Excellence in Communication and Emergency Leadership (ExCEL): Pediatric Primary and Secondary Survey in Trauma Workshop for Residents.

Introduction: Unintentional traumatic injury remains the leading cause of pediatric death in the United States. There is wide variation in the assessment and management of pediatric trauma patients in emergency departments. Resident education on trauma evaluation and management is lacking. This workshop focused on developing resident familiarity with the primary and secondary trauma survey in pediatric patients. Methods: This hands-on workshop utilized patient-actors and low-fidelity simulators to instruct learners on the initial assessment of trauma patients during the primary and secondary trauma surveys. It was designed for residents across all levels of training who care for pediatric trauma patients (including pediatrics, medicine-pediatrics, emergency medicine, and family medicine) and adapted for different session durations and learner group sizes. Results: Eighteen residents participated in this workshop at two separate institutions. Participants strongly agreed that the workshop was relevant and effective in teaching the initial primary and secondary trauma survey assessment of pediatric trauma patients. Residents also reported high levels of confidence in performing a primary and secondary trauma survey after participation in the workshop. Discussion: This workshop provided residents with instruction and practice in performing the primary and secondary trauma survey for injured pediatric patients. Additional instruction is needed on assigning Glasgow Coma Scale and AVPU (alert, voice, pain, unresponsive) scores to injured patients. The structure and time line of this curriculum can be adapted to the needs of an individual institution's program and the number of workshop participants.

Practical on primary trauma care training mode in public cardiopulmonary resuscitation training / 中华危重病急救医学

Objective:To envaluate the effect of public cardiopulmonary resuscitation (CPR) training in Ningnan Mountain area.Methods:Using the method of convenient sampling, 775 people in Ningnan Mountain area were investigated about CPR and first aid knowledge by questionnaire from January to December 2019. The awareness rate of CPR, operation score, and operation qualification rate of the public before and after CPR training in the primary trauma treatment (PTC) mode were observed.Results:After PTC training, the public's CPR knowledge score, operation score and operation qualification rate, in terms of first aid telephone, consciousness judgment method, identification of respiratory arrest, artificial respiration implementation method, effective CPR indication and extrathoracic cardiac compression position were significantly improved [first aid telephone score: 82.68±8.54 vs. 60.25±10.38, consciousness judgment method score: 79.46±10.82 vs. 58.35±9.26, identification of respiratory arrest score: 80.85±9.64 vs. 59.26±11.45, artificial respiration implementation method score: 81.54±9.48 vs. 56.47±10.54, extrathoracic cardiac compression site score: 80.35±10.48 vs. 59.56±9.85, effective indication of CPR score: 81.02±9.45 vs. 58.21±8.69, operation assessment score: 60.25±10.45 vs. 50.38±9.68, operation assessment qualified rate: 60.39% (468/775) vs. 12.13% (94/775), all P < 0.05]. Conclusion:PTC mode is helpful to improve the effect of public CPR training, which is worthy of clinical promotion.

Are Primary Trauma Care (PTC) courses beneficial in low- and middle-income countries - A systematic review.

BACKGROUND: Injuries remain an important public health concern, resulting in considerable annual morbidity and mortality. In low- and middle-income countries (LMICs), the lack of appropriate infrastructure, equipment and skilled personnel compound the burden of injury, leading to higher mortality rates. As Advanced Trauma Life Support (ATLS) courses remain uneconomical and inappropriate in LMICs, the Primary Trauma Care (PTC) course was introduced to provide an alternative that is both sustainable and appropriate to local resources. METHODS: A systematic review was performed in May 2019, utilising MEDLINE, EMBASE, Cochrane Library and Google Scholar. All studies reporting patient related outcomes (mortality and morbidity rates) and course participant related outcomes (knowledge, confidence and skills) in LMICs were included. PRISMA guidelines were adhered to throughout. RESULTS: Nine observational studies were identified (Level 3 evidence). Six studies reported improved knowledge in injury management post-PTC course (p < 0.05). Two studies reported improvements in confidence (p < 0.05) and one on skill attainment (p < 0.0001). One study reported a reduction in mortality rates post-PTC course (p < 0.01). CONCLUSION: Departmental, institutional and personal improvements may occur in clinical practice as a result of formal PTC training of trauma team members in LMICs. Further high-quality research is needed to evaluate this course's effects on observed change in clinical practice and patient outcomes. This may require long-term observational and epidemiological studies to assess improvements in morbidity and mortality. PROSPERO Registration Number: CRD42019133986.

