Ukraine Trauma Project: the feasibility of introducing advanced trauma-care skills to frontline emergency medical services responders.
BMJ Open · 2023-11-09 · Implementation & quality improvement
Abstract
OBJECTIVES: To design, develop, deliver and assess a training initiative on haemorrhage control for emergency medical services (EMS) staff in Ukraine, in an active wartime setting. DESIGN: Using the Medical Research Council framework for complex interventions, a training programme was designed and developed in a collaboration between Irish and Ukrainian colleagues and delivered by experienced prehospital clinicians/educators. Feedback was gathered from participants. SETTING: The Russian invasion of Ukraine has caused large numbers of trauma patients with limited access to advanced prehospital emergency care. Ukrainian authorities requested support in delivering such care. PARTICIPANTS: Ukrainian EMS nominated clinical staff as trainees, in partnership with an educational institution in Kyiv. INTERVENTION: One day provider and train-the-trainer courses were developed and delivered, focused on early delivery of tranexamic acid (TXA), using intraosseous access (IO) in victims of wartime trauma. OUTCOME MEASURES: Safe organisation and delivery of courses, assessed knowledge and skills competence and self-reported satisfaction and pre/post confidence/competence. RESULTS: Two provider and one train-the-trainer courses and four equipment supply exercises were delivered for 89 EMS staff (doctors, nurses, paramedics); none had prior experience of IO or prehospital delivery of TXA. All participants were assessed as competent as providers and/or trainers. High levels of satisfaction and significantly improved self-assessed confidence and competence were reported. CONCLUSION: Rapid design and delivery of a training programme focused on an identified need for advanced care of trauma patients in a wartime setting has been possible. Training and immediate access to appropriate equipment was demonstrated. Evidence of frequency of use and safe, effective interventions has not been collected; such data are important for evaluation but difficult to collect in this setting. A high level of demand for this training now exists.
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Tags
Ambulance & prehospital nurses · Haemostatics · Intraosseous access · Military & tactical · Paramedics & EMTs · Prehospital physicians · Tranexamic acid
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