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PRIMARY TRAUMA CARE COURSE Report

Hanoi & Ninh Binh Provence April – May 2012

Report by Associate Professor Marcus Skinner

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Contents Purpose of the visit

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Executive Summary

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Involvement of staff

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Professional aspects

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Activity details

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Subsidiary activities

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Organisation of the PTC Course

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Assessment

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Facility and Resources

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Summary

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Observations and Recommendations

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Teaching and Training material

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Course Budget

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Acknowledgments

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Appendix 1 12 Appendix 2 13 Appendix 3 15 Appendix 4 17 Appendix 5 27 Appendix 6 28

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1. Purpose of the visit To continue to provide training courses following discussions with Dr. Chinh and formal invitation (Appendix 1) from the Director of Viet Duc Hospital, Professor Nguyen Tien Quyet through Professor Tu and the Hanoi University Medical Hospital, Ha Noi, Vietnam as part of the ongoing Primary Trauma Care training model. To provide training courses to Provincial districts via the Ninh Binh General Hospital, Ninh Binh, Vietnam. 2. Executive Summary The members of Australian instructors arrived to Hanoi on the 21st April 2012 and finishing on 2nd May 2012. These consisted of:

• A/Prof Marcus Skinner (Anaesthetist and PTC Co-Founder)

• Dr. Haydn Perndt (Anaesthetist and PTCF Trustee) Professor Tu provided three Vietnamese Instructors: Dr. Minh, Dr. Thang and Dr. Tuan. The group interacted well with a generally good level of English within the instructor group. A total of 81 candidates attended the course in Hanoi. All of these candidates were anaesthetists; with the exception of one surgeon; from in and around Hanoi. Many of them new trainees and junior consultants (Refer Appendix 2). A total of 40 candidates attended the course in Ninh Binh. Candidates included Emergency doctors, Anaesthetists, Surgeons and Nurses from in and around Ninh Binh. Many of these candidates were consultants (Refer Appendix 3). 3. Key staff involved in planning and co-ordinating Dr. Marcus Skinner Dr. Haydn Perndt Dr. Nguyen Huu Tu Dr. Nguyen Duc Chinh Dr. Nguyen Ba Tuan Dr. Pham Quang Minh Dr. Nguyen Toan Thang Dr. Phan Thuy Chi

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Left to Right: Associate Professor Skinner, Dr. Minh, Professor Tu, Dr Tuan, Dr Perndt, Dr Thang.

4. Professional aspects of the visit The usual cultural differences were noted, particularly the language and initial responsiveness to questions. This improved on the second part of the course with good interaction. The Vietnamese doctors were again exposed to teaching methods new to them. 5. Details of activities The courses were undertaken with a transfer of more lecturing to the Vietnamese instructors along with the development of the Scenarios and skill stations by them. Guidance was given to instructors and attendees by the Australian instructors as required. 6. Subsidiary activities The Ninh Binh course received media coverage by the local news team and appeared on a provincial television station.

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7. Organisation of the PTC course The Hanoi course started on time and ran relatively smoothly. Local trauma perspective was covered by Professor Tu who has acquired data from Viet Duc hospital and has been sentinel in supporting the PTC programme. This data related the decrease in head injury observed with the introduction of Head Protection legislation in Vietnam in 2009. The Ninh Binh course was exceptionally well run and organisation conducted by the Senior Clinicians at the Hospital assisted in its success. It was apparent that the course was significantly anticipated and publicised. A large poster advertising the course was posted in the Training Skills Centre. Assessment Myself and Dr Perndt as well as the Vietnamese instructors took part in the assessment process. The assessment for the PTC basic course was done on the MCQ result and during an assessment on the primary survey in a standard scenario, which at any one time was the same for all candidates. The Scenarios were run as three stations with a different instructor at each station. The three Vietnamese instructors ran these stations with the Australian instructors giving guidance as required. The scenarios were completed satisfactorily. Pre and post course MCQ evaluation showed significant improvement. No Instructor course was undertaken on this occasion but a significant amount of coaching and mentoring was undertaken by the Australian Instructors to aid the Vietnamese Instructors to take control. We have now identified potential Instructors to attend an Instructors Course in Hanoi in 2013. Facility The facilities were high-quality with very good seating arrangements in the “Training Communicating Skill Room” provided at the Hanoi Medical University and the “Seminar Room” at the Ninh Binh General Hospital Training Skills Centre. These rooms were set up as lecture rooms with utilisation of a separate neighbouring room to be able to run separated scenarios and skills stations. All candidates were seated appropriately and due to the size of the room, audio equipment was utilised to ensure all candidates could hear. Most of the slides were in Vietnamese with the slides presented by the Australian Instructors presented by dual display English and Vietnamese. Equipment previously purchased, including the two Laerdel mannequins were utilised and other equipment from 2011 was utilised for these courses. Additional equipment brought from

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Australia for training purposes included, LMA’s, laryngoscopes, cervical collars and urinary catheters. This equipment was utilised during the skills stations and scenarios. The Intubating mannequins and trauma dummies utilised from previous years require replacement. Refer to recommendations. The training mannequins were used for the skills stations. Demonstration of crycothyroidotomy, cervical spine immobilisation techniques, chest drain and log rolling were undertaken by the Vietnamese Instructors with mentoring provided by the Australian Instructors.

