Systematic Approach to Save Lives in the Emergency Room - The ICRC in New Delhi

Emergency Room Trauma Course (ERTC), conducted across the world by the ICRC, is a skill development course that has the provision of timely and effective casualty care, aimed at reducing the morbidity and mortality of trauma patients. Dr Rohit Shrestha from Nepal, who is an ERTC trainer with the ICRC, shares his experience and reflections from the trainings held in India.

Trauma is one of the most common causes of death in the world. An estimated 1.3 million people are killed in road traffic crashes each year worldwide and as many as 78.2 million are injured. Projections indicate that these figures will increase by about 65 per cent over the next 20 years, unless there is a new commitment to prevention. This effect of the projected increment will be greater in low and middle income countries, as they currently account for over 90 per cent of all road traffic injury deaths. Young people in their most productive period of life (aged 15 to 40 years) are the most commonly affected. Proper and timely management of injuries caused by severe trauma can reduce the number of people succumbing to such injuries and disabilities. Expertise in trauma care helps save lives in the event of a natural disaster such as an earthquake, when healthcare professionals may have to cope with a large influx of patients.

There is evidence that standardised management of trauma patients in the emergency department of hospitals improves their clinical outcome. In today’s world, the International Committee of the Red Cross’ (ICRC) concerns with managing trauma cases stems from its mission to assist the victims of armed conflict and violence. The institution’s expertise in emergency room trauma management has developed from years of experience and specialisation in surgery for the war/weapon-wounded. Emergency Room Trauma Course (ERTC) is a highly practical and simulation-based course dedicated to dealing with trauma cases encountered in the emergency rooms. It is based on Advanced Trauma Life Support (ATLS) guidelines and was developed by the ICRC since the former course is copyrighted, expensive and most of all, not accessible where it is needed the most. ERTC is the philosophy which helps freshly graduated medical personnel and the specialist surgeons, orthopaedicians and anesthesiologists identify, prioritise and save the lives of severely injured people. The primary aim of this course is to make the participants familiar with different situations potentially fatal to life and focus on the stabilisation of the patient before proceeding into definitive management.

The methods of training include lectures, presentations and practical simulation exercises, including disaster preparedness, role play, drills, techniques of airway management by bag and masking and tracheal intubation, log rolling and immobilisation, fluid resuscitation, etcetera. The course comprises different stations with a fixed number of participants. Trainings are based on group work rather than the individual effort. Group discussions are key to learning the course more efficiently. Each and every step of learning is based on repeated performance and constructive critiquing for identification of errors, and its correction helps in making every participant competent. It also involves experience sharing sessions to enhance the interactions among the participants. The theoretical and practical knowledge of the participants is assessed by conducting mock tests (pre and post course).

ERTC also builds their training capacity, enabling them to coach their staff on the proper management of traumatic injuries. ©ICRC, Ashish Bhatia

Unlike other courses, this course focuses on hand to hand learning, simulation based learning and implementations of learned skills on dummy and co participants, making it more practice-oriented. It is based on straightforward clinical practice, and does not require the practitioner to have access to high-tech facilities. These facilities may not be available during emergencies due to the deterioration of the medical services as a result of a disaster or armed conflict or violence.

ERTC enhances and complements the expertise of local doctors in the management of emergency trauma cases. It is expected that such an enhancement would train local health care personnel to deal with trauma victims in a systematic manner and with available resources. It will also build their training capacity, enabling them to coach their staff on the proper management of traumatic injuries.

Rather than disseminating new information, this course helps the participants use their previous knowledge in a standardised way to assess, prioritise and treat their patients more efficiently. The training is conducted over two and a half day period by trained and experienced faculty members/ facilitators over a standard pattern of primary survey and secondary survey, using ABCDE principle. At the end of the course, the participants are asked to provide an anonymous feedback that includes objective structured rating and a segment of open ended subjective questions regarding the perceptions of the participants and the confidence that they have developed out of the trauma course.

Each and every step of learning is based on repeated performance and constructive critiquing for identification of errors, and its correction helps in making every participant competent. ©ICRC, Ashish Bhatia

Various level doctors and now recently, nurses and paramedics have also been enrolled in this course as they make a trauma team. The ICRC has taken a lead towards capacity building of the healthcare personnel on purely humanitarian grounds so that lives can be saved and sufferings can be reduced, in whatever forms of injuries one might have sustained. ERTC is being conducted worldwide where there is utmost need for it.

ERTC is a course on trauma life support and trauma management that enables doctors to establish a simple, coherent and concise approach to the premature care of trauma patients in emergency units. It is much of a need in the humanitarian field as the terror-stricken nations require the fundamental buttress of initial stabilisation of the wounded, in the wake of limited resources and paucity of time. Providing the resuscitation depends on possessing theoretical knowledge and skills, but it equally depends on having practical experience and presence of mind. This is where ERTC steps in – helping the medical personnel build the potential of efficiently managing the trauma patients and defeating death at its door.