Hostname: page-component-cc8bf7c57-l9twb Total loading time: 0 Render date: 2024-12-11T07:42:26.875Z Has data issue: false hasContentIssue false

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
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

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.

Type
Original Research
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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;242:512517.CrossRefGoogle Scholar
4.Sampalis, JS, Denis, R, Lavoie, A, et al. : Trauma care regionalization: A process-outcome evaluation. J Trauma 1999;46:657679.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;54:11881196.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;364:19841990.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;16:1932.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;103:508512.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;9:238242.CrossRefGoogle ScholarPubMed
14.Husum, H, Gilbert, M, Wisborg, T: Training prehospital trauma care in low-income countries: The “Village University” experience. Med Teach 2003;25:142148.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;17:2534.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;54:829833.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;50:597601.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;53:508516.CrossRefGoogle ScholarPubMed