Impact of the primary trauma care course in the Kongo Central province of the Democratic Republic of Congo over two years.

BACKGROUND: The two-day Primary Trauma Care (PTC) course covers the management of injured patients and takes into account resource constraints experienced in low and middle-income countries. Currently, there are no studies on the long-term impact of the course on knowledge or attitudes. The PTC course was introduced in Kongo Central Central province in the Democratic Republic of Congo (DRC) as part of a series of interventions to improve trauma care. The aim of this study was to evaluate the impact of PTC on the trauma knowledge, confidence and attitudes regarding trauma care of healthcare workers (HCWs) in the DRC over two years. METHOD: A retrospective cohort study was conducted comparing multiple-choice questionnaire (MCQ) and confidence matrix results of PTC attendees prior to the course, immediately after, and at the time of follow up at either 12, 16 or 24 months. A semi-structured questionnaire was additionally administered at follow up to explore the effect of PTC on key areas of trauma learning: skills, attitudes and relationships. RESULTS: A total of 59/80 HCWs who attended the PTC course completed follow-up questionnaires. Participants were predominantly male (42/59) with a mean age of 41.6 years. There was an increase of 4.8 in MCQ scores and 9.6 in confidence scores (p < 0.01) post-PTC. MCQ scores were maintained 24 months after the course, whereas confidence scores declined (p = 0.03). At follow-up, 36/59 participants reported that equipment was not available for procedures and 52/59 felt more could be done to better manage injured patients locally. All participants believed trauma services were important and felt that the course contributed to improving the management of trauma patients. CONCLUSIONS: This study found that knowledge gained from the PTC course was maintained over two years, although individuals felt less clinically confident. A refresher course may be appropriate within two years to improve relatively low overall knowledge scores and participants' confidence. Whilst resource constraints within the DRC may hinder trauma care development, the PTC course has equipped attendees with the knowledge, skills, confidence and attitudes to improve trauma service development in their region.

Experiencing and Witnessing Patient Violence - an Occupational Risk for Outpatient Therapists?

Violence against therapists by their clients are a common occurrence across clinical settings and may have a lasting impact on the clinician's professional and personal functioning. In spite of this, no study to date has looked at the frequency of trauma-induced symptoms in psychotherapists. Using a sample of N = 917 psychotherapists across Germany, Austria, and Switzerland, we analyzed the frequency and sequelae of patient attacks suffered or witnessed by therapists. More than half (51.3%) of the sample reported having been the victim or witness of patient attacks or threats of violence in their career. Among the affected therapists, 27.7% reported posttraumatic symptoms lasting longer than four weeks and 2.7% presented symptoms amounting to a full-PTSD diagnosis. Thus, while the frequency of attacks and trauma-induced symptoms were considerable, estimated PTSD rates were rather low. The findings suggest that practitioners should be conscious of client violence being an occupational risk and that it is advisable to have protective measures in place.

Primary Trauma Care: A Training Course for Healthcare Providers in Developing Countries.

Outcomes of injury in low and middle income countries may be compromised by skill deficiencies of healthcare providers. Short subspecialty training courses can be a useful solution to skill-deficits. We report on the Primary Trauma Care programme, a 2-day course designed to train frontline health workers in resuscitation and early management of the injured with limited resources and equipment. Developed for use in weak health systems and now conducted in over 70 countries, the programme is cost-efficient with built-in design sustainability by way of early transfer of ownership to local partners to effect a cascade of trauma courses in their communities. Published studies report a significant improvement in both knowledge and skills of the participants with greater confidence in managing trauma victims. A trained health workforce could address the unmet needs identified by Global Surgery and thus contribute to achieving the Sustainable Development Goals.

