In the wake of Sri Lanka's tsunami: The Health for the South Capacity-Building Project

Learning interventions and training methods in health emergencies: A scoping review

BACKGROUND

Keeping the health workforce and the public informed about the latest evolving health information during a health emergency is critical to preventing, detecting and responding to infectious disease outbreaks or other health emergencies. Having a well-informed, ready, willing, and skilled workforce and an informed public can help save lives, reduce diseases and suffering, and minimize socio-economic loss in affected communities and countries. Providing "just in time" support and opportunities for learning in health emergencies is much needed for capacity building. In this paper, 'learning intervention' refers to the provision of ad-hoc, focused, or personalized training sessions with the goal of preparing the health workers for emergencies or filling specific knowledge or skill gaps. We refer to 'training methods' as instructional design strategies used to teach someone the necessary knowledge and skills to perform a task.

METHODS

We conducted a scoping review to map and better understand what learning interventions and training methods have been used in different types of health emergencies and by whom. Studies were identified using six databases (Pubmed/Medline, Embase, Hinari, WorldCat, CABI and Web of Science) and by consulting with experts. Characteristics of studies were mapped and displayed and major topic areas were identified.

RESULTS

Of the 319 records that were included, contexts most frequently covered were COVID-19, disasters in general, Ebola and wars. Four prominent topic areas were identified: 1) Knowledge acquisition, 2) Emergency plans, 3) Impact of the learning intervention, and 4) Training methods. Much of the evidence was based on observational methods with few trials, which likely reflects the unique context of each health emergency. Evolution of methods was apparent, particularly in virtual learning. Learning during health emergencies appeared to improve knowledge, general management of the situation, quality of life of both trainers and affected population, satisfaction and clinical outcomes.

CONCLUSION

This is the first scoping review to map the evidence, which serves as a first step in developing urgently needed global guidance to further improve the quality and reach of learning interventions and training methods in this context.

Uptake of the World Health Organization's trauma care guidelines: a systematic review

OBJECTIVE

To understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines.

METHODS

We conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines - Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes - were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines' implementation.

FINDINGS

We identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries - 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions.

CONCLUSION

Although WHO's trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.

The Alfred Trauma Team Training Program in India and Sri Lanka

Injury is a major global health problem. India suffers more deaths from vehicle collisions than any other country. Since 2004 The Alfred Hospital in Melbourne, Australia has established strong linkages with Christian Medical College (CMC) in Ludhiana, the Punjab, India and Teaching Hospital Karapitiya (THK) in Galle, Sri Lanka, supporting trauma care capacity-building. In response to the demand for a systematic approach to trauma care in India and Sri Lanka, The Alfred Trauma Team Training Program was developed, funded by the Australian Agency for International Development, The Alfred and its participating staff, CMC and THK. The aim of the programme was to enhance the understanding and skill in reception and resuscitation of critically injured patients in a cohort of providers of emergency care. Participants were selected from nine sites: CMC, five government hospitals across the Punjab, Delhi, THK and Teaching Hospital Peradeniya in Kandy, Sri Lanka. The programme was conducted at CMC, with follow-up visits to THK and Teaching Hospital Peradeniya, and focused on team-based scenarios. The faculty included emergency clinicians from The Alfred. Participants showed improvement in the knowledge and skills of trauma reception and resuscitation. Observed programme challenges included the variety of health systems from which the participants were sourced. The Trauma Team Training Program allowed Australian emergency clinicians to impart some skills towards improving the level of trauma reception and resuscitation by 26 participants from nine sites. The team-based systematic approach to the delivery of emergency trauma care was valued by the participants.