Dr Katherine Murdoch, EM clinical fellow
Edited by Anisa Jafar
In Autumn 2024 I joined a team of clinicians from the United Kingdom (Dr Gavin Wooldridge, Dr Alex Taylor, Dr Nikhil Kadam, Dr Suzy O’Connor and Dr Alastair Stanley) Kingdom to deliver the teaching in Cairo for Save the Children. The training was planned in Egypt in preparation for the Rafah border reopening, with the future potential for local clinicians to be either caring for evacuated children from Gaza in a number of field hospitals set up in Egypt or enter the occupied state of Palestine and assist in healthcare delivery.
Trauma is one of the leading causes of paediatric deaths worldwide. This is perhaps unsurprising given that the number and extent children are affected by conflict is increasing globally. It is widely considered that bystander care improves outcomes in trauma care, but this is significantly less researched than the effects of bystander cardiopulmonary resuscitation (CPR) in the out of hospital cardiac arrests. This is especially important within low-resource settings where a 2021 review of the evidence (again, mostly non-trauma) points to the life-saving and morbidity-preventing potential of lay-people in emergency care situations.
The research that is available is promising. A two-city European study looked at the skill level of bystanders across over 1700 trauma cases. It found that correct extrication/positioning and haemorrhage control were influenced by bystander ability. There is also a suggestion that there may be a cost saving effect of teaching bystander trauma care, as shown in the example of a sub-Saharan African study. This especially important in low-resource settings and even moreso in those without a formal ambulance service or an expected delayed prehospital response.
The Paediatric Blast Injuries Partnership (PBIP) was initially set up specifically in response to the known challenges of caring for children with blast injuries. Led by Dr Paul Reavley, The Paediatric Blast Injury Field Manual was created to outline a uniform approach to paediatric trauma care (relevant in scenarios beyond the original blast-injury remit) for medical professionals, from injury through to discharge. This has been widely distributed by Save the Children in multiple languages. Since its publication in 2019, the manual has been documented to have been distributed widely to medics in Gaza and in Ukraine.
Lay first responder paediatric trauma training in low resource and conflict settings holds immense potential to save lives and reduce the impact of trauma on children. By empowering community members with the necessary skills and knowledge, it was felt there was the opportunity to create a network of first responders that have the potential to effectively respond to paediatric trauma incidents, in some of the world’s most challenging environments. Therefore, the PBIP set up a bystander and hospital trauma course to be delivered in low- and middle-income countries, which grew out of the Paediatric Trauma Resuscitation Course slowly establishing itself in the UK.
In our October course, we delivered a day of bystander trauma care to two groups of first responders from the Egyptian Red Crescent. After a short lecture, the cohort was split into four groups who rotated between stations. These included: a skills station (use of tourniquets and dressings); using the 10-second triage tool; and putting into practice the first three letters of the (C)ABCDE (haemorrhage control before airway and then breathing) approach in multiple different scenarios.
The second day involved teaching a prehospital trauma course to doctors based at the Cairo headquarters of the Egyptian ambulance service. This followed a similar format in the morning, with small groups rotating between stations, using a full (C)ABCDE approach to simulated emergencies, which progressively increased in complexity. In the afternoon, participants completed a short train the trainer course, where participants learn how to deliver the course they completed in the morning. Individuals were supported to write scenarios for their colleagues and then supported each other to take the role of student and teacher. We discussed the importance of following a framework and learning how to give feedback when teaching.
Whilst participant feedback was very positive, it was really helpful to understand how the education could be improved upon. For example one person noted that the introduction to the course would benefit from better scene-setting as well as some form of ice breaker to help navigate language barriers. As faculty we were acutely aware of a short lead time in both readying ourselves to deliver the course (as well as implementing suggested improvements) and assembling participants. As the course grows and develops, it is hoped that its potential can be fully reached in increasing the confidence of participants to manage paediatric trauma.
To find out more please take a look at the Save the Children website. If you are interested in supporting and delivering similar courses in the future, please take look at the embedded flyer.