O coração gelado: estratégias de sobrevivência psíquica a traumatismos severos / The frozen heart: psychic survival strategies against severe trauma / El corazón congelado: estrategias de supervivencia psíquica frente a los traumatismos severos / Le coeur gelé: stratégies de survie psychique contre les traumatismes graves

O presente artigo visa apresentar a ideia de congelamento como metáfora para a insensibilidade e a anestesia diante de "traumatismos precoces", no contexto da clínica da clivagem, de adoecimentos por "apassivação" e "patologias narcísico-identitárias". Para discutir o tema, é relatado brevemente o caso de uma paciente, aqui chamada Cecília, descrevendo seu adoecimento e defesas ativadas e destacando a "neutralização energética" diante de uma situação de desamparo extremo vivenciado na primeira infância. A aqui denominada clínica da cisão e dos adoecimentos por apassivação tem convocado os analistas a refletir acerca de outras estratégias terapêuticas, de modo que acompanhe não apenas as partes amortecidas, mas também os recursos egoicos de cada paciente.

The present article proposes the presentation of the idea of freezing as a metaphor for insensitivity and anesthesia against early trauma, understanding it within the context of a clinic of cleavage, deterioration due to apassivation and narcissistic pathologies. As an illustration, we present the report of a case of a patient, here called Cecília, describing her illness and activated defenses, highlighting the "energetic neutralization" of Roussillon, facing a situation of extreme helplessness experienced in early childhood. Faced to what we call the scission clinic and the illnesses by apassivation, we are called to reflect on the necessary therapeutic strategies that accompany not only the cushioned parts but also the egoic resources of the patient.

El presente artículo propone la presentación de la idea de congelación como metáfora de la insensibilidad y la anestesia contra el traumatismo temprano, entendiéndola en el contexto de una clínica de escisión, deterioro por apassivación y patologías narcisistas. A modo de ejemplo, presentamos el relato de un caso de una paciente, aquí llamada Cecília, describiendo su enfermedad y las defensas activadas, destacando la "neutralización energética" del Roussillon, frente a una situación de extrema indefensión experimentada en la primera infancia. Frente a lo que llamamos la clínica de la cisión y las enfermedades por apassivación, estamos llamados a reflexionar sobre las estrategias terapéuticas necesarias que acompañan no sólo las partes amortiguadas sino también los recursos egoicos del paciente.

Cet article est de proposer la présentation de l'idée de gel comme une métaphore de l'insensibilité et l'anesthésie avant au début du traumatisme, le comprendre dans le contexte d'un clivage clinique des maladies par passivation et pathologies narcissiques identité.Comme illustration, nous présentons le rapport de cas d'un patient ici nommé Cecília, décrivant sa maladie et les défenses ont permis, en vedette dans la "neutralisation de l'énergie" du Roussillon, par rapport à une situation extrême d'impuissance vécu dans la première enfance. Transférer à ce que nous nommons que la répartition et les maladies cliniques par passivation, nous sommes appelés à réfléchir sur les stratégies thérapeutiques nécessaires qui accompagnent non seulement les parties, mais aussi les amorties caractéristiques egoic du patient.

Do trauma courses change practice? A qualitative review of 20 courses in East, Central and Southern Africa.

BACKGROUND: Trauma courses have been shown to improve clinical knowledge and patient outcomes. However, little is known about the individual drivers of change in practice amongst course participants in their home clinic environment. METHODS: Front-line healthcare workers participated in a two-day Primary Trauma Care (PTC) course. Immediately after the course participants completed an evaluation survey on intended change in the management of trauma patients. Six months after the course, participants completed a survey on actual changes that had occurred. RESULTS: A total of 451 participants were sampled, with 321 responding at 6 months, from 40 courses across East, Central and Southern Africa. The most commonly reported intended change was the adoption of an ABCDE/systematic approach (53%). Six months after the course, 92.7% of respondents reported that they had made changes in their management, with adoption of an ABCDE/systematic approach (50.0%) remaining most common. 77% of participants reported an improvement in departmental trauma management, 26% reported an increase in staffing, 29% an increase in equipment and 68% of participants had gone on to train other healthcare workers in PTC. CONCLUSION: The findings suggest that PTC courses not only improve individual management of trauma patients but also but is also associated with beneficial effects for participants' host institutions with regards to staffing, equipment and training.

