Delivering PTC training in Fiji and the Pacific
“Fiji is the first place in the world the course was taught before it was taken around the globe and taught widely.””
When you train and practice emergency medicine (EM) in the Pacific, you are naturally inclined to do a significant amount of teaching – whether formal or ad hoc. Personally, I consider myself quite fortunate that, during my training, I got to learn as well as instruct on some important short courses.
One such course is the Primary Trauma Care (PTC) course. This free and life-saving education is offered in more than 80 countries around the world and teaches essential skills that aim to save lives and prevent disability following trauma. Fiji is the first place in the world the course was taught before it was taken around the globe and taught widely.
In its early days, the course was looked after by our anaesthetic team. Then, in 2015, some EM trainees were given the opportunity to train as instructors and join the local faculty. This inclusion paved the way for specialties working together in trauma care to train and teach together – further cementing the multi-team approach that is involved in trauma teams and trauma care within hospitals and healthcare systems.
PTC 2017 Faculty : (L-R) Dr Deepak Sharma, Dr Tekeua Uriam (Consultant Anaesthetist, Kiribati), Dr Hilda Schtuz (Anaesthetist, Kiribati), Dr Elizabeth Lee (Consultant Anaesthetist, PNG), Dr Sereima Bale (Senior Consultant Anaesthetist & Course Director), Dr Kabiri Uriam (Consultant Surgeon, Kiribati).
I was fortunate to be a part of that training team, and I haven’t looked back. After completing the instructor training, my first stint teaching the PTC was in Kiribati in 2015 as part of the team that assisted in the week-long training that year. Being in the company of some senior facilitators meant I quickly learnt techniques that helped me become a better facilitator.
The experience I enjoyed ensured I was always willing and available to deliver future PTC trainings in Fiji. I loved how the faculty always worked together, but it was also a chance to network with surgical and anaesthetic colleagues away from the hospital scene.
Evolving as a trainer
Fast-forward to 2021, when I took on a more senior role in coordinating and directing PTC training in Fiji. With the help of my EM colleagues, we were able to expand our local instructor pool and invite nursing and pre-hospital participants to the training as well. This was an important expansion of the reach for the PTC, as it allowed us to ensure all cadres involved in trauma care were speaking the same ‘language’ and had the same approach at the various stages of caring for the injured patient. It also allowed more camaraderie and helped break down any silos between cadres.
Returning to Kiribati
Dr Deepak Sharma in Kiribati.
In 2023, there was another request for external facilitators for a week of PTC training in Kiribati. It was my third invitation – and one I happily accepted. It took a bit of back-and-forth to lock in dates, but it wasn’t long before fellow facilitator and anaesthetist Dr Emily Fuakilau joined me for the trip to Kiribati.
Looking back, the major challenge in getting this training off the ground was the job of finding external facilitators who were available to travel. November is a busy time, with post-graduate exams for trainees across all specialties making it challenging to find faculty available to assist. The other unexpected challenge was that Kiribati changed its official start time for working hours from 8am to 9am. This meant our course started an hour later on all days (something we only learned about on arrival during our pre-course faculty meeting).
The response of the participants did become a little overwhelming for the second course when we had more participants than we could house in our training room, but I suppose this just showed the enthusiasm and eagerness of the doctors and nurses to learn and refresh on trauma training.
During the week-long training, we had two provider courses for the PTC and an instructor training course to increase local facilitator capacity, ensuring that future trainings could occur more easily.
A few things helped to ensure the success of the training:
enthusiasm of all the participants and commitment of the second group to show up on a Saturday despite a local sporting competition also taking place
the local faculty’s drive to lead the training, troubleshoot throughout the course and help each other to become better facilitators
the ability of both medical and nursing participants to train together and have discussions and presentations led by the nursing participants was inspirational
a committed local team who adjusted work rosters so that patient care was not affected and maximum staff made use of the training.
““A proud moment for me was seeing participants who were nursing students and medical interns during the 2017 training now progressing and looking after different departments.””
Communication builds stronger connections
Having small chats with the staff of the emergency department about their challenges and experiences during breaks and after the training not only helps build relationships and encourages learning on both sides, but also allows for collaboration and teamwork when delivering training courses like PTC in another country. I believe it helps us realise we all are working towards the same goal in our different settings with what we have locally.
A proud moment for me was seeing participants who were nursing students and medical interns during the 2017 training now progressing and looking after different departments – and encouraging staff junior to them to participate in the PTC, based on their experiences when they were trained.
The 2023 Faculty: (L-R) Dr Tabutoa Eria (ED Doctor, Kiribati), Dr Emily Fuakilau (Consultant Anaesthetist, Fiji), Dr Teakai Ariel Uriam (Surgical Registrar, Kiribati), Dr Maria Mikaere (Surgical Registrar, Kiribati) and Dr Deepak Sharma.
After the training in 2023, I played a part in conducting a week-long PTC in Vanuatu in March 2024, delivered through collaboration between EM physicians and PTC instructors from Fiji, PNG and the Solomon Islands.
I look forward to collaborating with other places and PTC instructors to keep the momentum of PTC going around Fiji and the Pacific.
The Primary Trauma Care Foundation is endorsed by ACEM as a recommended trauma course for LMICs. Primary Trauma Care (PTC) training is dedicated to empowering and equipping healthcare workers in low and middle-income countries with essential skills. At its core, the PTC course seeks to ensure that participants grasp the critical clinical priorities in trauma management and develop proficiency in conducting swift methodical assessments while resuscitating and stabilising trauma patients, even within resource-constrained environments.
