Building Resuscitation Capability In Low Resource Settings; Development Of The Pairs Course (Outlining The Development Of A Tailored Paediatric Resuscitation Programme For Low Resource Healthcare Settings)

We have developed and tested a dynamic, context-specific paediatric resuscitation course with tiered level of complexity with targeting different levels of healthcare workers in limited resource healthcare settings. The PAIRS course is now established in Dar Es Salaam, Tanzania with a plan for spread to Uganda and Nigeria in 2019. In 2012, under a joint initiative between the Paediatric Oncology Unit at Muhimbili National Hospital and the Tanzanian children’s cancer charity, Their Lives Matter (TLM), a team of Irish paediatric resuscitation specialists was invited to train the oncology staff. This early enterprise has matured into provision of an annual training programme by a dedicated paediatric faculty, with course content specifically designed for use in a limited resource setting and expanded to involve clinical staff from any specialty, with interest from all paediatric settings and from adult, maternity and neonatal specialties. Children on the paediatric oncology ward were experiencing poor clinical outcomes after common oncological emergencies and inter-current illnesses. Deterioration was sometimes slow to detect with 100% mortality rates for any child requiring CPR. Multifactorial issues were identified including: Poor team approach to resuscitation Low knowledge of basic and advanced life support Non–availability of emergency equipment No access to paediatric intensive care support Additional hurdles related to culture, communication and infrastructure Established internationally recognised resuscitation courses were trialled over the years, but none was deemed appropriate for the setting. The one-day Paediatric Assessment of Illness, Recognition and Resuscitation (PAIRS) course was designed to build foundational skills and knowledge of any nurse or doctor working with children in a limited resource setting. A further one-day PAIRS+ module was developed for paediatric doctors and senior nurses. The three-pronged implementation strategy consists of a massive rollout of the course, targeting the entire paediatric community of the hospital, championed by local nursing and medical management local endorsement and accreditation establishment of local faculty and national accreditation of the course with the aim of handing over to the local faculty after 5 years of sustained annual training. A variety of engagement strategies are necessary to influence behaviour and drive change. In order to achieve active buy-in for sustainability, it is essential to engage with local stakeholders, foster cooperative relationships and adapt, adopt or generate training programmes that reflect the real-life needs of the clinical team and setting are critical success factors that influence sustainability, scale and spread.