Analysis of trauma care education in the South Sudan community health worker training curriculum.

INTRODUCTION: Trauma is a leading cause of morbidity and mortality worldwide, with the majority occurring in low- and middle-income countries (LMICs). Allied health workers are often on the front lines of caring for trauma patients; this is the case in South Sudan, where a system of community health workers (CHWs) and clinical officers (COs) form an essential part of the health care structure. However, curricula for these workers vary, and it is unclear how much these training programs include trauma education. HYPOTHESIS/METHODS: The CHW training curriculum in South Sudan was reviewed to evaluate the degree to which it incorporates trauma education, according to established guidelines from the World Health Organization (WHO). To the authors' knowledge, this is the first formal comparison of a CHW curriculum with established WHO trauma guidelines. RESULTS: The curriculum incorporated a number of essential components of the WHO guidelines; however, the concepts taught were limited in scope. The curriculum only covered about 50% of the content required for basic providers, with major deficiencies being in the management of head and spinal injuries, safety protocols for health care personnel, and in the management of pediatric patients. DISCUSSION/CONCLUSION: The CHW training curriculum lacks the requisite content to provide adequately a basic level of trauma care and requires amending to ensure that all South Sudan citizens receive appropriate treatment. It is recommended that other LMICs review their existing training curricula in order to improve their ability to provide adequate trauma care and to ensure they meet the basic WHO guidelines.

Practice of primary trauma care training system for undergraduate teaching reform in anesthesiology / 中华医学教育探索杂志

The teaching team of undergraduates of anesthesiology in Anhui Medical University applied the primary trauma care system of encourage, heuristic teaching and practical teaching to further deepen the educational reform and improve teaching quality for undergraduate education.They designed the diversified section such as drills, discussion, teaching, questions, feedback and so on, implemented the simulation training of anesthesia crisis management skills and completed the feedback evaluation of comprehensive ability before and after the teaching, and then achieved the effect of improving the actual operation ability and clinical thinking capacity of students.So it is a good method and worth extending.

O trauma narcísico-identitário e sua transferência / The narcissistic-identity trauma and its transference / El trauma narcisístico-identitario y su transferencia

Este trabalho explora a noção de um trauma primário relacionado com uma decepção narcísica primária produzida pela inadequação das respostas do ambiente, primeiro ante as expectativas e pré-concepções inatas do bebê. Esse trauma primário produz um sofrimento narcísico-identitário do tipo “agonia psíquica”, caracterizado por ser sem representação, sem saída e vivido como sendo sem fim. Para sobreviver, o sujeito tem de se retirar de si mesmo, se clivar de sua experiência. Em seguida, tem de desenvolver modalidades de defesa e de ligações não simbólicas para enfrentar o retorno dos traços das experiências de que se clivou, o “retorno do clivado”. Quando, durante um trabalho psica-nalítico, essas experiências retornam, geram formas de transferência paradoxal ou reações terapêuticas negativas, que impõem ao analista um paciente trabalho de reconstrução das relações primitivas com o ambiente primeiro.

This paper explores the notion of a primary trauma related to a primary narcissistic disillusion produced by the inadequacy of the responses of the first environment in face of the innate expectations and preconceptions of the baby. This primary trauma produces narcissistic-identity suffering of the “psychic agony” type, characterized by having no representation, no exit and by the fact that it is experienced as being endless. In order to survive, the subject must remove himself from his own self, cleaving himself from his experience. Next, he must develop non-symbolic modes of defense and of connections in order to face the return of the traces of the experiences from which he cleaved himself, «return of the cleaved¼. When, during psychoanalytic work, these experiences return, they generate forms of paradoxical transference or negative therapeutic reactions which impose on the analyst a patient work of reconstruction of the primary relations with the first environment.

