Implementation of a trauma response system, San Salvador, El Salvador

  • Cioè E
  • Oliviera E
  • Heravian A
  • et al.
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Background: El Salvador has a high mortality rate caused by both accidental and intentional trauma. The World Health Organization estimates that trauma was responsible for 32% of all deaths between the ages of 15-60 in El Salvador in 2011. Currently, there is a lack of standardized, formal trauma training in El Salvador. We recently developed and administered a trauma response training in El Salvador. Here we report on the preliminary data from our first trauma training and its impact on trauma care during the single center, pilot phase of our study. Methods: The pilot phase of the study is taking place at Hospital Nacional San Rafael (HNSR), a major hospital in the metropolitan area of San Salvador. Clinical residents and medical students observed emergency ward (EW) shifts, 24 hours per day, and filled out a standardized checklist of critical actions performed by clinicians during the trauma resuscitation, including use of bedside ultrasound. Victims of trauma over the age of 12 years that met the criteria for the American College of Surgery's trauma team activation were included in the study. Patients that were dead on arrival and refused consent were excluded. Critical actions assessed include checking vital signs, primary and secondary surveys, and measures such as EW to operating room time, mortality, and ability to use available ultrasound equipment to perform a FAST exam. Partway through the pilot phase, the medical personnel at HNSR underwent a two-day course in Primary Trauma Care (PTC), which is a trauma training curriculum developed in the UK that uses a sustainable train the trainer model to teach trauma care in limited resource settings. Additional didactic and simulation-based training such as hands-on ultrasound training were also provided. In addition, a two week in-service FAST training was performed in the EW by trained staff. The data from the observation checklists were divided into pre and post PTC training. Findings: While data collection to get to our sample size of 200 is still ongoing, we have enrolled 162 patients, including 49 patients preintervention and 113 patients post-intervention. Significant results in the subgroup for use of FAST exam in trauma have been noted with 9.52% of correctly performed FAST exams occurring in the pre-intervention group compared with 23.90%inthe post-interventiongroup (p=0.034). Interpretation: This is the single center, pilot phase of a larger project designed to assess the impact of providing trauma-response trainings for emergency room staff at HNSR in San Salvador. The interim results show a dramatic improvement in physician FAST usage in major trauma cases. The final data collected in our study will be used to develop a nationwide trauma training program.




Cioè, E., Oliviera, E., Heravian, A., Wrightsmith, L., & Granados, J. (2015). Implementation of a trauma response system, San Salvador, El Salvador. Annals of Global Health, 81(1), 142.

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