Road traffic injuries (RTIs) are a leading cause of mortality and disability globally, with the greatest burden borne by low- and middle-income countries (LMICs). Sri Lanka continues to experience substantial RTI burden, yet prospective data describing injury characteristics and short-term functional outcomes outside the capital remain limited. We aimed to describe patterns of injury and trauma severity, modes of transport and access to care, and short-term functional outcomes at discharge and during early follow-up among patients presenting with road traffic injuries to a tertiary hospital in Sri Lanka’s Central Province. We conducted a prospective observational study at National Hospital Kandy from March–September 2024. Consecutive patients presenting with road traffic–related injuries were prospectively enrolled.Trained research assistants collected sociodemographic, crash and transport characteristics, and clinical data using standardized structured interviews and bedside chart review in REDCap (English/Sinhalese/Tamil). Trauma severity was assessed using the Kampala Trauma Score (KTS). Functional disability was measured at discharge and at 3 and 6 weeks post-injury using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Analyses were descriptive. A total of 567 patients were enrolled (mean age 37.8 years; 77.1

IntroductionCOVID-19 created a global need for healthcare worker (HCW) training. Initially, mass trainings focused on public health workers and physicians working in intensive care units. However, in resource-constrained settings, nurses and general practitioners provide most patient care, typically lacking the training and equipment to manage critically ill patients. We developed a massive open online course (MOOC) for HCWs in resource-constrained settings aimed at training bedside providers caring for COVID-19 patients. We describe the development, implementation and analysis of this MOOC.MethodsFrom May through June 2020, the course was developed by a multi-disciplinary team and launched on two online platforms in July. The 4-hour course comprises 6 video-based modules. Student knowledge was assessed using pre- and post-module quizzes and final exam, while demographics and user experience were evaluated by pre- and post-course surveys and learning platform data.ResultsFrom July 17th to September 24th, 30,859 students enrolled, 18,818 started, and 7,101 completed the course. Most participants worked in healthcare (78%) and resided in lower middle- (38%) or upper middle- (20%) income countries. Learners from upper middle-income and lower middle-income countries had higher completion rates. Knowledge gains were observed from pre-module to post-module quizzes and a final exam. Afterward, participants reported increased self-efficacy regarding course objectives, a 0.63 mean increase on a 4-point scale (95% CI [0.60,0.66]). Most participants (93%) would recommend the course to others.ConclusionThis article demonstrates the potential of MOOCs to rapidly provide access to emerging medical knowledge during a public health crisis, particularly for HCWs in high- and middle-income countries.

Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome that frequently goes undiagnosed due to its rarity and variable presentation. Additionally, patients with SCAD are frequently young and relatively healthy; factors that may inadvertently lower clinical suspicion of serious pathology, thereby causing delayed or missed diagnosis and inadequate management. Our case report describes a young female who presents after cardiac arrest with inconclusive initial labs and diagnostic tests who was ultimately diagnosed with SCAD. Additionally, we briefly review the pathogenesis and risk factors, as well as the diagnostic and management recommendations for SCAD.

The physiological role of nitric oxide (NO) on the mechanism of insulin secretion is unknown, but some studies suggest that NO affects glucose metabolism in pancreatic β-cells. We have aimed at clarifying the physiological role of endogenous NO and its target in the glucose metabolism of β-cells. The expression of brain-type NO synthase (bNOS) was detected in pancreatic islets by Western blotting. Under the condition of elevated intracellular Ca2+concentration induced in the β-cells by high glucose and forced depolarization by 40 mM K+, the generation of NO from the islets was enhanced. This increase was suppressed by the NOS blockers,N-iminoethyl-l-ornithine (L-NIO), and exposure to Ca2+-free extracellular solution. In addition, the NOS blockers L-NIO and 7-nitro indazole (7-NI) enhanced glucose-induced but not glyceraldehyde- or KIC-induced insulin secretion. In anin vitroenzyme study, the NO donor sodium nitroprusside (SNP) suppressed phosphofructokinase activity and activated glucokinase and glucose-6-phosphate isomerase activity, but SNP significantly inhibited the combined activity of the enzymes. This suggests that endogenous NO has an inhibitory role on insulin release induced by glucose and that its underlying mechanism is the suppression of phosphofructokinase activity in glycolysis.

