Trauma course Vietnam (Ninh Thuan)

  

 

 

  

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 Phien (director Ninh Thuan general hospital - NTGH) invited us to work with them to develop a trauma course appropriate for their resource poor environment. This was September 2017.

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) Train community, medical and nursing staff in skills and uniform procedures and embed those into practice

2) Build confidence that

  • an acceptable standard of care can be achieved with a minimum of technology
  • these courses could be run in the South and in a regional rather than a major city hospital. 

3) Find local solutions for early deaths and morbidity following major and minor trauma in Ninh Thuan province.
4) Strengthen ongoing knowledge sharing and exchange to spread these skills to other hospitals and medical centres in the province

When did it start?

The first course was September 2018

Who has been involved?

NTGH: Dr Phien, Dr Hong (director emergency department NTGH and lecturer), Dr The (lecturer), Dr Thai (department of quality), Ms Tuoi (course co-ordinator from NTGH) 

MESCH: Cuong Vu (lecturer and interpreter), John Cassey (paediatric surgeon, lecturer)

Other: Au Vu (lecturer and interpreter), Võ Xuân Khang (interpreter), Truong Bao Khuê (lecturer and interpreter) 

What’s happened? 

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. 

The slide sets with associated videos that were used in Lam Dong hospital were modified as a result of SKYPE and face-to-face discussion with the local lecturers. This provided the added benefit of education in content and style. 
A locally produced training video on airway management was added as a result of the video teaching session in the instructors' course 2018. More locally produced videos of “how to” are anticipated.  
Practical sessions have been extended with a focus on airway management throughout the course.  
The 2018 addition of a "discussion group" session early in the course resulted in more effective and earlier interraction amongst the group.
The course ran for 2.5 days and was delivered by Vietnamese doctors with Australian input for the skills and scenarios sessions.There were 15 attendees (doctors and nurses) at the PTC course in 2018 - coming from various hospitals and medical centres in Ninh Thuan province.

An instructor ("train-the-trainer") course of 1.5days duration followed the PTC. Unfortunately, not all the attendees (10) had attended the PTC..

A 1 day community first aid course (along with its own 1 day "train-the-trainer" course) was delivered by Cuong, Au and Bao Khue - largely to Red Cross members (20). As no govermnet organisation sees itself as having repsonsibility ofr community health education, there is no immediate future in this course. Although the executive management staff at NTGH suggetsed that smaller medical centres might dleiver it to their communities, there is no actual requirement fo rthem to do so.

Evaluation?

Having regard to the track record of previous PTC courses in Vietnam, particularly Lam Dong and the national hospital in HaNoi, what was achieved in this first year was very encouraging. It is a great initiative by Ninh Thuan Hospital with a very positive future.

The broad aims described above were subdivided into more specific and, at this point, achievable ones described in the table below. 
 

Aim Status Responsible
 Initiate Community first aid &    instructors courses at NTGH   Achieved but will not be   continued  Smaller hospitals, at their discretion
 Initiate PTC and instructors courses at NTGH  Achieved  
 Acquisition of knowledge and skills in PTC  Achieved  (direct observation and MCQ)  NTGH and MESCH
 Build confidence that care can be achieved with a minimum of technology  Achieved  (Resources and course evaluation forms by participants)  NTGH and MESCH
 Increased awareness of the need for training and for this to be driven from the senior staff  Achieved. MOU to continue  NTGH
 Introduce a new style of course delivery & determine participants’ perceptions of this  Well received (course evaluation forms & direct feedback)  NTGH and MESCH
 Understand what impediments might need to be resolved to improve trauma care in NinhThuan Province  In progress  NTGH and MESCH
 Understand the structure and processes behind trauma care in  Ninh Thuan province  In progress  NTGH and MESCH
 Modifications to the PTC course  In progress  NTGH and MESCH*
 Establish NTGH ownership of the course  Achieved  NTGH**

* Attempt at getting Vn language version of a free interactive (team building) game called “Spaceteam”. Positive replies from developer. Need volunteers with bi-lingual fluency.
** Video of simple jaw thrust airway management completed during the course by participants with assistance by Cuong, Au and John

Communication: The practical sessions and scenarios in PTC will be shared with Australians until they have enough trained staff and confidence to feel comfortable. 

Participants:
Attendees come from institutions with markedly different capabilities and backgrounds. Exchange of ideas and understanding the capacities and needs of the participants’ individual hospitals will take time.

An interesting finding (noted also in Lam Dong) is that, after the course, 25% of participants felt they needed less equipment and more training. This new style of course delivery is rewarding with strong uptake by all 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. 

Processes:
Transition from Australian input to completely Vietnamese is proceeding well.  
Debriefs were mostly at lunch and a little at the end of each day. They were very honest and constructive with tangible differences being made to content and delivery    

The inability to positively expand into community first aid at this time is unfortunate and we will continue to explore options.  
 

Building 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 NTGH, other hospitals and medical centres and Ninh Thuan 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.

Evaluation of these and the ability of other hospitals/ medical centres to assess and deal with serious trauma requires a joint decision by provincial health and MESCH.

 

We would like to continue to assist in making these communities safer and lessen the financial and social burdens of trauma. 

                           

 

What do we need to advance this?

1) Funding for

  • Support and mentoring of local doctors to deliver training locally and in additional hospitals 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 7000AUD once
  • Translators and interpreters 300AUD pa for 5 years
  • Equipment (Laerdal mannequins, resuscitation kits and spinal boards) 2000AUD once
  • Travel support for volunteers 2,500AUD pa for 5 years

2) Bi-lingual volunteers interested in developing a Vn language version of the free interactive game, “Spaceteam”. We want to use this in team building. We have had encouraging and positive replies from the developer.  


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.

Want to find out more?       Please email
      

 

 

John Cassey
For MESCH
30 October 2018