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Non-Doctors as Trauma Surgeons? A Controlled Study of Trauma Training for Non-Graduate Surgeons in Rural Cambodia

Published online by Cambridge University Press:  28 June 2012

Yang Van Heng ,
Chan Davoung  and
Hans Husum
Yang Van Heng
Affiliation:
Assistant Medical Officer, Head, Trauma Care Foundation, Battambang, Cambodia
Chan Davoung
Affiliation:
Instructor, Surgery, Trauma Care Foundation, Battambang, Cambodia
Hans Husum*
Affiliation:
Assistant Professor, Department of Surgery, Institute of Clinical Medicine, University Hospital Northern Norway
*
P.O. Box 80N-9038 University Hospital Northern NorwayNorway E-mail: tmc@unn.no
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Abstract

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Introduction:

Due to the accelerating global epidemic of trauma, efficient and sustainable models of trauma care that fit low-resource settings must be developed. In most low-income countries, the burden of surgical trauma is managed by non-doctors at local district hospitals.

Objective:

This study examined whether it is possible to establish primary trauma surgical services of acceptable quality at rural district hospitals by systematically training local, non-graduate, care providers.

Methods:

Seven district hospitals in the most landmine-infested provinces of Northwestern Cambodia were selected for the study. The hospitals were referral points in an established prehospital trauma system. During a four-year training period, 21 surgical care providers underwent five courses (150 hours total) focusing on surgical skills training. In-hospital trauma deaths and postoperative infections were used as quality-of care indicators. Outcome indicators during the training period were compared against pre-intervention data.

Results:

Both the control and treatment populations had long prehospital transport times (three hours) and were severely injured (median Injury Severity Scale Score = 9). The in-hospital trauma fatality rate was low in both populations and not significantly affected by the intervention. The level of post-operative infections was reduced from 22% to 10.3% during the intervention (95% confidence interval for difference 2.8–20.2%). The trainees' selfrating of skills (Visual Analogue Scale) before and after the training indicated a significantly better coping capacity.

Conclusions:

Where the rural hospital is an integral part of a prehospital trauma system, systematic training of non-doctors improves the quality of trauma surgery. Initial efforts to improve trauma management in low-income countries should focus on the district hospital.

Keywords

Cambodiadisasterdistrict hospitallandmineruralsurgerytrainingtrauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 6 , December 2008 , pp. 483 - 489
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

References

1.Mathers, CD, Bernard, C, Iburg, K, et al. : The Global Burden of Disease in 2002: Data Sources, Methods and Results. Geneva, World Health Organization (GPE Discussion Paper No. 54).Google Scholar
2.Mathers, CD, Loncar, D: Projections of global mortality and burden of disease from 2002 to 2030. 2006 3:e442. doi:10. 1371/journal.p.med.0030442. Available at http://www.who.int/evidence. Accessed 20 June 2007.CrossRefGoogle Scholar
3.Demetriades, D, Martin, M, Salim, A, et al. : The effect of trauma center designation and trauma volume on outcome in specific injuries. Ann Surg 2005;242:512–517.CrossRefGoogle Scholar
4.Sampalis, JS, Denis, R, Lavoie, A, et al. : Trauma care regionalization: A process-outcome evaluation. J Trauma 1999;46:657–679.CrossRefGoogle ScholarPubMed
5.Husum, H, Gilbert, M, Wisborg, T, et al. : Rural prehospital trauma systems improve trauma outcome in low-income countries: A prospective study from North Iraq and Cambodia. J Trauma 2003;54:1188–1196.CrossRefGoogle ScholarPubMed
6.Farmer, JC, Carlton, PK: Providing critical care during a disaster: the interface between disaster response agencies and hospitals. Crit Care Med 2006;34:s56–s59.CrossRefGoogle ScholarPubMed
7.Deacon, R: Globalization and Social Policy: The Threat of Equitable Welfare. Occasional Paper no. 5. Geneva: United Nations Research Institute, 2000.Google Scholar
8.Chen, L, Evans, T, Anand, S, et al. : Human resources for health: Overcoming the crisis. Lancet 2004;364:1984–1990.CrossRefGoogle ScholarPubMed
9.Seynaeve, G, Archer, F, Fisher, J, et al. : International standards and guidelines on education and training for the multi-disciplinary health response to major events that threaten the health status of a community. Prehospital Disast Med 2004;19:s17–s30.Google ScholarPubMed
10.Mock, C, Ofusu, A, Gish, O: Utilization of district health services by injured persons in a rural area of Ghana. Int J Health Plann Manage 2001;16:19–32.CrossRefGoogle Scholar
11.Pereira, C, Bugalho, A, Bergstrom, S, et al. : A comparative study of caesarean deliveries by assistant medical officers and obstetricians in Mozambique. Br J Obstet Gynaecol 1996;103:508–512.CrossRefGoogle ScholarPubMed
12. Landmine Monitor Report: Toward a Mine-Free World. Available at www.icbl.org/lm/2002/cambodia.html. Accessed 20 June 2007.Google Scholar
13.Sundet, M, Heger, T, Husum, H: Post-injury malaria: A risk factor for wound infection and protracted recovery. Trop Med Int Hlth 2004;9:238–242.CrossRefGoogle ScholarPubMed
14.Husum, H, Gilbert, M, Wisborg, T: Training prehospital trauma care in low-income countries: The “Village University” experience. Med Teach 2003;25:142–148.CrossRefGoogle Scholar
15.Association for the Advancement of Automotive Medicine: Abbreviated Injury Scale (AIS) 1990, Update 98. Barrington Illinois, USA; 1998.Google Scholar
16.Pender, FT, de Looy, AE: Monitoring the development of clinical skills during training in a clinical placement. J Hum Nutr Diet 2004;17:25–34.CrossRefGoogle Scholar
17. Confidence Interval Analysis [statistical computer program]. London: BMJ; 1992Google Scholar
18.Sava, J, Kennedy, S, Jordan, M, Wang, D: Does volume matter? The effect of trauma surgeons' caseload on mortality. J Trauma 2003;54:829–833.CrossRefGoogle ScholarPubMed
19.Margulies, DR, Cryer, HG, McArthur, DL, et al. : Patient volume per surgeon does not predict survival in adult level I trauma centers. J Trauma 2001;50:597–601.CrossRefGoogle Scholar
20.Sethi, D, Aljunid, S, Saperi, SB, et al. : Comparison of the effectiveness of major trauma services provided by tertiary and secondary hospitals in Malaysia. J Trauma 2002;53:508–516.CrossRefGoogle ScholarPubMed