course 2 participants were health providers from CHS Luangprabang, Lao Friendship Hospital for Children, 107 Military Hospital, LPH Hospital and UHS Vientiane.
The second 2-day PTC training was taught by the new Provincial PTC trainers from the nine different provinces as the key faculty. They were coached by UHS and HLIPTC faculty. See Appendix E for the schedule of the 2-day PTC course.
PTC Course Evaluation, Training Feedback, Training Outcomes
PTC Course 1 – 18 Provincial Hospital Training of Trainers Attendees – Day 1 & 2 PTC Course 2 - 19 Luang Prabang Attendees – Day 4 & 5PTC Instructor Methods Course – Day 3
Summary of Pre and Post MCQ – Course 1 and Course 2
Multiple Course ExamCourse 1
8
Mean % Pretest 48%Mean % Postest 84%% of Mean Improvement 36%Course 2Mean % Pretest 53%Mean % Postest 75%% of Mean Improvement 22%
Summary Pre and Post Confidence Matrix – Course 1 and Course 2
Scenarios
A5 yowith pelvic fx
B30 yo pregnant woman withfemur fx
C25 yo male with knife in abd
D60 yo female with 40% burns
E50 yo man unconscious witha fixed dilated pupil
F20 yo male who is conscious but cannotmove his legs
G2 yo child with a major hemorrhage froma traumatic amputation of his leg
H50 yo mancyanosed from a tension pneumothorax
Course 1
Pre 2.4 3.2 2.9 3.3 2.7 3.2 3.3 2.9Post 3.4 4.1 4.4 4.0 3.5 4.4 3.9 4.6Course 2
Pre 2.2 3.0 2.7 2.8 2.5 3.1 3.1 2.5Post 3.6 4.1 4.4 4.4 3.6 4.2 3.8 4.5
PTC Course Evaluation for Day 3 Course 1
Teach a PTC Skill
Deliver a PTC Skill
Run a Trauma Scenario
Run a Disscussion Group
3.9 3.8 4.2 4.1
Course Evaluation
The PTC training in Luang Prabang 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.
9
At the end of the Day -3 Instructor Course participants rated the six sessions as
good to very good for the usefulness of the content. They also rated their ability
to teach this course in the 4 to 5 range. (1-5 scale) The overall impact of the three
day training showed a high level of trainee confidence to roll-out the nationwide
PTC training in the Provinces.
Participant skill and knowledge improved as shown by MCQ results and higher
confidence matrix scores in managing trauma patients.
Recommendations and Conclusion
A recommendation is to simplify both the administrative and evaluation PTC
material in the upcoming district PTC trainings in 2019. Also, UHS and HLI will
continue to strengthen the Laotian medical edits of the PTC curriculum and skill
scenarios.
The recommendation of MoH, UHS and HLI is to move forward with a planned PTC
2-1-2 training in Vientiane in February 2019 of the second cohort of Emergency
Medicine residents. Also UHS and HLI have received approval for the future roll-
out of the district hospital PTC trainings in 2019 in both the North and the South.
These are tentatively planned to take place during June and November of 2019, in
the South and North, respectively.
A large number of participants (18) were included in the Instructor course, with all
18 instructing on the subsequent PTC course 2. This may have diluted their
experience as instructors but it was necessary to build a pool of Provincial
instructors for future courses at the District level in 2019.
There was positive feedback and support from the MoH , UHS, Provincial hospitals,
Colleges of Health Sciences 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 in November 2018. This training was funded by a generous grant to HLI from the US Department of State.
