Kevin Collopy, MHL, FP-C, NRP, CMTE, is the clinical outcomes and compliance manager for air and ground transport operations at Novant Health Mobile Health in Wilmington, North Carolina.
But in 2022, he was recruited to help develop programs for teaching trauma care skills to healthcare providers in Ukraine. Since then, he has helped train nearly 1,000 Ukrainian first responders, nurses, and physicians in providing prehospital care to injured Ukrainians.
Trauma System News interviewed Collopy by email to learn about his experience in Ukraine and find out what lessons it has for trauma leaders in the U.S.
How did this project get started?
The full-scale Russian invasion of Ukraine in February 2022 created several immediate needs as the Ukrainian healthcare system began seeing an influx of civilian and military injuries. One pressing need was the rapid delivery of trauma education to all aspects of the healthcare system, from the lay first-responder to the surgeon.
In response, International Medical Corps worked with several Ukrainian stakeholders to identify their specific education and training needs. That list of needs ended up including trauma patient assessment and management, mass casualty and surge preparedness, and Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) preparedness.
International Medical Corps then partnered with Harvard Humanitarian Initiative (HHI) to form an academic non-governmental organization partnership tasked with developing and implementing training programs throughout Ukraine.
To date, the partnership has implemented seven courses, several of which (indicated with a * mark) were created just for this program:
- Advanced Trauma Life SupportTM (ATLS)
- Trauma Nursing Fundamentals (TNF)*
- Prehospital Trauma Fundamentals (PHTF)*
- Stop the BleedTM (STB)
- Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE)*
- Mass Casualty ManagementTM (MCM)
- Pediatric Trauma Fundamentals (PTF)*
We are grateful for the support of the World Health Organization, which owns MCM, and the American College of Surgeons, which owns ATLS and STB.
I am the director of the PHTF course, one of eight course directors who led the development and planning of these programs. HHI was the academic lead and oversaw development and translation of each course and has provided extensive support. As the overall lead organization with established in-country presence, International Medical Corps coordinated all program implementation and logistics including travel, security, and transportation, and has been on site for every course with translators and a comprehensive logistics team.
Almost 100 instructors have deployed at various times over the past two years. We began teaching these courses in August 2022, and as of January 2024 we have taught more than 200 separate courses to just under 6,000 participants. In addition, 27 open-access training videos have been written and recorded in Ukrainian, and these videos have been viewed over 1.5 million times.
What is the content of the Prehospital Trauma Fundamentals course and how is it different from other prehospital trauma care trainings?
Fundamentally, PHTF follows a similar model to other hands-on prehospital training courses. It is 2 days and 16 hours long, and it is taught using a mix of didactic lecture and simulation/skills practice. The course provides 10 lessons and 16 skills stations/simulations.
The patient assessment taught in this course follows the XABCDE approach. Unique to PHTF, we included a lesson on war trauma and a lesson focused on pediatric and obstetrical traumatic emergencies.
What is the impact of PHTF so far?
As of the end of January 2024, PHTF has been taught 34 times to 943 providers.
For each training, we conduct pre- and post-course tests and confidence surveys as well as a 6- to 8-week follow-up survey:
- During Phase I (August to October 2022), 93.3% of PHTF students had a test score increase, and the average increase was 21%.
- In Phase II (November 2022 to April 2023), 93.7% of students had a score increase, with an average increase of 24.2%.
- In Phase III (August 2023 to January 2024), the numbers were 93.9% and 22.4%.
Further, the follow-up survey asks students whether they have used a skill or information from the course. Across the three phases, the percentage of respondents who reported using a course skill or information was 62.7%, 72.1% and 72.4%!
How are you making this program sustainable?
A transition to a Ukrainian-led program has always been a goal since the beginning of the project, and strengthening the capacity of Ukrainian instructors has been a priority throughout each of the program’s phases.
During Phase I, the PHTF courses included a half-day Training of Trainer (ToT) session at the conclusion of select courses for high-performing participants who showed instructor potential. Over a total of five sessions, 141 participants received this training.
Phase II included the incorporation of national instructors directly into program delivery, where they taught alongside international instructors under a mentorship approach. Four national instructors were imbedded in the PHTF program, travelling to teach in each location throughout the phase.
In an effort to rapidly scale up the number of Ukrainian instructors, Phase III began with a five-day ToT program that was followed by an observed teaching period, which a total of 17 national PHTF instructors completed. At the conclusion of Phase III, a Master Instructor training was held in which 16 PHTF national instructors were trained to deliver ToT courses for the purpose of training new PHTF course instructors in the future.
Phase IV, currently ongoing, will focus on ensuring Ukrainian institutions have the capacity to host and implement these trainings as well as support the growing cadre of Ukrainian instructors.
In terms of a sustainability model, our goal is that each course can continue to be taught via Ukrainian teaching institutions with Ukrainian faculty.
What are your most important take-aways from this experience?
First, the true first responders are always bystanders. We can’t ever forget to train them.
Second, we need to teach with an awareness of cultural differences, including learning practices and how people ask questions. In teaching PHTF, we often strove for conversation and an engaged classroom. However, the traditional cultural practice in Ukraine is to receive a lecture and ask questions towards the end. I relate this to a prior experience teaching in Taiwan. In Taiwan, I tried to observe my students’ mealtime practices; however, they always waited for me to eat first. After several days, one of the elders told me that in Taiwan the instructor/teacher must try each food first before the students.
Other important take-aways:
We must always be willing to adapt our lessons and messages to the environment. You can’t let the hope of perfection impede progress.
Nobody works alone in healthcare or in the care of the trauma patient. Together we can amplify the interventions we provide. Whether it is course work or actual patient care, we experience success because we help one another and get support from those around us.
We should always find the good that is happening around us.
The Ukrainian people are some of the most passionate and resilient people I’ve ever met.
What lessons from your experience in Ukraine can be applied to trauma systems in the U.S.?
I think we in the U.S. can learn quite a bit from what is happening in Ukraine.
First, while there is great value in commercial hemorrhage control devices, we also need to spend time teaching providers at facilities with limited resources how to improvise.
Second, lives are saved before patients arrive. We need to not only continue pushing hemorrhage control programs like Stop the Bleed™ into the communities, but there is also an opportunity to teach other life-saving trauma care to our lay responders. We have a variety of standardized courses available, which are wonderful. However, we do need to ensure we listen to our students (our communities) and deliver the education they need based on the patients they are seeing.
And I think the most important lesson we have learned (and demonstrated through our data) is that the fact that there is a crisis — whether it is a war, a hurricane, or some other disaster — does not mean it is too late to deliver just-in-time education to support our systems.
When necessary, we can deliver timely education just before or in the early phases of a disaster, and participants CAN successfully retain the lessons learned and apply them directly to patients.
Kevin Collopy will be speaking at the 2024 Metrolina Trauma Symposium. Learn More