Transcript Advanced Life Support in Obstetrics

Obstetric Emergency
Training
ESSENTIAL SKILLS FOR ALL
Mr.A. ELMARDI,M.Med,FRCOG
Consultant Gynaecologist(Urogyn)
Associate Prof.St.George Medical School
Grenada,USA
Staffordshire Foundation Hospital, UK
Obstetric Emergency
Training
 Be safe and keep yourself safe. Training is central to
good risk management.
 Highest standards of safety = Cost effectiveness in the
long term.
 CNST level 3 = 30% reduction in RMD (risk
management discounts) for CNST contributions.
 Annual skills drills – Recommended by RCM , RCOG
and 5th CESDI report
 Change in knowledge of obstetricians and midwives
following OE training: a Randomized Controlled Trial
BJOG Dec 2007
 Proven to improve standards of care not only in
developed nations but also in other parts of the world.
MOET was tried in Armenia with remarkable success.
Obstetric emergency
training
CNST Level3
Documenting
Implementing
Monitoring
Policy
Practice
Performance
Obstetric emergency
Training
LIST OF OBSTETRIC EMERGENCY COURSES RUN IN THE UK
Name
1 ALSO
Advanced Life Support
Training in Obstetrics
2 MOET
Managing Obstetric
Emergencies Training
3 POET
Pre-hospital Obstetric
Emergency Training
4 MOSES
Multi disciplinary Obstetric
Simulated emergency
Scenarios
6 SCOTTIE
Scottish Core Obstetric
Teaching & Training in
Emergencies
7 BLL
Skills/drills training in
Intrapartum Emergencies
5 PROMPT
Practical Obstetric
MultiProfessional Training
Organisers
ALSO –UK – Owned by American Academy of
Family Physicians.
Details
Junior Obstetricians, midwives, GPs.
Provider, Refresher and Instructor courses
Designed by Richard Johanson et al, administered
by ALSG, a medical education charity based at
Manchester. Currently available in Iraq, Pakistan
and Holland.
ALSG – a medical education charity from 1993.
Post-membership obstetricians, post-fellowship
anaesthetists and post-FFAEM A&E doctors.
Midwives can be observers. Re-certification
course every 4 years.
Community & pre-hospital obstetricians,
ambulance paramedics and nurses.
Barts and The London Medical simulation Centre.
Trainee obstetricians, obstetric anaesthetists
and midwives.
Scottish Maternity Development Programme based
on Recommendations from Expert Group on Acute
Maternity Services2001.
All health-care professionals relating to
childbirth
BabyLifeline private charity since 1981. This
particular day runs from 2008
Obstetricians and midwives
Tim Draycott
PROMPT Foundation
Bristol
Senior medical staff and managerial staff
LIST OF OBSTETRIC EMERGENCY COURSES RUN IN THE UK
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Name
ALSO
Advanced Life Support Training in
Obstetrics
MOET
Managing Obstetric Emergencies
Training
POET
Pre-hospital Obstetric Emergency
Training
MOSES
Multi disciplinary Obstetric Simulated
emergency Scenarios
SCOTTIE
Scottish Core Obstetric Teaching &
Training in Emergencies
BLL
Skills/drills training in Intrapartum
Emergencies
PROMPT
Practical Obstetric MultiProfessional
Training
Duration Course contents
.3 days Pre-course reading material followed by MCQ and OSCE
3 days
Emergency drills. Online learning, written test, practical test followed by
OSCE
2 days
Early pregnancy and late pregnancy emergency situations with limited
resources set-up. Online MCQ exam and OSCE for a pass
2 days
No written tests.
2 days
Pre-course study material, workshops and skill drills
1 day
Emergency skills drills + common intrapartum scenarios like VBAC ,
instrumental deliveries and second stage caesarean sections.
1 day
All emergency drills and training on how to set-up a teaching curriculum
and run the same in smaller units.
4 senior staff from the same unit should apply as groups.
Advanced Life
Support in
Obstetrics (ALSO®)
History
 ALSO was conceived in 1991 by family
physicians Dr Jim Damos and Dr John
Beasley, through the University of
Wisconsin department of Family Medicine.
They perceived a need for hands on
training in maternity emergencies.
AAFP purchased the program and its
copyright in 1993.
What is ALSO
 The ALSO provider course is an educational program designed to
assets in developing and maintaining the knowledge and skills
needed to effectively manage the emergencies which arise in
maternity care. The course includes required syllabus reading,
lectures and hands-on workstations.
 Evaluation is by a written exam and skill assessment stations
(megadelivery)
 There are many ways of managing emergencies, the treatment
guidelines presented in ASLO represent one way of them.
Therefore, candidates should restrict themselves to the spirit of the
manual and presentations as they stand.
 The material presented in ASLO is being available from many
resources of the literature which strongly stands for evidence based
practice.
Principles of ALSO Teaching
 Multidisciplinary course
 Structured
 ALSO way
Objectives
 Discuss methods of managing pregnancy
and birth emergencies, which may help
standardize the skills of practicing
maternity care providers.