Dr Minh guiding a skill station, Hanoi Medical University, Hanoi.

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Dr. Perndt guiding a skill station, Ninh Binh General Hospital, Ninh Binh.

8. Summary of PTC Course Initial meeting with Professor Tu and discussions regarding the facility occurred on the 22 April. 23 – 24 April the PTC Course was conducted in Hanoi. 1-2 May the PTC Course was conducted in Ninh Binh. After each section of the course debriefing was carried out between the foreign and Vietnamese Instructors. Mentoring on each section was provided by the Australian instructors. Each day, at the conclusion of the day the Course Instructors and Professor Tu met to evaluate the days programme. The Vietnamese Instructors were well motivated and participated actively.

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PTC Certificate Vietnamese translation of PTC Manual

Translation As we are now is a phase of training the trainer, the Vietnamese Instructors are expected to conduct all aspects of the course independently. The only issue was not knowing exactly what is being said despite the PTC slides being correctly translated to Vietnamese. Real time translation of the lectures is problematic. Many of the younger graduates have some English and if written i.e. via slides can ‘grasp’ the concepts even without translation. It is beneficial to translate the more complicated issues but this also requires a higher level of English in the translators. One of the current Instructors has been reviewed to come to Australia under the HOC MAI Fellowship Program but requires a higher level of English before this can occur. Discussion was undertaken to plan a programme of improved English with reassessment for the HOC MAI Program in 12-24 months time.

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Relevance of the visit A large amount of work has been undertaken to evolve preventative strategies on road safety health in Vietnam. Appendix 4 is a summary to 2012 of the Viet Duc Hospital statistics and reflects the current operational load in the premiere trauma facility in the north of Vietnam. Road Safety prevention in Vietnam is high priority and endorsement by the Minister of Health Vietnam to utilise PTC in its integration of the pre-hospital prevention and hospital care trauma program has strong support. It is clearly evident that the majority of motorcyclists now wear helmets in contrast to my first visit in 2004 when virtually no motorcycle users were wearing helmets.

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PTC Vietnam is excited to have this level of endorsement by the Vietnamese. The whole issue of pre-hospital trauma management remains a major issue in rural areas and future PTC will target more rural and regional facilities. The long distance movement of patients and primary medical care in provincial areas is problematic and long time delays exist to achieve tertiary medical care, particularly for the Head trauma patient. As the Neuro trauma is disproportionately high, in addition to our PTC Programme this year, we simultaneously conducted a Neurosurgical visit by senior members of the Neurosurgical service at the Royal Hobart Hospital. We undertook both elective and emergency neurosurgery at Viet Duc Hospital. The Director of Viet Duc Hospital, Professor Quyet has requested ongoing neurosurgical exchange in conjunction with ongoing Primary Trauma Care training in light of the significant neuro trauma this country sees. It is exciting and interesting to see the current data from Viet Duc ( Grap 1) reflecting a reduced in hospital mortality ratio. It would be an extrapolation to assume that this may be due to a modest implementation of public awareness on road safety and the implementation of compulsory use of helmets, however, the current data is encouraging but requires more formalised data analysis.

9. PTC Course Observations and recommendations Many of the problems originally seen when PTC started in 2005 in Vietnam are now gone. I.e. the organisational issues are now left to the PTC co-ordinator, Professor Tu, who ultimately delegates to the PTC Instructors Dr. Thang, Dr Tuan and Dr Minh as recommended in 2011. This year Dr. Thang acted as the course director. Cultural differences and translation are being overcome readily and should improve with the improved English speaking Vietnamese instructors. Arrangements have been made to make sure that applications from Anaesthetists involved in the PTC programme actively apply for

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HOCMAI Scholarship programme. One candidate, Dr. Lam, Anaesthetist, is coming to Australia on the HOC MAI Fellowship this year. The concept of the PTC, and the possibility of adapting it to different settings, was understood by the Vietnamese instructors despite little exposure.

• Recommendation 1: o Essential to conduct an Instructors course in 2013. Discussion with Dr. Thang and

Professor Tu have commenced in this regard with an expected provider and instructor course to be taken in Hanoi in November 2013.

• Recommendation 2: o That purchase of additional Airway Management trainers and Interventional

trainers (i.e. Cricothyroid Models) be funded. • Recommendation 3:

o Essential that additional “Training Equipment” for Scenario based training i.e. cannulae/ ETT’s/ LMA’s airways, be provided.

• Recommendation 4: o That individuals that have been identified as high quality potential instructor

candidates be supported by the PTC Programme to attend the Instructors Course in November 2013.

• Recommendation 5: o That a maximum of 24 candidates be placed on the provider course and a

maximum of 12 candidates be placed on the Instructor Course. 10. Details of teaching or other materials provided Vietnamese copies of PTC Manual (Appendix 6) and PTC Slides in both English and Vietnamese. Acknowledgments I would like to thank all the people who contributed to make the PTC Course Hanoi and Ninh Binh 2012 a success, particularly the funding support from HOC MAI Foundation.

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Appendix 1

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Appendix 2

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Appendix 3

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Appendix 4

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Appendix 5

Above: PTC Course participants and instructors, Hanoi Medical University, Hanoi.

Below: PTC Course Participants and instructors, Ninh Binh General Hospital, Ninh Binh.

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Appendix 6

PTC Manual Attached