title: Team-oriented training for damage control surgery in rural trauma: a new paradigm.
abstract: BACKGROUND
  The geography of Norway has led to an initiative to train teams from rural hospitals in damage control surgery using a team-oriented approach based on Crew Resource Management. Our aim was to evaluate this approach and its impact on trauma care in rural hospitals across Norway.
  
  
  METHODS
  Thirty-eight teams from 21 hospitals participated in 10 courses (during the years 2003-2006) where providers from the same hospital trained as a team. Each course consisted of interactive lecture modules and operative sessions on live porcine models that emphasize communication, collaboration and team-based problem solving. The data collection tools were a postcourse questionnaire and a phone survey of participating hospitals.
  
  
  RESULTS
  Teams consisted of surgeons (34%), operating room nurses (35%), and anesthesiology staff (31%). Almost all course participants (N = 228, 99%) reported a dramatic increase in their proficiency with damage control techniques. There was a mean increase of 2.3 points in proficiency with extraperitoneal pelvic packing and 1.5 points with emergency thoracotomy on a 5-step Likert scale. The team approach was perceived as crucial by 218 (94%) of participants. The phone survey revealed 12 cases of lifesaving rural damage control operations by course participants in the past 3 years (estimated cost: $15,075 per life saved). Of the 18 hospitals surveyed, 17 modified their trauma protocols as a result of the course.
  
  
  CONCLUSIONS
  Teaching damage control surgery using a team-oriented approach is an innovative educational method for rural hospitals.
authors.affiliation: Department of Surgery, Haukeland University Hospital, Bergen, Norway. kari.schroder.hansen@helse-bergen.no
authors.forename: Kari Schrøder
authors.initials: KS
authors.lastname: Hansen
authors.forename: Per E
authors.initials: PE
authors.lastname: Uggen
authors.forename: Guttorm
authors.initials: G
authors.lastname: Brattebø
authors.forename: Torben
authors.initials: T
authors.lastname: Wisborg
mesh_terms: D002983:Clinical Competence; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007318:Inservice Training; D033183:Interdisciplinary Communication; D008297:Male; D009664:Norway; D010348:Patient Care Team / Q000458:organization & administration*; D019035:Rural Health Services; D017751:Safety Management; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000193:education*; D014194:Traumatology / Q000193:education*; D014947:Wounds and Injuries / Q000601:surgery*