Elsevier

Resuscitation

Volume 52, Issue 2, February 2002, Pages 187-191
Resuscitation

Pre-hospital care—the evolution of a course for undergraduates

https://doi.org/10.1016/S0300-9572(01)00460-9Get rights and content

Abstract

Newly qualified doctors are ill equipped to deal with pre-hospital trauma emergencies. There is a public perception that medical education provides both experience and knowledge in this field. In Birmingham, United Kingdom (UK), committed doctors and nurses trained in pre-hospital care have evolved a specific course designed to equip the medical undergraduate to deal with pre-hospital trauma scenario. The pre-hospital trauma course for medical students has run annually from 1993 to 2000. The course caters for 200 students with a faculty of 30 instructors. Successful completion of the course which is rigorously assessed grants a certificate awarded by the Faculty of Pre-hospital Care at the Royal College of Surgeons of Edinburgh. Most importantly it equips the undergraduate with essential theoretical knowledge and practical skills to handle a pre-hospital trauma emergency.

Introduction

The majority of doctors who qualify in the UK do not have any training or experience in pre-hospital trauma management. Yet they may encounter a pre-hospital accident at any time. Most doctors have no knowledge of the specific difficulties of the pre-hospital environment, which include safety and management plans, assessment and treatment. It is a common misconception that doctors, both newly qualified and well-established practitioners, can deal with emergency pre-hospital trauma.

In recent years, a number of courses have emerged to provide a systematic approach to trauma and emergency medical care in the hospital setting. These include, for example, the Advanced Trauma Life Support course (ATLS) [1], Basic Life Support (BLS) courses, Advanced Life Support (ALS) courses and Advanced Paediatric Life Support (APLS) courses. Experience from North America and Israel has shown the correlation of undergraduate training in trauma and resuscitation with improved performance in trauma scenarios [2], [3], [4], [5]. Most medical undergraduates in the UK will have completed a Basic Life Support course, and in some medical schools the students have the opportunity for Advanced Life Support learning. Following this trend, a number of courses have been developed with the aim of improving the standard of care for patients prior to arrival at hospital. These include the Pre-hospital Trauma Life Support (PHTLS) course and the Pre-hospital Emergency Care (PHEC) course [6], [7].

The basic aim of these courses is to provide a framework on which to base assessment, diagnosis and treatment of the seriously ill or injured individual, in a given environment. Access for trainee doctors to courses (for example the ATLS course) is frequently limited by the number of available places, funding and time constraints. For newly qualified doctors, there is little time or opportunity during their first post-graduate year to obtain knowledge or qualifications in pre-hospital care. Consequently, relatively few newly registered doctors will have undertaken any specific training to enable them to function safely and skilfully at the scene of a road traffic or other accident.

In the UK pre-hospital care is provided by the Ambulance Service and, where and when appropriate, by the British Association for Immediate Medical Care Schemes (BASICS) doctors. The latter are a group of volunteer doctors, predominantly general practitioners, who have gained accreditation and training in enhancing ambulance paramedic care delivered at the roadside.

For Birmingham University undergraduates, the West Midlands Central Accident Resuscitation Emergency (CARE) Team, which in itself is an active BASICS scheme, have developed a course that follows the philosophy of existing courses and is of an appropriate standard and content for medical students. These students graduate with appropriate skills and underpinning knowledge enabling them to respond to a whole range of hospital trauma emergencies. The skills and operational experience of the CARE provide a sound basis to develop and deliver a course on pre-hospital trauma management for medical students in their fourth year. The aims of the course are simple: to provide a structured and systematic approach to the management of injured individuals at the scene of their injury (incorporating both basic and advanced life support techniques) and, to include all aspects of the practical skills for satisfactory patient management.

With the agreement of the medical school, the first course started in 1993, and all the students in the fourth year were invited to attend on a voluntary basis. The medical school provided no funding at that stage, and the cost of the course was borne by the CARE team. The course initially was delivered as a series of lectures over ten evenings augmented with demonstrations and practicals. Each seminar lasted approximately 212 h. Although a voluntary course, the attendance was outstanding, reaching between 95 and 100% on most evenings. At the end of each course a comprehensive examination of both theoretical and practical skills was undertaken.