Background Globally, half of all years of life lost is due to emergency medical conditions, with low- and middle-income countries (LMICs) facing a disproportionate burden of these conditions. There is an urgent need to train the future physicians in LMICs in the identification and stabilization of patients with emergency medical conditions. Little research focuses on the development of effective emergency medicine (EM) medical education resources in LMICs and the perspectives of the students themselves. One emerging tool is the use of electronic learning (e-learning) and blended learning courses. We aimed to understand Uganda medical trainees’ use of learning materials, perception of current e-learning resources, and perceived needs regarding EM skills acquisition during participation in an app-based EM course. Methods We conducted semi-structured interviews and focus groups of medical students and EM residents. Participants were recruited using convenience sampling. All sessions were audio recorded and transcribed verbatim. The final codebook was approved by three separate investigators, transcripts were coded after reaching consensus by all members of the coding team, and coded data were thematically analyzed. Results Twenty-six medical trainees were included in the study. Analysis of the transcripts revealed three major themes: [1] medical trainees want education in EM and actively seek EM training opportunities; [2] although the e-learning course supplements knowledge acquisition, medical students are most interested in hands-on EM-related training experiences; and [3] medical students want increased time with local physician educators that blended courses provide. Conclusions Our findings show that while students lack access to structured EM education, they actively seek EM knowledge and practice experiences through self-identified, unstructured learning opportunities. Students value high quality, easily accessible EM education resources and employ e-learning resources to bridge gaps in their learning opportunities. However, students desire that these resources be complemented by in-person educational sessions and executed in collaboration with local EM experts who are able to contextualize materials, offer mentorship, and help students develop their interest in EM to continue the growth of the EM specialty.

Introduction: Gynecological exam beds with stirrups are considered by many the gold standard for patient positioning when performing a pelvic exam and suturing following a birth. However, there are many instances when a stirrup bed is not available due to the cost of the equipment, insufficient number of stirrup beds, or emergent procedures in centers that do not regularly stock such beds due to cost or lack of sufficient space. When a stirrup bed is not available, many clinicians resort to using work-arounds such as an upside-down bedpan or rolled towels to lift the patient's pelvis. While this may lift the patient's pelvis, this is uncomfortable for the patient and may even cause the patient to tense up during the medical procedure, making the exam or procedure harder to complete. Materials and Methods: In 2018, a team at Stanford University developed a low-cost pelvic lift cushion as an alternative to upside-down bedpans that aimed improve patient comfort while maintaining satisfactory levels of visibility and physical access for clinicians. The Stanford team surveyed patient/clinician interactions in which the novel pelvic lift cushion, the stirrup bed, or an upside-down bedpan/rolled towels, were used. Results: Based on 19 patient and clinician interactions, the pelvic lift cushion was found to provide patient comfort and appropriate access for clinicians during a pelvic exam. Clinicians scored it higher than the upside-down bedpan/rolled towels in every area. Conclusion: This inexpensive innovation can improve patient comfort by using an appropriately designed device while maintaining clinician satisfaction in settings where gynecological stirrup beds are not available or desired. Further research is needed to determine the device's effectiveness for different procedures and with a more diverse sample size.

The COVID-19 pandemic created an urgent global need for healthcare worker (HCW) training. Initial COVID-19-related online courses focused primarily on training public health workers and physicians caring for patients in intensive care units (ICUs). However, in resource-constrained settings, nurses and general practitioners are responsible for providing most COVID-19 patient medical care, typically lacking the training and equipment necessary to manage complex, critically ill patients. In these environments, early recognition and interventions to prevent patient deterioration are essential to optimizing outcomes. We developed a massive open online course (MOOC) for HCWs in resource-constrained settings aimed at training bedside providers caring for patients with COVID-19. This study evaluates the impact of this MOOC by assessing HCW course engagement, knowledge, confidence in caring for COVID-19 patients, and user experience. From May thru June of 2020, the course was rapidly developed by a team of physicians, educators, medical illustrators, and education technology staff, and was subsequently launched on two online platforms in July 2020. The approximately 4-hour course comprises 6 video-based modules with accompanying handouts. Student knowledge was assessed using pre- and post-module quizzes and a final exam, while demographics and user experience were evaluated by pre- and post-course surveys and data collected through the platforms. From July 17th to September 24th, 30,859 students enrolled, 18,818 started, and 7,101 completed the course. Most participants worked in healthcare (86%) and resided in lower middle- (36%) or upper middle- (21%) income countries. Higher course completion rates were observed among learners who were from upper middle-income (aOR 1.152 [95% CI 1.019-1.303]) and lower middle-income countries (aOR 1.229 [95% CI 1.104-1.368]). Significant knowledge gains were observed from pre-module (mean 56% [SD 17%]) to post-module quizzes (80% [SD 15%], P<.001), and from pre-module quizzes to the final exam (78% [SD 17%], P<.001). After course completion, participants reported increased self-efficacy regarding the course objectives, with a 0.63 mean increase on a 4-point scale (95% CI [0.60,0.66]). Overall, there was high satisfaction with the course experience, with 93% of participants reporting they would recommend the course to others. This study demonstrates the potential of MOOCs to rapidly provide access to emerging medical knowledge during a public health crisis, particularly for HCWs in high- and middle-income countries. Further research is required to understand the impact of such online courses on patient care and how to better reach learners in low-income countries.