MoH, Lao PDRU. S. Department of State
Dr. Phouthone Vangkonevilay - President of UHSDr. Alongkone Phengsavanh – Vice Dean
10
Dr. Thavone Chanthasone – Vice DeanDr. Niranh Phoumindr MD, Director General; Department of Health Professional StudiesDr. Molina Choummanivong Vice Director, International RelationsDr. Celine Jacobs - Health FrontiersSuzie Nui MD- PTC Foundation –PTC coordinator
Appendix A: Course 2- 1-2 Participants (Instructor Course Participants –
Total Number Participants - 18)
First/Last Name Province Degree
Specialty
M/F
Age
Dr. Khaolar SYLOUNGLATH
Vientiane province
MD MD M 31
Dr. Koulor NAOHER
Vientiane province
MD MD M 41
Dr. Labee SIKANHA
Luangnamtha MD ANESTHESIA
M 35
Mr.Vongxay CHANTHALUNGSY
Luangnamtha Nurse M 28
Dr. Inthasamone PHONGSA
Xayaboury MD 1 YEAR ER TRAINING
F 35
Dr. Ounheuan BOUNCHANH
Xayaboury MD MD M 52
Dr. Ping PHETSAMONE
Phongsaly MD MD M 27
Dr. Buasi LILAVONG
Phongsaly MD ANESTHESIA
F 29
Dr. Veingkeo MITTAPHONE
Oudomxay MD M 39
Dr. Somphane OUDOMPHANH
Oudomxay DENTIST
DENTIST M 47
Dr. Somchit YANGSAIMONG
Bokeo MD M 28
Mr. Khia KEOVONGPHET
Bokeo Nurse M 26
Dr. Duangxai LATSAVONG
Xeingkhuang MD M 40
Dr. Kongsengsuriya TAYKEOPHITHOUNE
Xeingkhuang MD M 42
Dr. Vatsana CHALEUNPHON
Luangprabang
MD F 33
Dr. Sounthone Luangpraban MD M 56
11
KEOPASEUTH gDr. Vonekeo XAYSOMPHAN
Huaphun MD MD F 30
Dr. Kampheern INTHAPHANH
Huaphun Nurse NURSING F 44
Schedules for the 2-1-2 PTC Training in Luang Prabang for Northern Provinces of Lao PDR
Appendix B: Course Schedule for the 2-day PTC Training for Provincial TrainersDay 1 and 2- PTC Skill Training
Time/Minutes
Topic Slides
Lao Lead LP
Lao Lead Pakse
HLI Lead
8:30 / 30 min
Welcome, Intro, MCQ
Dr. Khamsay
Dr. Khamsay
Steve
9:00/15 min
Local Trauma Perspective
Dr. Khamsay
Dr. Khamsay
Steve
9:15/15 min
PTC Overview
1-13 Tim Bounkong Steve
9:30/30 min
Trauma ABCD Primary Survey
14-37
Anouphet
Thepbandith
Khamph
10:00/10 min
Break / / /
10:10/40 min
Airway & Breathing
38-62
Tim Anong Rick
10:50/35 min
Circulation & Shock
63-85
Pouifai Bounkong Khampho
11:25/35 min
Chest Injuries
86-104
Mouavang
Bounthavy
Cam
12:00/45 min
Lunch Break / /
12:45/80 min
Skills / /
/40 min
Basic/Advanced Airway
Mouavang & Tim
Anong & Bounkong
Khamph/Khampho
/20 min
Cervical Spine/Log Roll
Pouifai Thepbandith
Steve
/20 min
Chest Drains Chest Tube
Bounthavy
Rick/Cam
12
14:05/10 min
Break / /
14:15/60 min
Abdominal Pelvic Limb trauma
105-141
Tim Thepbandith
Cam
15:05/15 min
Demonstration scenario
All All Khamph
15:20/70 min
Scenario Practice
/
Steve Tim Thepbandith
Khamph Anouphet
Bounthavy
Khampho Mouavang
Anong
Rick/Cam Pouifai Bounkong16:30/5 min
Overview & Summary
Khampho
Day 2 – PTC Skill TrainingTime/Minutes
Topic Slides
Lao Lead LP
Lao Lead Pakse
HLI Lead
8:30/45min Head & Spinal Injuries
126-182
Mouavang
Bounkong Steve,Khampho
9:15/30 min
Trauma in Children &Pregnancy
183-214
Pouifai Anong Khamph, Cam
9:45/30 min
Burns 215-235
Anouphet
Bounthavy
Alicia
