Trauma course Vietnam
Thanks and acknowledgement go to AProf Marcus Skinner and Dr Haydn Perndt for permission to use the Primary Trauma Care (PTC) course as a background to what we eventually called an advanced trauma course. No doubt, it will find a appropriate Vietnamese name in the future!
Why was it initiated?
In a nationwide survey sponsored by the World Bank, road trauma was second only to earning a living as a priority by Vietnamese people. Preventative strategies, including compulsory wearing of helmets and drink driving legislation have been effective - though the legislation is not enforced.
Stabilisation and urgent treatment of victims reduces fatalities from serious traffic accidents and disasters, particularly in circumstances with limited medical equipment.
Acknowledging there was inadequate clinical trauma training for frontline staff, Dr Hy (director Lam Dong general hospital LDGH) invited us to work with a newly appointed senior executive doctor (Dr Nhuan) to develop a trauma course appropriate for resource poor environments. This was May 2013.
Our principal roles have been in mentoring, arbitration of clinical decisions and, initially, to give “western” credibility to the course. We all agreed to maintain local ownership from the outset.
What are its aims?
1) Build confidence that
- an acceptable standard of care can be achieved with a minimum of technology
- this course could be run in the South and in a regional rather than a major city hospital.
2) Find local solutions for early deaths and morbidity following major and minor trauma in Lam Dong province.
3) Using those solutions, train medical and nursing staff in skills and uniform procedures and embed those into routine practice
4) Strengthen ongoing knowledge sharing and exchange to spread these skills to other hospitals
When did it start?
The first course was November 2014 and it has run every year until 2018
Who has been involved?
LDGH: Dr Hy, Dr Nhuan (co-ordinator LDGH & course director), Dr Sinh (director anaesthetics LDGH, principal lecturer & course director), Dr Hiep Bui (lecturer), Dr Hiep Ngoc (director emergency department LDGH and lecturer)
MESCH: Peter Armstrong (anaesthetist, lecturer), John Cassey (paediatric surgeon, lecturer). La Cuong Vu (lecturer, negotiator, co-ordinator & interpreter) Au Vu (lecturer and interpreter)
Other: Lois Meyer (educational consultant UNSW)
Interpreters: Võ Xuân Khang, Truong Bao Khuê , Vy An, An Nguyen
Multiple slide set and course document revisions (VN and English) have resulted in quite a lot of education in content and style.
More videos of “how to”, including a locally produced one on management of distressed/ difficult relatives, have been added and continue to be modified
Practical sessions have become more locally relevant.
There is a realisation that a team approach requires nurses and doctors to attend a combined course and there are no longer separate courses.
The course runs for 2.5 days and is delivered by Vietnamese doctors with Australian input for the skills and scenarios sessions.There have been ~20 attendees (junior and senior staff) at each course, coming from over 15 hospitals in Lam Dong province.
In 2016 a "train-the-trainer" module was added.
In 2018 we added a community first aid course (along with its own "train-the-trainer" course). This was delivered by Cuong and Au Vu to Red Cross and members of prudential insurance at LDGH and community members, Red Cross, doctors and nurses at Lam Ha hospital. Mrs Tam (Prudential Insurance), Thuy Anh (a prominent business woman) and Mr Bao (a active community member) have committed to be involved through a respected NGO called Từ Tấm (“From the heart”). Cuong, Au and John will mentor this and both Cuong and Au will be back in DaLat in 2019 to help with teaching.
We will help to deliver both the PTC and first aid courses at Ninh Thuan hospital, Phan Rang Province in September 2018.
Having regard to the track record of previous PTC courses in Vietnam, what is being achieved here is truly remarkable.
It is critically important to thank, encourage and support the new lecturers and interpreters. These courses require considerable time, mental input and loss of income for everyone involved.
It is a great initiative by both Lam Dong and Ninh Thuan Hospitals with very positive futures.
The expansion into community first aid is a strong step that will add enormously to better outcomes .
We would like to continue to assist to make these communities safer and lessen the financial and social burdens of trauma.
Conversations with local staff and medical directors confirm the ongoing need for the course and a willingness to devote resources (people, infrastructure and equipment) to improve trauma care.
Attendees come from institutions with markedly different capabilities and backgrounds. Although nurses do most of the rapid assessment and early management (“ABCDE”), it is the doctors who dictate management decisions.
Exchange of ideas and understanding the capacities and needs of the participants’ hospitals will take time.
We are seeking input from Universities of Newcastle and NSW into effectiveness of the teaching, skills maintenance and clinical outcomes. Data obtained from solicited feedback using evaluation forms awaits analysis
The practical sessions and scenarios in PTC are no longer shared with Australians - but will be in Ninh Thaun until they feel comfortable. We are still required for the first aid courses. This adds considerably to the stress on the interpreters.
This new style of course delivery is rewarding with strong uptake by most participants.
Some of the difficulties we all (Vietnamese and Australian) experience with participant interaction, engagement and learning are a consequence of participants’ unmet and unknown expectations. Some may improve with insights by participants over time (perception) and some will always be insoluble.
Transition from Australian input to completely Vietnamese is proceeding well.
The end of day debriefs are a new concept and getting better.
WHO have set a target for reducing death and injury following trauma by 50% by 2020. The courses in LDGH and NTGH are part of improving outcomes after trauma. An ideal opportunity exists to make a huge change in outcomes of trauma across the provinces. Some funding for this could be sought at national level. We have no influence in this
Interpreters (all local DaLat)
Võ Xuân Khang Truong Bao Khuê Vy An
Dr Peter Armstrong Dr John Cassey La Cuong Vu
anaesthetist paediatric surgeon biomedical engineer
Guest lecturer Overall co-ordinator Negotiator, co-ordinator & interpreter
What do we need to advance this?
1) Funding for
- Support and mentoring of local doctors to deliver training locally and in additional hospitals (eg Lam Ha) 5000AUD pa for 5 years
- Support and mentoring of local doctors to deliver First aid courses to manufacturing and construction industry (in line with government directives), tourism, transport and then general public. 5000AUD pa for 5 years
- Research and evaluation to ensure we are using effective teaching methods and are enhancing clinical outcomes (5,000AUD annually for 3 years)
- Video production
- Translators and interpreters 1000AUD pa for 5 years
- Equipment (Laerdal mannequins, resuscitation kits and spinal boards) 2000AUD once
- Travel support for volunteers
2) Build community confidence in trauma care and hospital staff. Quite apart from improvements in patient outcomes, this course has the potential to improve the reputation of LDGH, other hospitals and medical centres and Lam Dong province as a whole. The flow on will positively impact on:
- staff morale - aligned with the hospital’s current quality improvement research and initiatives
- the community – trusting and using the hospitals more improves income, results in a lower probability of litigation for bad outcomes and less likelihood of abuse and threatening behaviours to staff. This is aligned with new funding arrangements due to commence late 2107.
3) Infrastructure – Emergency department re-design will improve patient flow and reduce access of the public to acute treatment areas. This is critical to address staff concerns about personal and patient safety and their ability to deliver quality care. The board of LDGH has approved emergency department changes and review of other centres is awaited
Evaluation of the ability of other hospitals/ medical centres to assess and deal with serious trauma requires a joint decision by provincial health and MESCH.
16 June 2018