As Cambodia works to rebuild its public health system, an area of focus has been improving the quality of emergency services. After a needs assessment in 2011, project partners identified the implementation of a patient triage system as the first target for development efforts. A context-specific triage system was created using the input of a spectrum of local stakeholders. It was tailored to fit the needs and resources available within the Cambodian health system. The system was implemented through a series of educational interventions at 35 public hospitals throughout nine Cambodian provinces. Follow-up quality improvement visits occurred on a quarterly basis between February 2016 and September 2018, during which feedback on the system was gathered using both quantitative and qualitative methods, and additional system updates were implemented. In this technical report we aim to describe the triage system design, implementation and quality improvement processes utilized with the hope of informing and supporting colleagues working to address similar challenges in other areas of the world. Through this assessment process a number of key observations were made: 1) Establishment of context-specific emergency triage systems is feasible in low resource settings; 2) Development of new triage processes requires an iterative approach; 3) Successful uptake of new practice systems requires flexibility from both the implementers and end-users in the development relationship; 4) Process improvement requires consistent retraining and reinforcement.

BACKGROUND:Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.METHODS:From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide).LESSONS LEARNED:During the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials.CONCLUSION:These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

BackgroundCurrently, Myanmar does not have a nationalized emergency care or emergency medical services (EMS) system. The provision of emergency medicine (EM) education to physicians without such training is essential to address this unmet need for high quality emergency care. We queried a group of healthcare providers in Myanmar about their experience, understanding and perceptions regarding the current and future needs for EM training in their country.MethodsA 34-question survey was administered to a convenience sample of healthcare workers from two primary metropolitan areas in Myanmar to assess exposure to and understanding of emergency and pre-hospital care in the country.Results236 of 290 (81% response rate) individuals attending one of two full-day symposia on emergency medicine completed the survey. The majority of respondents were female (n=138, 59%), physicians (n=171, 74%), and working in private practice (n=148, 64%). A majority of respondents (n=133, 57%) spent some to all of their clinical time providing acute and emergency care however 83.5% (n=192) of all surveyed reported little or no past training in emergency care; and those who have received prior emergency medicine training were more likely to care for emergencies (>2 weeks training; p=.052). 81% (n= 184) thought the development of emergency and acute care services should be a public health priority.ConclusionsAlthough this subset of surveyed health practitioners commonly provides acute care, providers in Myanmar may not have adequate training in emergency medicine. Continued efforts to train Myanmar’s existing healthcare workforce in emergency and acute care should be emphasized.

