H.E.E.T. & EMS-TruShoc
- Improving the quality of prehospital (i.e. ambulance-based) traumatic shock care in low-and-middle income countries is one strategy to help address the global burden of disease.
- This innovative project sought to improve prehospital providers’ knowledge, attitudes, and skills, and thereafter, to improve patient outcomes as a consequence of enhanced prehospital traumatic shock care in the Western Cape of South Africa.
- We used a novel implementation strategy (called H.E.E.T. – High-Efficiency EMS Training) to introduce a bundled clinical intervention (called EMS-TruShoC – EMS Traumatic Shock Care).
- We conducted a two-arm, controlled, mixed-methods, hybrid type-II study in the Western Cape Government Emergency Medical Services (EMS) system. We pragmatically implemented a simplified prehospital bundle of trauma care (with 5 core elements) using a novel workplace-based, peer-to-peer, rapid training format. We assigned the intervention and control sites.
- We assessed implementation effectiveness among EMS providers and stakeholders, using the RE-AIM framework. Clinical effectiveness was assessed at the patient level, using changes in Shock Index x Age (SI x Age). Indices and cut-offs were established apriori. We performed a difference-in-differences (D-I-D) analysis with a multivariable mixed effects model.
- We found that EMS providers’ knowledge, attitudes, and skills significantly improved due to the initiative. We found the most improved clinical outcomes among patients in severe haemorrhagic shock who received care from BLS providers. Our initiative was well-received by EMS stakeholders and practitioners, all of whom agreed the program was a great fit for the EMS service and for adult learners in the workplace.
- H.E.E.T. continues to be an area of active investigation and interest to the WCG EMS system (and several other EMS systems in Africa and beyond).