Projects training in emergency and extreme medicine
Primary emergency care in low-resource settings settings health training project:
1. for medical / paramedical staff working in difficult environments, poor;
2. method to deal with health emergencies contextualized to the realities of different places derivig from international protocols on emergency (ATLS, BLS, PTC … ..);
3. theory, practical exercises and simulation;
4. available in different languages (Italian, French, Spanish, English);
5. residential or traveling, as required;
6. equipped with specific simulators;
7. free teached by volunteers specialists.
The project has partnerships with other organizations (Doctors for Africa to Genoa, Les amis du coeur d’Aosta) and the University of Genoa.
During the last course held in Africa, in 20 days of work, they have imparted training at various levels in several hospitals around 150 people, including health professionals and lay people were also donated two AED (automatic defibrillators) placed in two areas strategic; All training was self-funded and has commissioned the association has provided accommodation and a car to travel.
Other training is given to hospitals tall.
EXTREME MEDICAL TRAINING
1. O2-based therapy and CPAP:
2. altitude sickness, pulmonary and cerebral edema; FiO2 low coinfections (TB) and;
3. Chronic lung disease
4. Chronic anemia: no compensatory function;
5. malnutrition and deficiencies;
6. extreme environmental conditions: freezing, rhabdomyolysis, burns, heat stroke, dehydration;
7. animal bites;
8. plant poisoning;
9. traditional medicine.
This project will also include some ventilatory support machines.
The courses are accessible to hospitals, non-profit and non-governmental organizations that consider appropriate and upon request; the team always offers training free of charge; only contribution to accommodation and possibly travel expenses is required.
PEIC (Primary Emergency and Intensive Care)
The project rises from work experiences in healthcare contexts tropical difficult or low resources as well as maxi emergencies;
It consists of 2 parts:
1. theoretical: lessons and website support http://tropicaldoctor.altervista.org;
2. practical: training effective, specific and contextualized according to different needs;
Targets:
web library containing scintific protocols and updates;
training for health care workers who are going to work different contexts having to adapt their capacities in situations of reduced resources, diagnostic, therapeutic or deal with stress scenarios difficult or dangerous; training to operators on site sharing systems and methods of work;
telemedicine through volunteers specialized;
application of modern technology to remote and harsh environments, increasing diagnostic and therapeutic possibilities;
development of strategic plan for rural hospitals, from field to maxi emergencies or disasters;
enhancing the activity of teaching hospitals already operate and collaborate in specific courses already in place;
recovering and sending sanitary materials.
The project is:
• independent of any association or organization;
• offered free of charge by specialized volunteers;
• supported by professionals from various hospitals and involved in experiences of cooperation in humanitarian or educational collaborations with several Italian universities; teaching team is composed of doctors and nurses.
The PEIC GUINEA:
• is designed in collaboration with the Cooperative Medico-Sanitary MADRUGADA Campus Madrugada Antula Bono – Bissau – Guine-Bissau and the University of Verona;
• it based in Guinea Bissau, in the city of Bissau;
• orientation lasts 4 years (May 2014-May 2018);
• it consists of different courses:
1. PEC: lasting one week with 5 mornings theory + 5 afternoons of practical exercises;
2. PIC: duration 3 weeks;
3. Course + tutoring anesthesia: 5 weeks duration;
4. Course emergency basis: life one day.
The courses are designed to:
doctors, nurses, lay personnel as police, fire, rescue volunteers ….
Courses provided in four years:
• 100 PEC
• 10 PIC
• 50 courses of anesthesia
• 400 basic courses
PEC (PRIMARY EMERGENCY CARE)
It consists of a training designed for health personnel who will work in difficult situations, difficult, both in tropical environments or low resources to maxi emergencies.
Pitch:
• aimed at pre-hospital emergency treatment / territorial and early acceptance of neonatal, pediatric and adult;
• consists of a theoretical part and a simulated;
• with guidelines adapted to the contexts (tropics, mountains, war, earthquakes) and for the treatment of specific parts “low profile” of critically ill patients (polytrauma, crush syndrome, burned, altitude sickness ….);
• exportable in English, French, Spanish, Portuguese.
Annex PEC program.
1 day:
• analysis of the work and the available infrastructure of the place;
• concept maxiemergenza;
• Disaster prevention;
• triage + maxi-management inflows;
• Infrastructure: blood bank, operating room, intensive care unit, medications.
Day 2:
• management of trauma on the territory;
• golden hour;
• extrication + immobilization;
• first look;
• stabilization;
• second look;
• CPR;
Day 3:
• venous access;
• tetanus prophylaxis and antibiotics;
• sedo-analgesia;
• management of critically ill patients and shock;
Day 4:
• analysis of the various traumatic diseases;
• thoracic drainage and pericardial;
• Use basic diagnostics (RX + ETG);
•
Day 5:
• management of head injury;
• management burns;
• directions to S.O. Emergency;
• assessment of the critical patient transfer to another center;
PIC (PRIMARY INTENSIVE CARE)
For intensive care and basic primary care are those that:
1. under certain conditions acute save lives;
2. require a major commitment of specialists and principals;
3. affect previously healthy patients or with good life expectancy and with concrete possibilities of lasting recovery;
4. along with essential drugs and surgical primary care should be accessible to all people of the world without distinction.