# Background Many factors align to reduce access to quality emergency services in Cambodia, resulting in unnecessary morbidity and mortality among the country's most vulnerable populations. The lack of a well-coordinated emergency referral system acts as a critical barrier for many seeking emergency care, limiting overall referral frequency and quality. To increase the effectiveness of the Cambodian healthcare system, the Quality Health Services (QHS) project implemented a spectrum of targeted, low-cost, locally-tailored interventions, including: triage systems, provincial clinical guidelines and referral hotlines, standardized referral-communication slips, and referral-feedback forms. To inform future health-system-strengthening efforts, the primary aim of this study is to describe the challenges facing the Cambodian referral system and the interventions applied to address these challenges. Secondarily, this study aims to characterize the frequency of emergency referrals in the post-intervention period and the utilization patterns of the implemented referral-system-strengthening tools. # Methods Data was collected prospectively on a quarterly basis at 35 government referral hospitals in six Cambodian provinces between March 2016 and June 2017, data from 25 of these facilities was analyzed. Data on overall numbers of referrals was collected from each facility's referral logbook. The frequency and thoroughness of standardized referral-communication slip and standardized referral-feedback form use was ascertained by reviewing copies of these tools collected at each facility during the preceding quarter. # Results The average number of emergency referrals to target facilities increased from 114.4 to 190.4 per quarter, a 66% increase. Target facilities also received 86% more standardized referral-communication slips and sent 200% more standardized referral-feedback forms per quarter during the monitoring period. # Conclusions After receiving a package of referral-system-strengthening interventions the 25 hospitals analyzed in this study noted a significant increase in the frequency of emergency referral receipt. The frequency and quality of referral related communication improved consistently during the observation period as well. This data suggests that the interventions implemented addressed ongoing gaps in the Cambodian health system, and improved access to emergency referrals. These developments create a foundation upon which to build future health system strengthening interventions can be built and may provide guidance to implementors in other similarly resourced settings.

AEM Education and TrainingVolume 2, Issue 3 p. 238-238 Correspondence Comparing Teaching Methods in Resource-Limited Countries Swaminatha V. Mahadevan MD, Swaminatha V. Mahadevan MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorRebecca Walker MD, MPH, Rebecca Walker MD, MPH Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJoseph Kalanzi MBChB, MSC, MD, Joseph Kalanzi MBChB, MSC, MD Makerere University College of Health Sciences, Kampala, UgandaSearch for more papers by this authorLuggya Tonny Stone MBChB, MMEC, Luggya Tonny Stone MBChB, MMEC Makerere University College of Health Sciences, Kampala, UgandaSearch for more papers by this authorCorey Bills MD, MPH, Corey Bills MD, MPH Department of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, CASearch for more papers by this authorPeter Acker MD, MPH, Peter Acker MD, MPH Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJordan C. Apfeld MD, Jordan C. Apfeld MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJennifer Newberry MD, JD, Jennifer Newberry MD, JD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJoseph Becker MD, Joseph Becker MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorAditya Mantha MD, MS, Aditya Mantha MD, MS University of California Irvine School of Medicine, Irvine, CASearch for more papers by this authorAnne N. Tecklenburg Strehlow PhD, Anne N. Tecklenburg Strehlow PhD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorMatthew C. Strehlow MD, Matthew C. Strehlow MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this author Swaminatha V. Mahadevan MD, Swaminatha V. Mahadevan MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorRebecca Walker MD, MPH, Rebecca Walker MD, MPH Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJoseph Kalanzi MBChB, MSC, MD, Joseph Kalanzi MBChB, MSC, MD Makerere University College of Health Sciences, Kampala, UgandaSearch for more papers by this authorLuggya Tonny Stone MBChB, MMEC, Luggya Tonny Stone MBChB, MMEC Makerere University College of Health Sciences, Kampala, UgandaSearch for more papers by this authorCorey Bills MD, MPH, Corey Bills MD, MPH Department of Emergency Medicine, University of California San Francisco School of Medicine, San Francisco, CASearch for more papers by this authorPeter Acker MD, MPH, Peter Acker MD, MPH Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJordan C. Apfeld MD, Jordan C. Apfeld MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJennifer Newberry MD, JD, Jennifer Newberry MD, JD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorJoseph Becker MD, Joseph Becker MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorAditya Mantha MD, MS, Aditya Mantha MD, MS University of California Irvine School of Medicine, Irvine, CASearch for more papers by this authorAnne N. Tecklenburg Strehlow PhD, Anne N. Tecklenburg Strehlow PhD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this authorMatthew C. Strehlow MD, Matthew C. Strehlow MD Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CASearch for more papers by this author First published: 12 April 2018 https://doi.org/10.1002/aet2.10100Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume2, Issue3July 2018Pages 238-238 RelatedInformation

