A Pilot Study Using a Standardized Trauma Assessment Tool After Tactical Combat Casualty Care Course: A Comparison of the United States and Ghana.

INTRODUCTION: Assessment, monitoring, and evaluation have been a required part of Global Health Engagement but difficult to accomplish. The current assessment, monitoring, and evaluation frameworks require implementation at the start of the project and are not designed to use for already existing programs. Tactical Combat Casualty Care (TCCC) is a standardized course now offered in 89 countries, but there has not been a standardized method of evaluating the quality across programs. Ghana's TCCC program began in March 2022 and provides a platform for development of a new method of evaluation globally. METHODS: In this study, a standardized trauma scenario was performed by two groups of students, one who completed a TCCC Medical Provider course in Fort Detrick, MD and one who completed the course in Accra, Ghana. The students were scored using a standardized Trauma Assessment Score Sheet and the scores compared across the two groups. RESULTS: The mean Trauma Assessment Score was 58.5% in the United States and 58.3% in Ghana, with no statistically significant difference between the two groups (P-value of .97). When regressed for confounding variables such as years of experience and deployment, the two groups still had no statistically significant difference (P-value of .783). DISCUSSION: The two groups achieved similar mean scores despite significantly different testing environments and experience levels. Written post-test scores did not correlate well due to multiple confounding factors and appear to be a less accurate representation of student understanding and application than the Trauma Assessment Score. CONCLUSION: This study demonstrates use of a standardized scenario with graded checklist to compare between international programs. This can be used to and expanded to compare programs and support quality assurance and medical interoperability.

Sustainable Tactical Combat Casualty Care Implementation in Ghana: A Model for Future Development.

INTRODUCTION: Department of Defense policy for Global Health Engagement (GHE) activities prioritizes interoperability and sustainability within security cooperation, yet these elements, along with monitoring and evaluation, are not well reported. MATERIALS AND METHODS: In this case study reviewing 1 year after the implementation of a Tactical Combat Casualty Care (TCCC) program in Ghana, the Ghana Armed Forces (GAF) has conducted five independent TCCC Medical Provider Tier courses and four All Service Member Tier courses. They have certified 240 students, 21 instructors, and appointed 2 affiliate faculty members with the National Association of Emergency Medical Technicians (NAEMT). Ghana is one of the only four active NAEMT-certified TCCC training sites in Africa. The principles that allowed for this achievement could serve as a 'best practice' model for GHE. RESULTS: Principally, the GAF took ownership of the program from the onset. The program also had an extensive preparatory phase 0 before initiating phase 1 on the ground training, which included establishing leadership and a medical modeling and simulation center pre-engagement. The triple partnership achieved between the U.S. DoD's African Peacekeeping Rapid Response Partnership, the GAF, and the NAEMT, a civilian certifying organization, allowed the sustainment of the TCCC program. African Peacekeeping Rapid Response Partnership also built on experience from other programs to develop a multifaceted model. Persisting challenges to the current program and future GHEs include continued funding and equipment, the associated issues with rapid expansion, and monitoring and evaluation, which all pose barriers to continued sustainment. CONCLUSION: The year sustainment of the GAF TCCC training program provides hope as a model for future DoD GHEs to attain sustainable development and points to the possibility of long-term programs with meaningful outcomes.