Establishing a national advanced trauma life support charter for Ghana

A team of sixteen doctors are in the United Kingdom for a one-week intensive training programme to become Advanced Trauma Life Support (ATLS) Instructors.

They are accompanied by three people – Prof. Kankam Boadu, National ATLS Educator, Emmanuel Kwasi Acheampong, National ATLS Coordinator and Dr.George Oduro, National ATLS Director. 

The training programme is the second of three stages for Ghana to gain a Charter from the American College of Surgeons. 

The Charter will allow Ghana to establish an internationally recognised ATLS training programme for Ghanaian doctors with the goal to help improve the care of patients who have sustained injuries, however these injuries were caused. 

The three stages include a site inspection, a Train the Trainers’ course, and a Promulgation (or first) course in-country. 

The site inspection visit was successfully completed last year at the Department of Emergency Medicine, Komfo Anokye Teaching Hospital (KATH) in Kumasi.  

A memorandum of understanding was signed between ATLS International and the Ghana College of Physicians and Surgeons on November 14, 2015.

The estimated total cost of completing all three stages to acquire the ATLS training Charter for Ghana is US$250,000. 

According to Emmanuel Kwasi Acheampong, ATLS Coordinator, they appealed for funds from more than 60 corporate bodies and from individuals and to date US$80,000 has been raised to pay for the first of the two stages.

“We are still appealing to individuals, philanthropists, and corporate bodies to provide the remaining financial assistance towards the funding needed to complete the establishment of ATLS training in Ghana under a national Charter,” he said.

The table below shows the yearly human toll from road traffic crashes in Ghana.

Road accidents are among the top causes of death in Ghana.  Following mass casualties like the recent Kintampo MMT bus accident which claimed more than 50 lives, the issue gains transient prominence in the news, but then is soon forgotten; and the steady toll of death continues with an average of five deaths every day from road traffic crashes.  Ghana has been ranked as number 38 in global road traffic deaths. 

The most vulnerable group comprises young people of working age (WHO, 2015).  There is also published evidence that given the same level of injury, a patient in Ghana is six times more likely to die than if the same patient were in the USA.  The cost in human lives, pain, suffering, and disabilities are high, but so also is the financial cost.  Ghana loses 1.6% of her GDP (which translates to more than US$ 165 million in 2006, US$ 288 million in 2009, and more than US$ 500 million at current estimates) to this carnage through the loss of productive hours, increased incidence of disability, and increased healthcare cost.  We are of the view that improving the care that is given to all patients injured in accidents can help to control this silent epidemic.

It is a fact that these accidents do not respect person or position.  Laudable efforts by the National Road Safety Commission, Motor Transport and Traffic Directorate of the Ghana Police Service, and seasonal road safety campaigns are geared towards prevention, which is good.  The sad truth is that over the years the carnage on our roads has continued at a relentless pace.  Prevention is always better than cure.  But since accidents will be with us for the foreseeable future, no matter how much we might improve prevention, it makes good sense to invest in highly skilled physicians, nurses, and paramedics who often are the last hope for a seriously injured patient.

ATLS was started in the USA around 1980 following an accident in which an Orthopaedic Surgeon and his family sustained serious injuries; his wife was killed instantly.  The surgeon subsequently championed improvements in the early care of severely injured patients during the first few hours following injury, the so-called “Golden Hour”; if good care is provided during the “golden hour” the patient has the best chance of survival, but after this period the chance of survival decreases exponentially.  

ATLS is internationally recognized as a standardized way of treating injured patients to improve outcomes and reduce death and disability from injuries.  The combined educational format of lectures, lifesaving skills demonstrations, and practical experience form the basis of the ATLS course.  The ATLS course was adopted by the American College of Surgeons in 1980, and since then the course has been “exported” to 64 countries worldwide.  We hope to become the 65th country when we promulgate our first course in Ghana (stage 3) next year.  We have only been able to come this far because of the financial support from the previously mentioned benefactors.

There is evidence that the intensive, structured training improves the knowledge, skills, confidence, and performance of doctors who have taken part in an ATLS course when they treat injured patients; and these effects may be more pronounced in developing countries.  This would seem to support the wise quote from Bruce Lee that “I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times”.  The educational content is further supported by a robust quality assurance program.  ATLS Providers also gain valuable competencies which are transferable to the care of other medical emergencies.

ATLS courses have been held in Ghana in the past by visiting expatriate faculty.  A number of doctors certified as ATLS Providers are thus available in Ghana.  However, without a national Charter a country is not certified to train ATLS Instructors.  It is our belief that there are distinct advantages in acquiring a national Charter so that Ghana can train doctors to become Providers and Instructors.

The 16 doctors participating in the training will serve as the first cohort of ATLS Instructors in Ghana, under the International ATLS Charter. They will go on to train other doctors (Providers) to use ATLS protocols in caring for patients injured in accidents.  They will also be able to train those Providers who excel in an ATLS course to become ATLS instructors.  Funding for the local training program will be from fees charged to participating doctors, so that the ATLS Ghana Chapter will become self-sustaining when established.  Our mission is to rapidly build capacity to improve safe and effective emergency care to all injured patients in Ghana, to reduce deaths and disabilities from injury, and thereby maximize quality of life for injured patients, their dependents, and the wider community.

We expect that after successful completion of the Train the Trainers’ Course the first course or Promulgation course (stage 3) will be held at Komfo Anokye Teaching Hospital in 2017.  ATLS courses will be run biannually and later quarterly, and it is hoped over time will enroll all doctors providing care to injured patients.  With local experience of running these courses, and with increasing numbers of ATLS Instructors, the courses will spread to other selected hospitals.  Support from the Ministry of Health, Ghana Health Service, Ghana College of Physicians and Surgeons (GCPS), Ghana Medical and Dental Council (GMDC), the Teaching Hospitals and CHAG Hospitals, in this regard will be helpful.