Damage Control Surgery: paving access for trainees

Abstract

Background: Damage control surgery (DCS) is a crucial concept in trauma surgery, that has shown to reduce mortality in selected patients. The principles are to stop haemorrhage, restore blood flow and prevent contamination. Currently, there is no DCS training exists within the region and the confidence of Speciality Registrars at performing DCS is unknown.

Aim(s): To assess surgical Specialty Registrars’ confidence in preforming DCS before and after the delivery of a dedicated DCS course.

Method: Using Likert scale, confidence of General, Vascular and Paediatric Surgery Specialty Registrars was assessed, using an online survey, pre and post course (1 – not confident, 5 – extremely confident).  The DCS course consisted of the following Skills:

• Resuscitative thoracotomy
• Trauma laparotomy
• Abdominal packing for major haemorrhage

The course was run over 1-day and used a combination of porcine tissue and synthetic models. Using paired T-tests, pre-course and post course confidence scores were compared for each skill. A p value of <0.05 was considered significant.

Results:

Pre-course and post-course mean confidences of each skill are listed:

• Abdominal packing for major haemorrhage

o Pre:2.83

o Post:4.25

• Trauma laparotomy:

o Pre:2.75

o Post:4.17

• Resuscitative thoracotomy

o Pre:1.75

o Post:4.25

All results were statistically significant.

Discussion: This one-day course has demonstrated a statically significantly increase in the mean confidence of registrars performing key DC Skills. Its success has led to its inclusion as an annual course within the Major Trauma Centre, at no cost to the trainees.