Over subsequent years, the course has developed and matured using improved teaching qualities, feedback from undergraduates and an increasing teaching faculty. In September 1998, for the first time, the course was run over two and a half days. The change was undertaken to ensure continuity of interest and commitment by the medical student, and to simplify the time commitment for the faculty. In 1998, the course was given formal recognition by the Education and Assessment Committee of the Faculty of Pre-hospital Care at the Royal College of Surgeons in Edinburgh. Each successful candidate now receives a certificate of achievement. In 1999, it was agreed that the course should be funded formally by the medical school and this would become an obligatory course for the students.

Section snippets

Method—the course structure (1999)

A detailed course manual was produced, and in 1999, this was made available to each of the 210 participating students 4 weeks before the course. All presentations in the course were delivered using Power Point projection. This gave dynamic presentations and allowed pre-hospital clinical images to be illustrated with the text. Lectures were delivered by doctors and nurses qualified in pre-hospital care. Each small group teaching session was facilitated by a combination of doctors, nurses,

Results

In 1999, 190 out of 205 students were successful in passing the examination.

Course funding was provided by the medical school which included course organisation, manuals, disposables, hire of teaching materials, mannequins, faculty catering and provision of tea, coffee and cold drinks for undergraduates. The total cost in 1999 was £6200.

Conclusions

The undergraduate pre-hospital trauma course delivers a stimulating mixture of lectures, skill stations and tutorials addressing a wide spectrum of issues related to the care of the injured patient in the pre-hospital setting. This includes scene safety, mechanism of injury, airway management, management and assessment of chest injuries, assessment and arrest of external haemorrhage, neurological assessment, and practical instruction in how to relieve a problem found during the examination. In

Portuguese Abstract and Keywords
Os médicos recém licenciados estão mal preparados para lidar com emergências pré-hospitalares de trauma. A percepção pública é a de que a educação médica fornece experiência e conhecimento nesta área. Em Birmingham, Reino Unido, médicos e enfermeiros empenhados e treinados em cuidados pré-hospitalares desenvolveram um curso especı́fico, destinado a preparar o pessoal médico pré-graduado para lidar com situações de trauma em condições pré-hospitalares. O curso de

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Portuguese Abstract and Keywords
Os médicos recém licenciados estão mal preparados para lidar com emergências pré-hospitalares de trauma. A percepção pública é a de que a educação médica fornece experiência e conhecimento nesta área. Em Birmingham, Reino Unido, médicos e enfermeiros empenhados e treinados em cuidados pré-hospitalares desenvolveram um curso especı́fico, destinado a preparar o pessoal médico pré-graduado para lidar com situações de trauma em condições pré-hospitalares. O curso de trauma pré-hospitalar para estudantes de medicina tem sido anual de 1993 a 2000. O curso destina-se a 200 estudantes, com um corpo docente de 30 instrutores. A conclusão do curso com sucesso, que é rigorosamente avaliado, permite obter um certificado passado pela Faculty of Pre-hospital Care at the Royal College of Surgeons of Edinburgh. Mas o mais importante é que prepara os recém licenciados com formação teórico e aptidões práticas essenciais para lidar com emergências pré-hospitalares de trauma.
Palavras chave: Educação; Ensino; Trauma; Ressuscitação; Suporte básico de vida

Spanish Abstract and Keywords
Doctores recientemente graduados están mal preparados para tratar las emergencias de trauma prehospitalario. Existe una percepción pública que la educación médica proporciona conocimiento y experiencia en este campo. En Birmingham, Reino Unido (UK), un grupo de médicos y enfermeras entrenadas en atención prehospitalaria fueron comisionados para desarrollar un curso especı́fico diseñado para preparar a los médicos en pregrado para tratar con trauma prehospitalario. El curso de trauma prehospitalario para alumnos de medicina ha sido realizado anualmente desde 1993 hasta 2000. El curso atiende a 200 alumnos con un equipo de 30 instructores La Facultad de Cuidados Prehospitalarios del Real Colegio de Cirujanos de Edimburgo evalúa rigurosamente y certifica la aprobación exitosa del curso. Principalmente, prepara al pregraduado con el conocimiento esencial y las destrezas prácticas necesarias para manejar una emergencia de trauma prehospitalaria.
Palabras clave: Educación, Trauma, Resucitación, Soporte vital básico.

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