Este trabajo explora la noción de un trauma primario relacionado a una decepción narcisista primaria producida por la inadecuación de las respuestas del ambiente primario ante las expectativas e ideas preconcebidas innatas del bebé. Ese trauma primario produce un sufrimiento narcisístico - identitario del tipo “agonía psíquica”, caracterizado por el hecho de ser sin representación, sin salida y vivido como si no tuviera fin. Para sobrevivir, el sujeto tiene que retirarse de él mismo, escindirse de su experiencia. Inmediatamente, tiene que desarrollar modalidades de defensa y de relaciones no simbólicas para enfrentar el retorno de los rasgos de las experiencias que escindió, “retorno de lo escindido”. Cuando, durante un trabajo psicoanalítico, esas experiencias retornan, las mismas generan formas de transferencia paradójica o reacciones terapéuticas negativas que imponen al analista un trabajo paciente de reconstrucción de las relaciones primitivas con el primer ambiente.

Effectiveness of an improved medical care system for children in a critical care medical center: is it possible to provide an equivalent level of trauma care for children as we do for adults?

AIM: In trauma care, most events that result in preventable trauma death tend to occur in the initial phase of treatment, and providing prompt and accurate care affects the outcomes of patients with severe trauma. Developing a system for administering prompt and accurate care and encouraging team coordination is essential for children as well as adults. However, differences in physical size and vital signs specific to children are potential obstacles to carrying out physical assessments, decision-making, procedures, and treatments in pediatric patients. An improved medical care system for children was designed at the Osaka Prefectural Senshu Critical Care Medical Center. We evaluated the effectiveness of the new system. METHODS: We enrolled all patients with severe trauma admitted to our center. The therapeutic process and outcomes of trauma care before and after the establishment of the improved system was retrospectively compared. RESULTS: The results showed a significant decline in the time required to establish an i.v. line and perform tracheal intubation before computed tomography. There were also no statistically significant differences in the timing of craniotomy or trepanation, or the time required to carry out hemostatic procedures, between children and adults. Furthermore, no patients with a probability of survival over 0.5 died following the establishment of the new system. CONCLUSION: Our newly improved medical care system facilitates treatment for children using standards equivalent to those used in adults in critical care centers, regardless of the physical size and vital signs of the patient.

Effectiveness of the Primary Trauma Care Course: Is the outcome satisfactory?

OBJECTIVE: To assess the improvement of knowledge and skills of trauma management among participant of Primary Trauma Care (PTC) workshop. METHODS: A two days Primary Trauma Care (PTC) provider workshop was organized at Dow International Medical College, Karachi - Pakistan on March 5(th) and 6th 2011. Participant's knowledge was assessed by 30 Best Choice Questions (BCQs) and their trauma management skills were assessed by management of trauma case scenario both at pre and post workshop. All scenarios performed by participants were video recorded and marked on a 20 points check list and evaluated by two PTC trainers and graded after consensus. Percentage of participants who scored more than 70% marks on knowledge and skills component were also analyzed. Data was analyzed by SPSS version 17. Wilcoxon Sign Rank test was used to find out significant difference between pre and post workshop score. RESULTS: A total of 20 participants attended the full workshop. Median One best question score before the workshop was 19.5 and post workshop was 25 (p<0.0001). Trauma skills scenario score also showed marked improvement with median score of 3.5 pre workshop and 9.5 post workshop (p<0.0001). Total 19 participants had ≥70% post workshop knowledge score. However, only 4 participants had trauma skill score with ≥70 marks. CONCLUSION: Primary Trauma Care workshop could be an effective course for gaining of knowledge and skills of initial management of trauma patients. However, some modifications need to be done for training of skills components to maximize the output of this interactive workshop.