Improving trauma care in low resource settings

Kurdin, Anton (2018) Improving trauma care in low resource settings. Masters thesis, Memorial University of Newfoundland.

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Abstract

Introduction: Caring for traumatic injuries often requires significant resources that may be sparse in certain environments, such as rural communities and Low and Middle Income Countries. To improve trauma care in low resource settings, strategies focusing on education and telemedicine have been proposed. However, such methods have not been thoroughly evaluated and their effectiveness remains unknown. Objectives: 1) To evaluate the novel use of a Trauma Evaluation and Management course and its effectiveness as a low-cost alternative to ATLS for providing trauma teaching in Low and Middle Income Countries; 2) To assess the effectiveness of telemedicine for providing remote trauma teleconsultations. Methods: The Trauma Evaluation and Management course was provided to health care professionals in Haiti and Bangladesh. The participants were asked to complete a survey which was analyzed to determine the effectiveness, the potential for modifications and the versatility of the course. To determine the feasibility of remote trauma management, a simulation study was constructed to test the feasibility of providing an accurate representation of an injured patient using telemedicine. Two modes of telemedicine were tested against a control group: a conventional ceiling mounted camera and a handheld device. Results: Health care professionals in Bangladesh and Haiti provided excellent evaluations of the Trauma Evaluations and Management course. Areas for improvement focused on modifications to reflect the low resource setting and included considerations for lack of specialist referrals, unavailability of patient transfers to high level facilities and a greater role for ancillary and nursing staff. Regarding the use of telemedicine for remote trauma management, Situational Awareness scores did not demonstrate any difference between control and the two intervention groups. Conclusions: Educational initiatives, such as the Trauma Evaluation and Management course, are an effective method of trauma teaching and are well suited for Low and Middle Income Countries. With the advancements in technology, the use of telemedicine is a viable option for remote trauma management.

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