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Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial
- Adam R. Aluisio, Pia Daniel, Andrew Grock, Joseph Freedman, Ajai Singh, Dimitrios Papanagnou, Bonnie Arquilla
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- Journal:
- Prehospital and Disaster Medicine / Volume 31 / Issue 5 / October 2016
- Published online by Cambridge University Press:
- 05 August 2016, pp. 516-523
- Print publication:
- October 2016
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Objective
In resource-constrained environments, appropriately employing triage in disaster situations is crucial. Although both case-based learning (CBL) and simulation exercises (SEs) commonly are utilized in teaching disaster preparedness to adult learners, there is no substantial evidence supporting one as a more efficacious methodology. This randomized controlled trial (RCT) evaluated the effectiveness of CBL versus SEs in addition to standard didactic instruction in knowledge attainment pertaining to disaster triage preparedness.
MethodsThis RCT was performed during a one-day disaster preparedness course in Lucknow, India during October 2014. Following provision of informed consent, nursing trainees were randomized to knowledge assessment after didactic teaching (control group); didactic plus CBL (Intervention Group 1); or didactic plus SE (Intervention Group 2). The educational curriculum used the topical focus of triage processes during disaster situations. Cases for the educational intervention sessions were scripted, identical between modalities, and employed structured debriefing. Trained live actors were used for SEs. After primary assessment, the groups underwent crossover to take part in the alternative educational modality and were re-assessed. Two standardized multiple-choice question batteries, encompassing key core content, were used for assessments. A sample size of 48 participants was calculated to detect a ≥20% change in mean knowledge score (α=0.05; power=80%). Robustness of randomization was evaluated using X2, anova, and t-tests. Mean knowledge attainment scores were compared using one- and two-sample t-tests for intergroup and intragroup analyses, respectively.
ResultsAmong 60 enrolled participants, 88.3% completed follow-up. No significant differences in participant characteristics existed between randomization arms. Mean baseline knowledge score in the control group was 43.8% (standard deviation=11.0%). Case-based learning training resulted in a significant increase in relative knowledge scores at 20.8% (P=0.003) and 10.3% (P=.033) in intergroup and intragroup analyses, respectively. As compared to control, SEs did not significantly alter knowledge attainment scores with an average score increase of 6.6% (P=.396). In crossover intra-arm analysis, SEs were found to result in a 26.0% decrement in mean assessment score (P < .001).
ConclusionsAmong nursing trainees assessed in this RCT, the CBL modality was superior to SEs in short-term disaster preparedness educational translation. Simulation exercises resulted in no detectable improvement in knowledge attainment in this population, suggesting that CBL may be utilized preferentially for adult learners in similar disaster training settings.
,Aluisio AR ,Daniel P ,Grock A ,Freedman J ,Singh A ,Papanagnou D .Arquilla B Case-based Learning Outperformed Simulation Exercises in Disaster Preparedness Education Among Nursing Trainees in India: A Randomized Controlled Trial . Prehosp Disaster Med.2016 ;31 (5 ):516 –523 .
Epidemiology of Traumatic Injuries in the Northeast Region of Haiti: A Cross-sectional Study
- Adam R. Aluisio, Annelies De Wulf, Ambert Louis, Christina Bloem
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 6 / December 2015
- Published online by Cambridge University Press:
- 09 November 2015, pp. 599-605
- Print publication:
- December 2015
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Introduction
More than 90% of traumatic morbidity and mortality occurs in low- and middle-income countries (LMIC). Haiti is the poorest country in the Western Hemisphere and lacks contemporary statistics on the epidemiology of traumatic injuries. This study aimed to characterize the burden of traumatic injuries among emergency department patients in the Northeast region of Haiti.
MethodsData were collected from the emergency departments of all public hospitals in the Northeast region of Haiti, which included the Fort Liberté, Ouanaminthe, and Trou du Nord sites. All patients presenting for emergent care of traumatic injuries were included. Data were obtained via review of emergency department registries and patient records from October 1, 2013 through November 30, 2013. Data on demographics, mechanisms of trauma, and anatomical regions of injury were gathered using a standardized tool and analyzed using descriptive statistics. Temporal analysis of injury frequency was explored using regression modeling.
ResultsData from 383 patient encounters were accrued. Ouanaminthe Hospital treated the majority of emergent injuries (59.3%), followed by Fort Liberté (30.3%) and Trou du Nord (10.4%). The median age in years was 23 with 23.1% of patients being less than 15 years of age. Road traffic accidents (RTAs) and interpersonal violence accounted for 65.8% and 30.1% of all traumatic mechanisms, respectively. Extremity trauma was the most frequently observed anatomical region of injury (38.9%), followed by head and neck (30.3%) and facial (19.1%) injuries. Trauma due to RTA resulted in a single injury (83.8%) to either an extremity or the head and neck regions most frequently. A minority of patients had medical record documentation (37.9%). Blood pressure, respiratory rate, and mental status were documented in 19.3%, 4.1%, and 0.0% of records, respectively. There were 6.3 injuries/day during the data collection period with no correlation between the frequency of emergent trauma cases and day of the week (R^2=0.01).
ConclusionsTraumatic injuries are a common emergent presentation in the Northeast region of Haiti with characteristics similar to other LMIC. Documentation and associated data to adequately characterize the burden of disease in this region are lacking. Road traffic accidents are the predominate mechanism of injury, suggesting that interventions addressing prevention and treatment of this common occurrence may provide public health benefits in this setting.
