Trauma course Lam Dong 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 (coordinator 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, coordinator & interpreter) Au Vu (lecturer and interpreter)

Other: Lois Meyer (educational consultant UNSW) 

Interpreters: Võ Xuân Khang,  Truong Bao Khuê , Vy An, An Nguyen 

What’s happened? 

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 businesswoman) 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 helped deliver both the PTC and first aid courses at Ninh Thuan hospital, Phan Rang Province in September 2018. We have been unable to ascertain if the community first aid course is continuing as Mr Bao has not replied to our attempts at contact. The delivery of the PTC course was poorly done in 2018.

Evaluation?

Having regard to the track record of previous PTC courses in Vietnam, what was initially achieved here was very encouraging.
It is critically important to thank, encourage and support the 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 hospital, though it has an uncertain future since there seems very little push by the new hospital management for this.
The expansion into community first aid was a strong step towards better outcomes. Despite an obvious need and request for this course by community members, the availability of trained lecturers and an approved mechanism to deliver the course, there appears to be considerable barriers to its continuance.
We would like to continue to assist to make these communities safer and lessen the financial and social burdens of trauma. In the absence of a request or feedback from them, these projects are on hold.   

1) Relevance:

Conversations with local staff and prior medical directors confirmed the ongoing need for the course and a willingness to devote resources (people, infrastructure and equipment) to improve trauma care.
Attendees came 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 were unable to attract interest from Universities of Newcastle or NSW into effectiveness of the teaching, skills maintenance and clinical outcomes. Similarly, data obtained from solicited feedback using evaluation forms awaits analysis

2) Communication:
The practical sessions and scenarios in PTC are no longer shared with Australians. 

3) Participants:
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. 

4) Processes:
Transition from Australian input to completely Vietnamese has occurred.  
The end of day debriefs were useful, though not taken up by local staff. 

5) Funding:
WHO have set a target for reducing death and injury following trauma by 50% by 2020.  The courses in LDGH are part of improving outcomes after trauma. An ideal opportunity exists to make a huge change in outcomes of trauma across the province. Some funding could be sought at national level. We have no influence in this

   

Interpreters (all local DaLat)

Võ Xuân Khang               Truong Bao Khuê                             Vy An