Advanced Trauma Care Course

Reflecting on my call nights in the casualty (emergency) department of Mulago over the past four years I can recall countless times I ran through the ABCs of resuscitation or followed through an ATLS algorithm in my head. During most of these occasions I was simultaneously reviewing the approach with Ugandan residents and students and realizing the lack of a more organized trauma training and certification here is a significant but addressable problem.





The residents here at Makerere are the frontlines for trauma care not only at Mulago but in the community as well. As enhancing workforce training is a primary goal of GPAS, we have just completed a pilot course in advanced trauma care here at Mulago.





Injury and trauma contribute to a huge burden of disease here and in other developing countries. The development of trauma systems has been shown to decrease medically preventable deaths in injured patients by as much as 50%. One of the essential elements of trauma systems is the capacity of providers to approach injured patients with the required skills to evaluate and treat these patients.





In collaboration with GPAS, the departments of Surgery, Orthopedics, and Anesthesia here at Makerere University offered an “Advanced Trauma Care” course on February 28 and 29th, 2008. The topics and content were adapted from the similar ATLS course offered by the American College of Surgeons. The faculty here had not previously run a similar course themselves, and it was quite well received by the students, all residents in orthopedics, general surgery, and anesthesia—25 in total. Materials provided by GPAS as well as by www.trauma.org proved to be very helpful in course design and evaluation.





The formal ATLS course includes quite a few algorithms that require technology simply not available here. Therefore the faculty here modified most of the basic ATLS course to fit the context that is readily available in Uganda. The introduction of the ATLS course proper in developing countries has been previously studied—though quite some time ago—and showed a 50% decline in mortality after the introduction of the course (Ali et al. 1993 in Trinidad). A number of modified ATLS courses are available, one that is being used in more rural areas and district hospitals in Africa is the Primary Trauma Care course (see Wilkinson et al. Anesthesia 2006). After discussing with faculty leadership here and reviewing content and materials from all these courses, we came up with the course offered last week for Mulago. In the meantime, in collaboration with GPAS, the surgeons here are planning to formally apply to the ACS Committee on Trauma to support trauma training here through ATLS.





We started very early both days, and went quite late! Lectures were mixed in with practical skills sessions. Presentations were quite animated at times and refreshingly the presenters modified the “accepted doctrine of the west” to tailor to the conditions here, where every form of resource is just more scarce. One of the highlights was having such close collaboration between all the departments of surgery, anesthesia, orthopedics, and obstetrics. Despite resource limitations, the basic approach and principles to identifying and treating life-threatening injuries was stressed.





We are in the process of conducting formal evaluations of the course as well as assessing its impact on patient care. The hospital leadership is making a commitment to ensuring the provision of essential supplies and equipment so that the skills gained by the students can be maximized in patient care.





We hope this course can lay the foundation for other similar courses that can be run here locally—but will need more resources to do so! It cost about $1500 to run, so we will be trying to procure resources to keep it going. Hopefully we can raise independent funding with matching or partial support from the hospital. In the coming weeks we are planning to create an online teaching module containing resources used by GPAS at Mulago as well as resources used by other organizations for similar initiatives worldwide.