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You may use this brief for informational, non-commercial purposes with credit attribution: The Global Health Delivery Project,, Aug 09, 2011. Please see our Terms of Use for more information.

Enhancing Training Capacity for Prehospital Trauma Care in Developing Countries

Added on 09 Aug 2011

Authors: By Robert Szypko; Reviewed by Regan Marsh, MD, MPH

Emergency medical conditions such as traumatic injury, acute medical illness and obstetric complications are major causes of death and disability worldwide. With advances in medical care, conceptions of emergency medical services (EMS) have expanded to include prehospital care and transport. Yet, EMS often is given a low priority, particularly in resource-limited settings. Interest in disaster response and management often takes precedence over system-wide improvements to EMS infrastructure, which are necessary for long-term improvements in morbidity and mortality (Kobusingye et al. 2006). Proper training for EMS providers can improve patient outcomes and bolster the sustainability and efficiency of prehospital care (Kobusingye et al. 2006). Of note, improvements to EMS systems extend beyond training programs and include efficient, high quality care at receiving hospitals, an informed public capable of recognizing and acting upon medical emergencies, and public infrastructure able to provide proper and swift transportation (Baez et al. 2009). Nonetheless, informed consideration of costs, resources, efficacy and local context in developing EMS training programs are a central component to improving emergency medical care in the developing world.

In a GHDonline panel discussion in June 2011, managers, physicians, technicians and paramedics discussed the importance of and prerequisites for successful prehospital training programs. Drawing from examples of successful and unsuccessful attempts to provide prehospital care in numerous countries, they suggested methods for evaluating and tracking training programs, as well as ensuring their success and long-term sustainability.

Key Considerations in Developing Prehospital Training Programs

  • Curricula should be compatible with the local environment. This requires more than translating materials into the local language — pictures, videos and diagrams should depict people within the service area.
  • Using an evidence-based approach, curricula should address a breadth of general emergency conditions to maximize utility across disciplines, preferably avoiding a vertical, “disease-specific” (e.g., trauma) focus.
  • Training should build on the tools and resources available in the region and consider the current state of regional EMS education, existing infrastructure, and preferred EMS delivery models. Training should include both prehospital and hospital-based personnel.
  • Training should be implemented as part of a broader strategy for EMS improvement that includes health information systems, mass casualty response protocols, and the development of a universal emergency phone number.

Key Stakeholders to Include in the Development of Training Programs

  • Involvement of national stakeholders — including national and local government, civil society and medical and nursing boards — is critical to the success of training programs. These relationships should be built as early as possible to produce more productive partnerships.
  • The Ministry of Health is an important stakeholder to legislatively institutionalize capacity building.
  • Programs should also create partners in the private sector, such as telephone companies and ambulance providers.
  • Successful training programs often establish a local emergency medicine working group that includes national stakeholders.

Key Metrics to Include in Monitoring and Evaluation

  • Many metrics may be tracked: program indicators (number trained, test scores), community indicators (KAP scores), operational indicators (response time, call volume) and hard indicators (morbidity, mortality).
  • Both hard and soft skills should be monitored. Non-technical skills, such as the ability to interact with patients, control the emergency scene, communicate effectively and within a team, need to be assessed.
  • Monitoring should be done on medium- and long-term time horizons.
  • Affordability and cost-effectiveness of training programs are important metrics to track.

Recommended Measures for Ensuring Long-Term Viability of Training Programs

  • Support from local and national government, as well as from the medical education community, is essential.
  • Cost-sharing with local government and/or communities for training and continuing education can facilitate long-term financial viability.
  • Legislators should establish a lasting infrastructure of EMS standards and licensure, and mandate that all EMS providers receive certified training.
  • Training programs should work to build a local job market for trained EMS staff. This provides a crucial incentive for participation in training.
  • Some projects have achieved long-term sustainability by charging limited fees to trainees based on their ability to pay.

Key References

Enrich the GHDonline Knowledge Base
Please consider replying to this discussion with the following information

  • If you currently are involved in a prehospital trauma care training program, whether as a trainee or trainer, please post descriptions of your experiences.
  • If you are interested in implementing such a training program or want advice on improving training, consider posting your challenges, questions, observations, and feedback.

Download: 07.25.11_EMS_Training_Brief.pdf (82.3 KB)