10:15/15 min
Break
10:30/ 80 min
Workshops / /
20min
Analgesia Mouavang
Bounthavy
Rick Cam
20min
Transport Tim Anong Alicia Khampho
20min
Peds Trauma
Pouifai Thepbandith
Khamph
20min
Neuro Assessment
Anouphet
Bounkong Steve
12:00/ 30 min
SecondarySurvey
236-248
Pouifai Thepbandith
Rick
12:30/40 min
Lunch Break
13:10/50 min
Disaster Managem
Tim Bounthavy
Cam, AliciaKhampho
13
ent14:00/80 min
Scenarios
/20 min
1 Steve Pouifai Bounthavvy
/20 min
2 Khampho
Mouavang
Anong
/20 min
3 Alicia Khampho
Anouphet
Bounkong
/20 min
4 Rick Cam
Tim Thepbandith
15:20/10 min
Break
15:30/15 min
Repeat MCQ
Khamph
15:45/20 min
Summary, FeedbackEvaluation
KhamphoAlicia
16:05/15 min
Close, discussionPlanning for InstructorDay
Steve
16:20/15 min
Certificates
Steve, Reba
Appendix C: Course Schedule for Day 3 – Instructor Course 2-1-2 TrainingDay 3 – Teaching Methods Training for PTC Instructors
Time/Minutes Topics Slides8:00/ 15 min Registration, Fill in
forms8:15/15 min Welcome, Intro
Educational Philosophy1-4
8:30/55 min Session I: CommunicationsSkills
5-10
/15 min Training input /5 min Explain Feedback /30 min Practical Workshop /5 min Reflection & Summary9:25/80 min Session 2: Interactive
Teaching11-25
/20 min Training Input 1: Questions
14
In Lectures /15 min Practical Workshop /5 min Reflections /15 min Training Input 2: PTC
Workshop /20 min Practical Workshop /5 min Reflection & Summary10:45/20 min Break11:05/80 min Session 3: Scenarios 27-34 /20 min Training Input: The
Training Scenario /15 min Practical Scenario /40 min Practical Workshop /5 min Reflection & Summary12:25/ 45 min Lunch Break13:10/80 min Session 4: Skill Stations 35-43 /15 min Training Input 1:
TeachingThe skill with demonstration
/15 min Running the Skill StationWith demonstration
/5 min Organization of the skill Stations
/40 min Practical WorkshopSet up and practiceRole Play Log roll
14:30/35 min Session 5: How to Run a PTCCourse
45-50
/15 min In a new venue /15 min Who does what the next
day /5 min Taking charge of the
room and safety
15:05/15 min Break15:20/90 min Section 6: Slides &
Lectures53-58
/10 min Training input 1:Using slides effectively
/20 min Practical Workshop:Speaking with slides on aLaptop
/15 min Training input 2: PreparingPTC lectures
/40 min Final Presentations /5 min Final Feedback
15
16:50/10 min Confidence Matrix, EvalsSummary, Certificates
17:00 Finish
Appendix D: PTC 2-day Course Participants – All from Luang Prabang Province – (Total Number of Participants – 19)
16
First/Last Name workplace Degree
Specialty M/F
Age
Dr Khamsing LATTANASONG
107 Military Hospital
MD - M 27
Dr PanyMATILA
107 Military Hospital
MD - F 34
Ms Souphaphone THIPSAVANH
107 Military Hospital
Nurse - F 33
Ms Phaivanh NUANTHANONG
107 Military Hospital
Nurse - F 33
Dr Lakiher LEETONGXAI
Lao-Friendship Hospital for Children
MD - M 27
Dr Thongher LIA
Lao-Friendship Hospital for Children
MD - M 30
Mr. Khamsai XONGYIKHANGSUTHOR
Lao-Friendship Hospital for Children