 Demonstrate content and skill acquisition
as demonstrated by successful of
completion of the course written
examination and megadelivery testing
station
Assessment and Evaluation
• During workstations
• MCQs
• Mega delivery testing
• Feedback – Timely
Background FACTS
• The owner is AAFP
• 2000 the course was revised
• 2008 another course has been
added, Basic Life Support in
Obstetrics.(BLSO)
SUDAN
ALSO IN SUDAN
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WHY
WHO
HOW
WHERE
WHAT
Sudan at a glance
 Poor health MDGs indicators
 Life expectancy 56 years
 Low coverage and access to PHC services (45-60% 2004)
 MMR 509/100.000 .Now it has reached 1017/100.000 .
 IMR 68/1.000
 U-5MR 104/1.000
 Low level of health expenditure (less than 0.9% GDP)
 Health scene is dominated by communicable diseases – yet
entered epidemiological transition phase (double burden of
diseases)
 However: blessed country with natural resources and oil
 Lots of opportunities and challenges (CPA, Process of MP
Democracy and Health sector- wide reform)
Recognition
Recognition
Referral
Recognition
Referral
Responsiveness
But WHY Do These Women
Die?
Three Delays Model
 Delay in decision to seek care
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Lack of understanding of complications
Acceptance of maternal death
Low status of women
Socio-cultural barriers to seeking care
 Delay in reaching care
 Mountains, islands, rivers — poor organization
 Delay in receiving care
 Supplies, personnel
 Poorly trained personnel with punitive attitude
 Finances
EmOC is the foundation
ALSO in Sudan (1)
 ALSO courses in Sudan are run under
license from the American Academy of
Family Physicians (AAFP), which is
accredited to the Faculty of Medicine,
University of Khartoum.
ALSO in Sudan (2)
Historical overview:
 The first course was conducted at Soba
University Hospital in Feb. 2004.
 Ever since there had been 19 courses,
10 of them at Soba University Hospital,
1 course at Dongula and 1 course at
Wad Madani,1at Elobeid&1 at Kosti .
 There had been 480 candidates up till
now, 125 became instructors
Also Faculty in Sudan
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Saudi Arabia
Bahrain
Ghana
Egypt
Yemen
Jordan
THE IMPACT OF ALSO
 What are the benefits to the mothers and
babies?
 What are the educational benefits to the
candidates and the instructors?
THE IMPACT OF ALSO
ON INSTRUCTOR’S
ATTITUDE
Objectives
 Study demographics of instructors
 Perceived benefits of instructors to the
learning experience of the ALSO
 Level of commitment to action
 Professed changes in confidence,
abilities and motivation
 Apparent changes in knowledge, skills
and attitude
 Evaluate before and after perception on
KAP
Results
Conclusion
 Instructors felt more confident in tackling
obstetrical emergencies such as post
partum haemorrhage
 An improved capability in teaching
(fellows and juniors) acquired knowledge
and skills was stated
 There was a widespread use of the
ALSO pneumonics in practical settings
Recommendations
 To facilitate the running of regular, frequent ALSO courses across
teaching institutions in the Sudan
 The ALSO course should be a mandatory component of the M.D
curriculum
 The course should be sponsored by the Federal MoH as part of its
strategy to reduce MM and morbidity~
 Further studies are required to fully assess the impact of the
ALSO on different obstetrical indices e.g. incidence of MM due to
PPH, outcomes of neonatal resuscitation and complications
following instrumental deliveries.
ALSO Around the World
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USA
UK
Southern Ireland
Hong Kong
Canada
Australasia
Denmark
Belgium
Brazil
China
Kenya
Pakistan
Ecuador
Malawi
Mexico
New Zealand
Palestine
Egypt
Sudan
Greece
Guatemala
Honduras
Nigeria
Qatar
Rwanda
Saudi Arabia
Tajikistan
Zambia
ALSO needs your support to
make a difference
THE FUTURE !
Simulation Centre
 WHAT IS SIMULATION ?
 WHY NOW ?
 WHY SIMULATION CENTRE ?
WHAT IS SIMULATION ?
 Clinical areas, wards & operating theatres are
mocked up &medical scenarios are run from a
control room.Using animated dummies as
patients,medical teams are then trained to
respond correctly to a variety of situations
recreated in a realistic patient-free
environment.
 Every scenario is recorded using high-tech
digital video.In an interactive debriefing
session, the scenario is then replayed&
lessons learnt are explored & discussed .
SIMULATION CENTRE
WHY NOW ?
 20 million killed or permanently maimed by
western medical practice in the last
decade(BMA .J.NOV.2000).
 Estimated cost on NHS is more than 2 billion
pounds per annum in lost bed days.(BBC
News NOV 2005).
 Adverse events occur in around 10% of
admissions =850,000events per year;
(BMJ.AUG.2004).
 In USA, death caused by medical error is more
common than death due traffic accidents,ca.
breast or AIDS .
WHY SIMULATION ?
 It is seen as a key means to improve patient
safety in the future.
 Society &health policy increasingly require
medical techniques to be tried &tested before
they are used on patients, to reduce risk.
 In the USA &part of Europe, simulation is now
mandatory in some areas of medical training.
 Deaneries in UK are starting to introduce
simulation for junior doctors as part of their
specialist trainning ,
THE FUTURE
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SIMULATION CENTRE :
Equipped with high-fidelity facilities.
Sophisticated mannequins .
Surgical laboratory .
Critical incident review & replay .
Crisis resource management training .
High-tech digital recording equipment .
Trauma simulation.
Mock hospital with operating theatre,ITU&a
ward .
Thank you