1. 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

2. 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.

3. Obstetric emergency training

6. Obstetric Emergency Courses in UK
ALSO
ALSO-UK
MOET
ALSG, Manchester
POET
MOSES
Barts & The London Medical Simulation Centre
SCOTTIE
SMMD Programme
BLL
Baby Lifeline
PROMPT
PROMPT Foundation, Bristol

7. Obstetric Emergency Courses in UK
ALSO
MCQ, OSCE
MOET
Online learning, MCQ, OSCE
POET
MCQ +OSCE
MOSES
Simulation Scenarios
SCOTTIE
Lectures + Skills drills
BLL
Lectures + group discussions
PROMPT
Skills drills and teaching/managing staff in emergency situations

8. Advanced Life Support in Obstetrics (ALSO®)

9. 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.

10. 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.

11. Principles of ALSO Teaching
Multidisciplinary course
Structured
ALSO way

12. 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

13. Assessment and Evaluation
During workstations
MCQs
Mega delivery testing
Feedback – Timely

14. Background FACTS The owner is AAFP 2000 the course was revised
2008 another course has been
added, Basic Life Support in Obstetrics.(BLSO)

15. SUDAN

17. ALSO IN SUDAN
WHY
WHO
HOW
WHERE
WHAT

18. Sudan at a glance Poor health MDGs indicators Life expectancy 56 years
Low coverage and access to PHC services (45-60% -2004)
MMR 509/ Now it has reached 1017/
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)
Multiple factors affect WHY a woman dies during pregnancy.
The “three delays” model”:
Delay in decision to see care: lack of information about problems/warning signs, social factors
Delay in reaching care: having transportation, road conditions
Delay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnel

19. Recognition

20. Recognition
Referral

21. Recognition
Referral
Responsiveness

22. But WHY Do These Women Die?
Three Delays Model
Delay in decision to seek care
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
Multiple factors affect WHY a woman dies during pregnancy.
The “three delays” model”:
Delay in decision to see care: lack of information about problems/warning signs, social factors
Delay in reaching care: having transportation, road conditions
Delay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnel

24. Multiple factors affect WHY a woman dies during pregnancy.
The “three delays” model”:
Delay in decision to see care: lack of information about problems/warning signs, social factors
Delay in reaching care: having transportation, road conditions
Delay in receiving care: lack of equipment or personnel at facility, lack of funding, poor attitude of personnel

25. EmOC is the foundation

26. 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.

27. ALSO in Sudan (2) Historical overview:
The first course was conducted at Soba University Hospital in Feb
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

35. Also Faculty in Sudan
Saudi Arabia
Bahrain
Ghana
Egypt
Yemen
Jordan

36. THE IMPACT OF ALSO What are the benefits to the mothers and babies?
What are the educational benefits to the candidates and the instructors?

37. THE IMPACT OF ALSO ON INSTRUCTOR’S ATTITUDE

38. 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

39. Results

45. 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

46. 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.

47. ALSO Around the World New Zealand Palestine Egypt Sudan Greece
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

48. ALSO needs your support to make a difference

49. THE FUTURE ! Simulation Centre
WHAT IS SIMULATION ?
WHY NOW ?
WHY SIMULATION CENTRE ?

50. 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 .

51. 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 .

52. 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 ,

53. THE FUTURE 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 .

54. Thank you