Nurse - M 24
Mr. Bounmi LEE Lao-Friendship Hospital for Children
Nurse - M 27
Ms Vilayvanh CHANTHAPHASOUK
CHS Luangprabang Nurse - F 40
Mr Soulivong KHOUNTHIGOUMMARN
CHS Luangprabang Nurse - M 25
Mr Bounthavy THONGSAVANH
LPB Hospital Nurse - M 44
Ms Amphay CHANHBOULAPHA
LPB Hospital Nurse - F 52
Ms Naovalath PHIVAKOUN
LPB Hospital Nurse - F 50
Ms Vannida THAVICHITH LPB Hospital Nurse MIDWIFE F 35Mr Sengkane KEOMIXAY LPB Hospital Nurse - M 37Mr Somkeid TAKOUNSACK
LPB Hospital Nurse - M 33
Mr Bounpheng VISIEN LPB Hospital Nurse - M 25Mr Oudtama KHOUNPHANIT
LPB Hospital Nurse - M 22
Dr Sompasong KANTHAVONG
UHS Vientiane MD - M 25
Appendix E: Course Schedule for Day 4 and 5 – PTC 2-day course taught by new Provincial Hospital Trainers from Nine Northern ProvincesPTC Skill Training for Luang Prabang Health Providers as the Attendees Day 4
Time/Minutes
Topic Slides
Lao Lead LP
Lao Lead Pakse
HLI Lead
8:30 / 30 min
Welcome, Intro, MCQ
Dr. Khamsay
Dr. Khamsay
Steve
9:00/15 min
Local Trauma Perspective
Dr. Khamsay
Dr. Khamsay
Steve
9:15/15 min
PTC Overview
1-13 Tim Bounkong Steve
9:30/30 min
Trauma ABCD Primary Survey
14-37
Anouphet
Thepbandith
Khamph
10:00/10 min
Break / / /
10:10/40 min
Airway & Breathing
38-62
Tim Anong Rick
10:50/35 min
Circulation & Shock
63-85
Pouifai Bounkong Khampho
11:25/35 min
Chest Injuries
86-104
Mouavang
Bounthavy
Cam
12:00/45 min
Lunch Break / /
12:45/80 min
Skills / /
/40 min
Basic/Advanced Airway
Mouavang & Tim
Anong & Bounkong
Khamph/Khampho
/20 min
Cervical Spine/Log Roll
Pouifai Thepbandith
Steve
/20 min
Chest Drains Chest Tube
Bounthavy
Rick/Cam
14:05/10 min
Break / /
14:15/60 min
Abdominal Pelvic Limb trauma
105-141
Tim Thepbandith
Cam
15:05/15 min
Demonstration scenario
All All Khamph
15:20/70 Scenario /
min PracticeSteve Tim Thepband
ithKhamph Anouph
etBounthavy
Khampho Mouavang
Anong
Rick/Cam Pouifai Bounkong16:30/5 min
Overview & Summary
Khampho
Day 5Time/Minutes
Topic Slides
Lao Lead LP
Lao Lead Pakse
HLI Lead
8:30/45min Head & Spinal Injuries
126-182
Mouavang
Bounkong Steve,Khampho
9:15/30 min Trauma in Children &Pregnancy
183-214
Pouifai Anong Khamph, Cam
9:45/30 min Burns 215-235
Anouphet
Bounthavy
Alicia
10:15/15 min
Break
10:30/ 80 min
Workshops
/ /
20 min
Analgesia Mouavang
Bounthavy
Rick Cam
20 min
Transport Tim Anong Alicia Khampho
20 min
Peds Trauma
Pouifai Thepbandith
Khamph
20 min
Neuro Assessment
Anouphet
Bounkong Steve
12:00/ 30 min
SecondarySurvey
236-248
Pouifai Thepbandith
Rick
12:30/40 min
Lunch Break
13:10/50 min
Disaster Management
Tim Bounthavy
Cam, AliciaKhampho
14:00/80 min
Scenarios
/20 min
1 Steve Pouifai Bounthavvy
/20 2 Mouava Anong
min Khampho ng /20 min
3 Alicia Khampho
Anouphet
Bounkong
/20 min
4 Rick Cam
Tim Thepbandith
15:20/10 min
Break
15:30/15 min
Repeat MCQ
Khamph
15:45/20 min
Summary,FeedbackEvaluation
KhamphoAlicia
16:05/15 min
Close, discussionPlanning for InstructorDay
Steve
16:20/15 min
Certificates
Steve, Reba
Recommended