Staffing and Training Among Prehospital and Hospital Trauma Care Providers in Haiti Open Access

Abstract

Background: The burden of trauma is disproportionally greater in low and middle-income countries (LMIC) such as Haiti. As a follow up to a previous survey in Haiti's Central Plateau, this study was designed with the goal of addressing the current state of trauma training among prehospital and hospital practitioners throughout Haiti.

Methods: A survey was designed to globally assess the needs of trauma-related care in Haiti, comprised of 13 sections containing a total of 260 questions. 59 questions were prepared with the goal of quantifying staffing and trauma training in hospital departments that care for injured patients. Medical directors, hospital administrators, surgeons, and physicians staffing the ED were questioned via interpreter to complete the survey based on interviewee knowledge and availability. Formal trauma training among physicians was defined as having taken a course in Advanced Trauma Life Support (ATLS) or ATLS-equivalent.

Results: The survey was administered at district hospitals in all 10 Departments in Haiti. 4 hospitals were designated as tertiary centers, and 6 were designated at secondary. 9 hospitals had full-time access to an ambulance. Only one of the hospitals had ambulance drivers that were medically trained. All 10 facilities had a 24-hour ED staffed by nurses and physicians, though the physicians come from multiple different levels of training. 2 facilities had trauma trained ED physicians. 2 hospitals had 24-hour in-house general surgeons. 3 hospitals had trauma trained surgeons. 3 facilities have offered an ATLS course at some point, but only 1 offers it every year.

Discussion: Formal training in trauma care is infrequent or absent throughout large hospitals in Haiti, despite an increased burden of disease compared to high-income counties. Formal trauma training to prehospital, nursing, and physician providers have shown benefit in LMIC and would likely benefit providers and injured patients in Haiti. This information was obtained in coordination with the Haitian Ministry of Health in efforts to improve hospital care and outcomes of trauma victims.

Table of Contents

Chapter 1. Introduction 1

1a. Problem Statement 3

1b. Purpose Statement 4

1c. Significance Statement 5

1d. Definition of Terms 6

Chapter 2. Literature review 7

2a. Prehospital 8

2b. Nursing 12

2c. Physician 14

2d. Conclusion 19

Chapter 3. Manuscript 20

3a. Title Page 21

3b. Contribution of the Student 22

3c. Abstract 23

3d. Introduction 24

3e. Methods 25

3f. Results 27

3g. Discussion 30

3h. Conclusion 34

3i. References 35

3j. Tables 37

Chapter 4. Discussion and Recommendations 40

4a. Prehospital 43

4b. Nursing 44

4c. Physician 44

4d. Recommendations 46

References 48

Appendix 53

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery
Keyword	injury trauma training
Committee Chair / Thesis Advisor	Sharma, Joe, Emory University
Committee Members	Rochat, Roger, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International Non-governmental organization (e.g., CARE, Inc.)

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