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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

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

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