Training Laypeople to Prepare Trauma Patients for Hospitalization and Surgery

Patients who experience traumatic injury in resource-poor and rural settings often fail to receive important accident scene care that would increase the likelihood of good surgical outcomes. These settings simply don't have pre-hospital trauma services that more developed urban areas employ well. Many nations and areas are turning to trained laypeople to improve outcomes. A study published in the Journal of Surgical Research describes a program that engages and equips first responders.

This collaborative effort between surgeons from Michigan State University and colleagues in India involved a 2 day training course for non-physician first responders in Jodhpur, Rajasthan.

The pilot program, conducted in the first responders' native language, used high-fidelity simulation, video-assisted debriefing, and self-directed learning videos.

These researchers recruited 18 local instructors to train 48 layperson first responders, creating a ratio of 1 instructor for every 3 to 4 students. They designated 10 subjects "essential" and structured the program as follows:

• First responders completed self-directed learning videos that were 15 to 20 minutes long
• Next, they participated high-fidelity simulation sessions that were 40 minutes in length or shorter
• Finally, they ended with short video-debriefing periods

Pre-training and post-training surveys indicated that across-the-board, first responders' competence increased. They were significantly more likely to manage airway, hemorrhage, fractures, cervical spine injury, chest injury, IV line placement, extrication, scene assessment, triage, and communication effectively and appropriately.

First responders experienced the greatest gain in competence in cervical spine injury and hemorrhage management.

IV line placement (the most involved procedure in the training module) and extrication changed the least. The researchers indicate that IV line placement appears to be an advanced skill, and may need to be addressed in advanced level courses.

This innovative approach to trauma management could be applied in rural American settings. The researchers suggest that the instructor-to-student ratio would be better if 1 instructor could work with just 2 students. They also indicate that the course needs a jargon-free, picture-laden manual.