OBJECTIVES:Severe global shortages in the health care workforce sector have made improving access to essential emergency care challenging. The paucity of trained specialists in low- and middle-income countries translates to large swathes of the population receiving inadequate care. Efforts to expand emergency medicine (EM) education are similarly impeded by a lack of available and appropriate teaching faculty. The development of comprehensive, online medical education courses offers a potentially economical, scalable, and lasting solution for universities experiencing professional shortages.METHODS:An EM course addressing core concepts and patient management was developed for medical students enrolled at Makerere University College of Health Sciences in Kampala, Uganda. Material was presented to students in two comparable formats: online video modules and traditional classroom-based lectures. Following completion of the course, students were assessed for knowledge gains.RESULTS:Forty-two and 48 students enrolled and completed all testing in the online and classroom courses, respectively. Student knowledge gains were equivalent (classroom 25 ± 8.7% vs. online 23 ± 6.5%, p = 0.18), regardless of the method of course delivery.CONCLUSIONS:A summative evaluation of Ugandan medical students demonstrated that online teaching modules are effectively equivalent and offer a viable alternative to traditional classroom-based lectures delivered by on-site, visiting faculty in their efficacy to teach expertise in EM. Web-based curriculum can help alleviate the burden on universities in developing nations struggling with a critical shortage of health care educators while simultaneously satisfying the growing community demand for access to emergency medical care. Future studies assessing the long-term retention of course material could gauge its incorporation into clinical practice.

Welcome to Annals of Global Health,Annals of Global Health is a peer-reviewed, fully open access, online journal dedicated to publishing high quality articles dedicated to all aspects of global health. The journal's mission is to advance global health, promote research, and foster the prevention and treatment of disease worldwide. Its goals are to improve the health and well-being of all people, advance health equity, and promote wise stewardship of the earth's environment. The latest journal impact factor is 3.64.Annals of Global Health is supported by the Program for Global Public Health and the Common Good at Boston College. It was founded in 1934 by the Icahn School of Medicine at Mount Sinai as the Mount Sinai Journal of Medicine. It is a partner journal of the Consortium of Universities for Global Health. Authors of articles accepted for publication in Annals of Global Health will be asked to pay an Article Publication Charge (APC) to cover publication costs. This charge can normally be sourced from your funder or institution. We are committed to supporting authors from all countries to publish their work in Annals of Global Health regardless of national income level, and to achieve this goal, we waive the Article Publication Charge for manuscripts where all authors are from low-income or lower-middle-income countries (as defined by the World Bank). From time to time, Annals of Global Health publishes Special Collections, a series of articles organized around a common theme in global health. Recent Special Collections have included “Strengthening Women’s Leadership in Global Health”, “Decolonizing Global Health Education”, and “Capacity Building for Global Health Leadership Training”. Global health workers interested in developing a Special Collection are strongly encouraged to contact the Managing Editor in advance to discuss the project.

With over 10,000 EMTs, India's GVK Emergency Management and Research Institute operates the largest EMS network in the world. Efficiently disseminating updated training materials to a group of this size presents a number of challenges. This study compared the impact on knowledge of two EMT training presentation formats: novel video-based lectures versus traditional live lectures. Study participants were practicing EMTs attending a training course in one of three Indian states. At each site, participants were quasi-randomized by alternate allocation. One group received training materials in a live lecture format. The other group received training materials in a video-based lecture format. Knowledge was assessed using a 30-MCQ pre-test and a 60-MCQ post-test. Data was analyzed using analysis of variance. 191 participants were enrolled, the majority were enrolled in Tamil Nadu (53%), and were male (73%). Mean participant age was 24.5 years (± 4.0), median length of employment as an EMT was 46 months (IQR = 18-66). Comparing groups, there was no difference in pre-test scores (Video: 63.3 ± 11.1%, Live: 61 ± 11.5%, p=0.086), scores improved significantly in both groups (Video: 9.4% ± 8.4%, p < 0.001, Live: 12.5% ± 9.8% p < 0.001), with scores improving to a greater degree in a statistically significant fashion in the live group (p=0.013) and there was no difference in post-test scores (Video: 72.6% ± 7.2%, Live: 73.2% ± 7.0%, p = 0.58). These data demonstrate a positive immediate impact on knowledge of the two educational methods. Further investigation into alternate factors influencing training effectiveness will be needed to determine the most appropriate teaching method for this setting.

Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia's most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.

Methods Study participants were GVK EMRI EMT instructors who attended the inaugural EMT refresher training course. These participants were from nine states within India and represented mixed educational backgrounds, including doctors and EMTs. After receiving a confidential unique ID, each study participant took a 30 multiple-choice question (MCQ) pre-test and a 60 MCQ post-test before and after the course, respectively. Differences between preand post-test scores were analyzed using the Wilcoxon signed rank sum test paired by participant.