221 Basic Emergency Care: Post-Covid Implementation Utilizing Regional Teams

Strengthening healthcare capacity is a strategic priority for Belize, who in 2019 launched a nationwide campaign to train essential healthcare workers (HCWs) in the foundational tenets of emergency care through the World Health Organization and International Committee of the Red Cross’ Basic Emergency Care (BEC) course, utilizing a regional training of trainers (ToT) model. After a pause during the covid pandemic, in 2022 the Southern Health Region (SHR) of Belize was prioritized to resume regional BEC training due to the traditionally under-resourced healthcare system and long distance to higher level of care hospitals. This study aims to assess the efficacy of the staged ToT model. In coordination with the Belize Ministry of Health and Wellness, a ToT was held in August 2022 creating BEC facilitator teams that led courses in the region. The BEC mobile application (BEC app), developed by University of California San Francisco, was also utilized to supplement in-person training. Demographic data of trainees, pre-, post- and 6-month post-course knowledge and pre- and post-confidence levels (Likert scale 1-5) were collected. Participants were also surveyed on the potential utility of BEC and barriers to BEC implementation. Demographic and survey data was analyzed utilizing descriptive statistics. Pre- and post-course knowledge and confidence was analyzed using the Wilcoxon Signed-Rank Test. Associations between confidence level, clinical role, clinical experience, BEC app use and knowledge were analyzed utilizing the Kruskal-Wallis Test. The SHR ToT produced 13 new BEC facilitators: 5 physicians and 8 nurses, adding to the existing 5 master facilitators in the SHR. The facilitators taught 3 BEC courses. A total of 46 HCWs were trained, 31 nurses (67%) and 15 physicians (33%). Most (91%) reported limited experience with critically ill patients (< 5 per day). There was a significant association between higher baseline knowledge and higher pre-course confidence (chi2(4)=10.9, p=0.03), but not with clinical role or greater experience. Nearly all (98%) successfully completed the BEC course. There was a significant improvement in knowledge (mean pre 77 vs. post 90, p<0.0001, z-factor -5.632, n=44) and confidence (mean pre 3.2 vs. post 4.0, p<0.0001, z-factor -4.331, n=44) after the course. Knowledge gains persisted 6 months post-course (mean 92, p=0.0001, z-factor -3.568, n=24). Approximately half (54%) of the participants utilized the BEC app; most (96%) found it helpful for the training but there was no significant difference in post-course knowledge between BEC app groups. Survey data showed consensus (100%) agreement that BEC would be beneficial for clinical practice, but most (54%) reported they did not have all the tools to be successful in implementation. The most commonly cited tools needed were essential equipment and medications (61%), additional staffing (11%) and more practice with skills (11%). Two of the three major emergency healthcare facilities for the region achieved a majority of HCWs trained in BEC in 9 months (72% and 83% respectively). The staged regional model is an effective method of BEC training. In preparation for BEC implementation, facilitators should ensure the appropriate clinical resources will be available. Future studies will include continued assessment of long-term knowledge retention and clinical translation of knowledge to improve emergency care.