Background Prehospital (ambulance) care can reduce morbidity and mortality from trauma. Yet, there is a dearth of effective evidence-based interventions and implementation strategies. Emergency Medical Services Traumatic Shock Care (EMS-TruShoC) is a novel bundle of five core evidence-based trauma care interventions. High-Efficiency EMS Training (HEET) is an innovative training and sensitization program conducted during clinical shifts in ambulances. We assess the feasibility of implementing EMS-TruShoC using the HEET strategy, and feasibility of assessing implementation and clinical outcomes. Findings will inform a main trial. Methods We conducted a single-site, prospective cohort, multi-methods pilot implementation study in Western Cape EMS system of South Africa. Of the 120 providers at the study site, 12 were trainers and the remaining were eligible learners. Feasibility of implementation was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Feasibility of assessing clinical outcomes was assessed using shock indices and clinical quality of care scores, collected via abstraction of patients' prehospital trauma charts. Thresholds for progression to a main trial were developed a priori. Results The average of all implementation indices was 83% (standard deviation = 10.3). Reach of the HEET program was high, with 84% learners completing at least 75% of training modules. Comparing the proportion of learners attaining perfect scores in post- versus pre-implementation assessments, there was an 8-fold (52% vs. 6%) improvement in knowledge, 3-fold (39% vs. 12%) improvement in skills, and 2-fold (42% vs. 21%) increase in self-efficacy. Clinical outcomes data were successfully calculated-there were clinically significant improvements in shock indices and quality of prehospital trauma care in the post- versus pre-implementation phases. Adoption of HEET was good, evidenced by 83% of facilitator participation in trainings, and 100% of surveyed stakeholders indicating good programmatic fit for their organization. Stakeholders responded that HEET was a sustainable educational solution that aligned well with their organization. Implementation fidelity was very high; 90% of the HEET intervention and 77% of the implementation strategy were delivered as originally planned. Participants provided very positive feedback, and explained that on-the-job timing enhanced their participation. Maintenance was not relevant to assess in this pilot study. Conclusions We successfully implemented the EMS-TruShoC educational intervention using the HEET training strategy in a single-site pilot study conducted in a low-resource international setting. All clinical outcomes were successfully calculated. Overall, this pilot study suggests high feasibility of our future, planned experimental trial.

中文翻译：

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在资源有限的环境中为院前提供者实施的新型创伤培训计划的单点试点实施。

背景 院前（救护车）护理可以降低创伤的发病率和死亡率。然而，缺乏有效的循证干预措施和实施策略。紧急医疗服务创伤性休克护理 (EMS-TruShoC) 是一套新颖的五种核心循证创伤护理干预措施。高效 EMS 培训 (HEET) 是在救护车临床轮班期间进行的一项创新培训和宣传计划。我们评估了使用 HEET 策略实施 EMS-TruShoC 的可行性，以及评估实施和临床结果的可行性。调查结果将为主要试验提供信息。方法 我们在南非西开普省 EMS 系统进行了一项单点、前瞻性队列、多方法试点实施研究。在研究现场的 120 名提供者中，12 人是培训师，其余是合格的学习者。实施的可行性以 RE-AIM（范围、有效性、采用、实施和维护）框架为指导。使用休克指数和临床护理质量评分评估评估临床结果的可行性，这些评分是通过提取患者的院前创伤图表收集的。进入主要试验的阈值是预先制定的。结果所有实施指标的平均值为83%（标准差=10.3）。HEET 计划的覆盖率很高，84% 的学习者完成了至少 75% 的培训模块。比较在实施后和实施前评估中获得满分的学习者的比例，知识提高了 8 倍（52% 对 6%），技能提高了 3 倍（39% 对 12%），自我效能感提高 2 倍（42% 对 21%）。临床结果数据被成功计算——在实施后与实施前阶段，休克指数和院前创伤护理质量有临床显着改善。HEET 的采用效果很好，83% 的辅导员参与了培训，100% 的受访利益相关者表示他们的组织具有良好的计划适合性。利益相关者回应说，HEET 是一种可持续的教育解决方案，与他们的组织非常吻合。执行保真度非常高；90% 的 HEET 干预措施和 77% 的实施策略按原计划交付。参与者提供了非常积极的反馈，并解释说在职时间提高了他们的参与度。在这项试点研究中，维护与评估无关。结论 我们在资源匮乏的国际环境中进行的单点试点研究中使用 HEET 培训策略成功实施了 EMS-TruShoC 教育干预。所有临床结果均已成功计算。总体而言，这项试点研究表明我们未来计划的实验试验具有很高的可行性。