Team-oriented training for damage control surgery in rural trauma: A new paradigm

Background: The geography of Norway has led to an initiative to train teams from rural hospitals in damage control surgery using a team-oriented approach based on Crew Resource Management. Our aim was to evaluate this approach and its impact on trauma care in rural hospitals across Norway. Methods: Thirty-eight teams from 21 hospitals participated in 10 courses (during the years 2003-2006) where providers from the same hospital trained as a team. Each course consisted of interactive lecture modules and operative sessions on live porcine models that emphasize communication, collaboration and team-based problem solving. The data collection tools were a postcourse questionnaire and a phone survey of participating hospitals. Results: Teams consisted of surgeons (34%), operating room nurses (35%), and anesthesiology staff (31%). Almost all course participants (N = 228, 99%) reported a dramatic increase in their proficiency with damage control techniques. There was a mean increase of 2.3 points in proficiency with extraperitoneal pelvic packing and 1.5 points with emergency thoracotomy on a 5-step Likert scale. The team approach was perceived as crucial by 218 (94%) of participants. The phone survey revealed 12 cases of lifesaving rural damage control operations by course participants in the past 3 years (estimated cost: $15,075 per life saved). Of the 18 hospitals surveyed, 17 modified their trauma protocols as a result of the course. Conclusion: Teaching damage control surgery using a team-oriented approach is an innovative educational method for rural hospitals.