A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting

Nee-Kofi Mould-Millman; Julia Dixon; Andrew Lamp; Shaheem de Vries; Brenda Beaty; Lani Finck; Kathryn Colborn; Kubendhren Moodley; Amanda Skenadore; Russell E Glasgow; Edward P Havranek; Vikhyat S Bebarta; Adit A Ginde

doi:10.1186/s40814-019-0536-0

A single-site pilot implementation of a novel trauma training program for prehospital providers in a resource-limited setting

Pilot Feasibility Stud. 2019 Dec 5:5:143. doi: 10.1186/s40814-019-0536-0. eCollection 2019.

Authors

Nee-Kofi Mould-Millman^{1

2}, Julia Dixon^{1

2}, Andrew Lamp¹, Shaheem de Vries³, Brenda Beaty⁴, Lani Finck^{1

2}, Kathryn Colborn⁵, Kubendhren Moodley⁶, Amanda Skenadore⁴, Russell E Glasgow⁴, Edward P Havranek^{1

4

7}, Vikhyat S Bebarta^{1

2

8}, Adit A Ginde^{1

2}

Affiliations

¹ 1University of Colorado, School of Medicine, Aurora, CO USA.
² 2Department of Emergency Medicine, University of Colorado, School of Medicine, 12401 E. 17th Ave, B215, Aurora, CO 80045 USA.
³ Western Cape Government Health, Emergency Medical Services, Bellville, Cape Town, South Africa.
⁴ 4Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, CO USA.
⁵ 5Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO USA.
⁶ College of Emergency Care, Western Cape Government, Bellville, Western Cape South Africa.
⁷ 7Department of Medicine, Denver Health Medical Center, Denver, CO USA.
⁸ 8Office of the Chief Scientist, 59th Medical Wing, Joint Base San Antonio-Lackland, San Antonio, TX USA.

Abstract

Background: Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial.

Methods: We conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients' prehospital trauma charts. Thresholds for progression to a main trial were developed a priori.

Results: The average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated-there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study.

Conclusions: We successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial.

Keywords: Education; Effectiveness; Emergency medical services; Feasibility study; Global health; Implementation science; Pilot study; Prehospital; Resource-limited; Trauma.

Abstract

Grants and funding