Initial Emergency Care During our visit in 2012, we were asked by the Mongolian Society of Anesthesiologist to develop a basic emergency course with the aim of training a core group of doctors and other medical providers in emergency medicine, which currently does not exist as a separate medical specialty in Mongolia and is in need of development.
The development of Emergency Medicine is a high priority as documented in The National Emergency Medical Retrieval Network Programme of Mongolia 2010-2016 (Annex to the Mongolian Government’s Resolution #318 of 2010) .
Specifically within the document
4.2.1.to introduce ‘emergency care training in medical, disaster and critical cases’ to the undergraduate and postgraduate curriculum of the medical university and nursing colleges
4.2.2. to provide professional training for physicians and nurses managing medical emergencies and to train them abroad for specialization;
4.2.3. to organize the training of paramedics and other staff in specialized emergency care service
The vision of the MSA was to create a train the trainer course that would be adaptable from field Felshers, through to tertiary hospital doctors. We undertook the challenge and over 9 months, with the invaluable help of emergency physicians, remote general practitioners and anaesthetists crafted the Initial Emergency Care course (IEC). We based much of our material on "Emergency Department Guidelines", largely written by a hard working emergency physician, Dr James Hayes, from the Northern Hospital and based the format of the course on the highly successful Primary Trauma Course (PTC) and Essential Pain Management (EPM). IEC comprises a two-day workshop, a one-day instructor workshop and additional resources.
Initial Emergency Care has been developed to improve the initial care of patients presenting to emergency and primary care providers in resource-limited settings. It is intended that the health care worker will gain the skills to administer first aid, and to be able to perform an initial assessment and treatment of life-threatening or limb-threatening conditions prior to referral to definitive care at the same or a different medical facility
The Initial Emergency Care Reference Text (licensed under a Creative Commons Attribution-Non Commercial 3.0 License) presents concise, point form management plans. The material is produced for resource rich environments, and hence includes investigation, treatment and disposition options that will not be universally available.
The IEC instructor workshop is designed to provide participants with the knowledge and skills to become an IEC instructor
The instructors listed below developed a reference text, slide set and instructor manual. Our Mongolian colleagues translated the slide set and printed in “pocket book” form the IEC reference text.
In 2013 we ran a two-day course in Ulaanbaatar from June 20-21st titled "Initial Emergency Care" (IEC) followed by a one-day instructor course at the MSA training centre. We then traveled to two remote locations, Arkhangai Aimag and Khentii Aimag, to teach the course at a regional level on 24th and 25th of June. (See separate formal report). The doctors who instructed IEC were:
Dr Simon Smith, FACEM, Emergency Physician, Victoria, Australia
Dr Loren Sher, Emergency Physician, Victoria, Australia
Dr Simon Hendel, Provisional Fellow, Australian and New Zealand College of Anaesthetists (travelling on the ANZCA scholarship award)
Dr Andrew Lees, General Practitioner, Victoria, Australia
Dr Samuel Kennedy, General Practitioner, Victoria, Australia
Dr David Pescod, Anaesthetist, The Northern Hospital, Australia
Dr Amanda Baric, Anaesthetist, The Northern Hospital, Australia
Dr Hella Deifuss, Anaesthetist, The Northern and Austin Hospitals, Australia
Dr Leona Leong, Anaesthetist, The Northern Hospital, Australia
Mr Timothy Furlong, Surgeon, Royal Melbourne Hospital, Australia
Dr Sathi Seevanayagam, Anaesthetist, Singapore
The IEC course:
Day one included an introduction to Initial Emergency Care, a pre-test, trauma management and head injuries, pre-hospital emergency care and transport, communication, triage, cardiac and respiratory emergencies, skills stations on ECG interpretation, CXR interpretation, airway management and intercostal catheter insertion.
Day two included burns, wound care, fractures, paediatric and obstetric emergencies, abdominal pain, diabetes, the alcoholic patient and skills stations on the primary trauma survey, FAST and basic life support and a post test.
The Instructor course included sessions on: adult teaching, how to lecture effectively, running a discussion, teaching a skill and scenario teaching.
IEC Ulaanbaatar: was attended by in excess of 100 medical professionals. It was evident that though the content of IEC was appropriate to the city medical professionals, the format of the lectures will need refinement.
IEC Provinces: was attended by approximately a dozen soum and aimag doctors who, as expected, have a great deal less resources and substantially different priorities of treatment and learning to their city counterparts. The content of IEC was significantly less appropriate to the province doctors and small number of attendees would promote a change in education techniques, however the IEC was greatly appreciated by Soum health professionals and there is a very significant need for Soum and Intra soum education.
It is evident that a universal IEC for tertiary and provincial health care providers is less optimal than courses tailored for the two significantly disparate environments. The task now is to separate craft courses that provide optimal training. We believe that the Mongolian emphasis at the moment may be for a course that is aim at provincial health care workers
Since our return Ganbold has (email from Ganbold 21/8/13) “met with the director of Center for Health Development (this is the government agency which implement the policy of MoH and government) while we talked about the CME for rural doctors (Soum and InterSoum). Your country have plenty of experiences and organizations in this field. The Director Dr. Bat-Erdene (CHD) was also interested in the training and working condition in Emergency as well as intensive care system in your country, this is a priority in building up the current policy and realization in routine practice as whole system.” The MOH hopes “to link and a find most appropriate way to broaden the structured training modules (like Initial Emergency Care; Primary Trauma Care; Essential Pain Management and otheres) in Mongolia which we developed through our project realization in last 10 years”