Prehospital trauma care systems - World Health Organization

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PREHOSPITAL TRAUMA CARE SYSTEMS 4.4 Recruiting and training providers The required level of training depends on local and cultural considerations, the availability of transportation, the amount of time members of the selected target group can dedicate to training and, for those who provide first-aid, the willingness of community members to acquire and use their training.The length of the training and the proportion of theoretical and practical sessions will vary from country to country.The training and education of prehospital providers must be undertaken in a manner that makes optimal use of local resources and personnel and ensures compatibility with local cultural norms, practices and traditions. Training may be conducted by individuals or organizations, or both, but all trainers must have among their areas of expertise prehospital care and system development as well as experience of the local health-care system, the local culture and societal norms. In some instances, the initial training may involve international organizations and individuals who participate in “train the trainer” programmes.There are many educational tools and training manuals available (Box 8).To be effective, however, they must be translated into locally appropriate languages. In addition to the clinical and patient management skills these courses teach, they must also give providers a common language with which to communicate among themselves in order to provide a team approach to caring for injured people.These programmes should be conducted under the auspices of local health-care organizations, governments and their administrations, and should be designed to develop local trainers who will serve both as leaders and as resources for future educational efforts. Developing dedicated career paths for prehospital care providers may assist in recruiting and retaining staff as well as providing long-term stability of the system. Box 8.Training materials for prehospital providers ● Husum H, Gilbert M,Wisborg T. Save lives, save limbs.Penang, Malyasia, Third World Network, 2000. ● International harmonization of first aid: first recommendations on life saving techniques, International Federation of Red Cross and Red Crescent Societies, Geneva, 2004 (http://www.ifrc.org). ● First aid in the community: a manual for trainers of RC/RC volunteers in Africa, International Federation of Red Cross and Red Crescent Societies, Geneva, 1995 (http://www.ifrc.org). ● Werner D,Thurman C, Maxwell J. Where there is no doctor: a village health handbook. 2nd ed. Berkeley, CA, Hesperian Foundation, 1992. ● Varghese M, Mohan P. When someone is hurt: a first aid guide for lay persons and community workers.New Delhi,The Other Media Communications, 1998. ● Henry M, Stapleton E. EMT prehospital care. 3rd ed. St. Louis, MO, Mosby, 2004.. ● Basic Trauma Life Support International – http://www.btls.org ● Prehospital Trauma Life Support – http://www.phtls.net/ ● United States Department of Transportation, National Highway Traffic Safety Administration – http://www.nhtsa.dot.gov ● The Sphere Project – http://www.sphereproject.org ● Systematic Approach to Victim Entrapment Rescue (SAVER Foundation) – http://www.savertraining.org 28
5. Resource matrix for prehospital trauma care systems 5.1 Background The following section outlines those resources that we feel are essential to providing effective prehospital trauma care services.These are presented in a matrix that describes in depth the vital services and related equipment needed during initial evaluation and resuscitation efforts, especially for immediately life-threatening injuries. These services are incremental in nature. Every government should seek to train large numbers of laypeople to provide first aid. Governments should provide a basic level of trauma care either by training and equipping those who can provide basic first aid or by training selected community members to provide an advanced level of first aid. However, the use of advanced life support interventions, equipment and techniques in the prehospital setting should not be considered unless the more basic elements of prehospital care can be consistently assured. The first column in the matrix lists the specific elements of trauma care that are needed.These are divided into two categories: knowledge and skills, and equipment and supplies.The category of knowledge and skills describes the training needed to perform diagnostic and therapeutic activities safely and successfully for different levels of provider and also assumes that these skills will be maintained through continuing education.The category of equipment and supplies lists the items that should be available to assist all patients who need them, without consideration of ability to pay, especially in life-threatening emergencies. It also assumes that they are not only physically present but are also readily available.Thus, organizational and administrative mechanisms must exist to quickly replace depleted or expired stocks of supplies and medicines and to quickly repair equipment when needed.The quality control mechanisms necessary to assure the provision of supplies and the quality of medical care provided are addressed in section 8. For further details and discussion of trauma services functioning within fixed facilities, please see WHO documents Guidelines for essential trauma care (52) and Surgical care at the district hospital (53). Detailed discussion of these items is beyond the scope of this publication. 5.2 Terms and definitions For each cell within the matrix we recommend which resources (in the first column) should be provided by specific levels of the prehospital trauma care system. Each item 29
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Page 5 and 6: Contents Preface ..................
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Page 9 and 10: Contributors Editors Scott Sasser,
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Prehospital trauma care systems - World Health Organization

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