Modules intensive care essentials:
1. Insuf. resp. Acute:
to. bronchospasm, glottis edema … .;
b. tracheostomy for tetanus, diphtheria, trauma …;
c. bilateral pneumonia;
d. pneumothorax / voucher rib;
is. pleural empyema;
2. Shock hypovolemic / hemorrhagic:
to. trauma;
b. dehydration;
c. burns;
3. cardiogenic shock:
to. IMA thrombolysis;
b. EPA;
4. septic shock:
to. Post-operative;
b. primary infections;
5. shock neurological / anaphylactic;
6. suf. Acute renal failure:
to. purifying dialysis;
b. treating crush syndrome;
7. severe malnutrition;
8. treatment intoxication and poisoning;
9. treatment HELLP / eclampsia;
10. severe head injury: craniotomy without imaging + stabilization;
11. different.
Aims:
1. training of health personnel through courses on emergency PEC;
2. formation of anesthetic technicians on the Swiss model contextualized;
3. subsequent formation of Intensivists able to manage intensive therapy including dialysis essential;
4. Creation of network for territorial emergency with uniform call number, dedicated vehicles for the islands and the transfer by air abroad.
SPECIALIST TOPICS
1. CPAP / NIV IN CONTEXT A LIMITED RESOURCES OR WEATHER disadvantaged
to. Framing the patient in chronic respiratory remote contexts (with high prevalence of MDR TB, co-infections, … ..);
b. O2 therapy protocol at high altitude in patient chronic respiratory;
c. EGA;
d. treatment of pulmonary edema;
is. supports CPAP / NIV rural hospitals;
f. O2 home therapy with O2 concentrator;
g. temporary tracheotomy in patients with tetanus, diphtheria, noma;
2. Neurology CONTEXT IN A LIMITED RESOURCES OR WEATHER disadvantaged
to. Protocol EEG epilepsy without referring to specific situations “tropical” coma cysticercosis;
b. High-altitude cerebral edema;
c. management of head injury without CT / MRI;
d. dell’ecodoppler use as monitoring / diagnostics;
3. CARDIOLOGY IN CONTEXT A LIMITED RESOURCES OR WEATHER disadvantaged
to. Heart failure and severe malnutrition;
b. Echocardiography base;
c. Specific frameworks: M. Chagas, leptospirosis, … .;
PRIMARY ANAESTHESIA AND LOW PROFILE ICU
GENERAL: part theoretical / practical inspired, although contextualized, from training courses for technicians anesthesia popular in Europe (especially Switzerland).
1. shock and coma in tropical environment;
2. FAST ultrasound + chest;
3. war surgery and disasters, management of multiple trauma;
4. self-control and stress management;
5. consensus and cultural mediation;
THE SPECIALIST
1. Primary and field anesthesia: drugs for safe and rational anesthesia in difficult situations;
2. anesthetic risk assessment based on:
• nutritional status
• coexisting infections
• chronic diseases
• anemia
• hydroelectrolytic alterations
3. tracheotomy surgical and minimally invasive;
4. transfusions and emorecupero;
5. gynecology and obstetrics in rural hospitals:
• pathophysiology of childbirth;
• partogram;
• risk situations;
6. neonatal resuscitation;
7. stabilization of the newborn;
8. Intensive Care specific frameworks:
• severe acute malnutrition;
• treatment of burns;
• crash syndrome;
9. neurosurgery: general patient’s unconscious with head trauma, patient monitoring, indication and anesthesia for craniotomy;
10. antibiotic treatment: protocols for TB, parasites, malaria … .;
11. Traditional Medicine and poisoning;
A) theoretical and practical simulated;
B) internship tutoring.
SIMULATED TOPIC HOURS HOURS
SAFE ANAESTHESIA WHO GUIDELINES 2
GENERAL ANESTHESIA
in contexts with limited resources WITH AND WITHOUT INTUBATION
managing difficult airway manikin 5 5
DRUGS anesthetics ketamine, halothane, curare;
conservation and quality 2
PERIPHERAL BLOCKS WITH ONLY anatomical landmarks
AND ECOGUIDATI 4 Course ECO + dummy 10
TRACHEOSTOMY SURGICAL EMERGENCY Minitrach, minimally invasive dilated 1 2 2
SIMULATED TOPIC HOURS HOURS
INTENSIVE CARE BURNS 3
POST-SURGICAL 2 8
Hemolytic crisis 0.5
CHOLERA 0.5
CRASH SYNDROME 0.5
COMA in context TROPICAL 2
HEAD TRAUMA
Craniotomy without imaging and electricity 2
COMPLICATIONS BIRTH 2
SIMULATED TOPIC HOURS HOURS
Neonatal Resuscitation 8
STABILIZATION NEWBORN 8
NUTRITION TROPICAL PERI-OPERATIVE 2
SEVERE MALNUTRITION 6 nutritional Kits
PREGNANCY 2
TROPICAL TOX +
Traditional medicine 2
TRANSPORT AND RECOVERY 8
TRANSFUSION + EMORECUPERO 2 Research Group + rH
rapid tests for infections
Haemocue 2
ANALGESIA 2
Practical objectives of the Master
a) knowledge and use of drugs not commonly known;
b) training with basic technologies for ventilation and monitoring;
c) management with limited resources of septic patients, postoperative complicated organ failure;
d) performing various procedures (chest drains, pericardial, streets intraosseous, CVC … ..);
e) execution of tracheostomy surgical and minimally invasive (Griggs modified);
f) newborn care postpartum, management and transfer of critical newborn;
g) management burns;
h) rationalizing antibiotic therapy
• empirically;
• with cultural base;
• resistors connected to the critical.
Staff:
• MD. M. Sarboraria, emergency surgery / anesthesia and resuscitation;
• MD. S. Pala anesthesia and resuscitation, rescue helicopter;
• NP. G. Cavarero resuscitation / emergency territorial / dialysis;
• Stud. G. Antonello.