,Aluisio AR ,De Wulf A ,Louis A .Bloem C Epidemiology of Traumatic Injuries in the Northeast Region of Haiti: A Cross-sectional Study . Prehosp Disaster Med.2015 ;30 (6 ):599 –605 .
Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study
- Annelies De Wulf, Adam R. Aluisio, Dana Muhlfelder, Christina Bloem
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- Journal:
- Prehospital and Disaster Medicine / Volume 30 / Issue 6 / December 2015
- Published online by Cambridge University Press:
- 21 October 2015, pp. 553-559
- Print publication:
- December 2015
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Introduction
The North East Department is a resource-limited region of Haiti. Health care is provided by hospitals and community clinics, with no formal Emergency Medical System and undefined emergency services. As a paucity of information exists on available emergency services in the North East Department of Haiti, the objective of this study was to assess systematically the existing emergency care resources in the region.
MethodsThis cross-sectional observational study was carried out at all Ministry of Public Health and Population (MSPP)-affiliated hospitals in the North East Department and all clinics within the Fort Liberté district. A modified version of the World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care and Generic Essential Emergency Equipment Lists were completed for each facility.
ResultsThree MSPP hospitals and five clinics were assessed. Among hospitals, all had a designated emergency ward with 24 hour staffing by a medical doctor. All hospitals had electricity with backup generators and access to running water; however, none had potable water. All hospitals had x-ray and ultrasound capabilities. No computed tomography scanners existed in the region. Invasive airway equipment and associated medications were not present consistently in the hospitals’ emergency care areas, but they were available in the operating rooms. Pulse oximetry was unavailable uniformly. One hospital had intermittently functioning defibrillation equipment, and two hospitals had epinephrine. Basic supplies for managing obstetrical and traumatic emergencies were available at all hospitals. Surgical services were accessible at two hospitals. No critical care services were available in the region. Clinics varied widely in terms of equipment availability. They uniformly had limited emergency medical equipment. The clinics also had inconsistent access to basic assessment tools (sphygmomanometers 20% and stethoscopes 60%). A protocol for transferring patients requiring a higher level of care was present in most (80%) clinics and one of the hospitals. However, no facility had a written protocol for transferring patients to other facilities. One hospital reported intermittent access to an ambulance for transfers.
ConclusionsDeficits in the supply of emergency equipment and limited protocols for inter-facility transfers exist in North East Department of Haiti. These essential areas represent appropriate targets for interventions aimed at improving access to emergency care within the North East region of Haiti.
,De Wulf A ,Aluisio AR ,Muhlfelder D .Bloem C Emergency Care Capabilities in North East Haiti: A Cross-sectional Observational Study . Prehosp Disaster Med.2015 ;30 (6 ):553 –559 .
Prehospital Characteristics in the North East Department of Haiti: A Cross-sectional Study from a Low-income Setting Without Prehospital Systems
- Adam R. Aluisio, Robert Gore, Isnelle Decome, Annelies De Wulf, Christina Bloem
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- Journal:
- Prehospital and Disaster Medicine / Volume 29 / Issue 3 / June 2014
- Published online by Cambridge University Press:
- 12 May 2014, pp. 230-236
- Print publication:
- June 2014
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Introduction
Although prehospital care is recognized as key in health systems development, it has been largely neglected in Haiti. The North East Department is one of the poorest areas of Haiti, and is a region where no data on out-of-hospital health care exists. This research assessed prehospital characteristics in the North East Department with the aim of providing baseline data to inform prehospital systems development.
MethodsIn this observational study, data were collected from patients presenting at the Fort Liberté Hospital, the public regional referral health center in the North East Department. Data were accrued from April 2, 2012 through June 5, 2012. All patients accessing acute care at the hospital were eligible for enrollment. After obtaining consent, data on demographics, health needs, and prehospital information were gathered via a standardized questionnaire administered by hospital staff trained in study protocols.
ResultsData were collected from 441 patient visits. The median age was 24 years, with 62% of the population being female. Medical complaints comprised 75% of visits, with fever and gastrointestinal complaints being the most common reasons for presentation. Traumatic injuries accounted for 25% of encounters, with an equal distribution of blunt and penetrating events. Extremity injuries were the most common traumatic subclassification. The majority of patients (67.2%) were transported by motorcycle taxi and paid transport fees. Trauma patients were more likely to be transported without charge (OR = 9.10; 95% CI, 2.19-37.76; P < .001). Medical patients were most commonly brought from home (78.5%) and trauma patients from a road/street setting (42.9%). Median time to presentation was 240 minutes (IQR = 120-500) and 65 minutes (IQR = 30-150) for medical and trauma complaints, respectively (P < .001). Eleven percent of patients reported receiving care prior to arrival. As compared with medical patients, trauma victims were less likely to have received prehospital care.
ConclusionsAssessing prehospital care in this low-income setting that lacks surveillance systems was feasible and required minimal resources. Motorcycle taxi drivers function as the primary emergency transport mechanism and may represent an access point for prehospital interventions in the North East Department of Haiti. Out-of-hospital care is nearly nonexistent in the region and its development has the potential to yield public health benefits.
. ,Aluisio AR ,Gore R ,Decome I ,De Wulf A .Bloem C Prehospital Characteristics in the North East Department of Haiti: A Cross-sectional Study from a Low-income Setting Without Prehospital Systems . Prehosp Disaster Med.2014 ;29 (3 ):1 -7