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.

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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.

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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

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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.

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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.

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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.

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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

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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.

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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

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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

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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

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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

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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

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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)

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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