This Is a Drill: Developing an Obstetric Emergency Drills Program
By María Belizán, Daniela Colaci, Agustina Mazzoni, Ezequiel García-Elorrio, Sebastián García-Martí, and Fernando Althabe, Institute for Clinical Effectiveness and Health Policy (IECS)
This post describes field experience that helped shape the Obstetric Emergency Drills Training Kit, a new free resource for clinicians seeking ways to manage complications like postpartum hemorrhage and pre-eclampsia/eclampsia, the leading causes of maternal mortality globally.
Introducing the Concept of Obstetric Emergency Drills in Ethiopia
Since obstetric emergency events are rare, clinicians have few opportunities to practice managing these complications when they occur. Obstetric emergency drills—a simulated obstetric emergency in a facility—allow midwives, nurses, and physicians to maintain skills, optimize practices, and improve teamwork within and among facilities.
In November 2012, representatives from the Maternal Health Task Force (MHTF) and researchers from Argentina’s Institute for Clinical Effectiveness and Health Policy (IECS) met with local clinicians and administrators at Saint Paul Millennium Hospital in Addis Ababa, Ethiopia to introduce the concept of the obstetric emergency drill and learn ways to adapt the strategy for the urban Ethiopian context. Prior to this project, clinicians had never utilized drill exercises in health care settings in Ethiopia; our challenge was to build rapport with local partners and explain the benefits of conducting obstetric emergency drills.
In order to better understand the Ethiopian context, we conducted formative research, which included observation and in-depth, semi-structured interviews. We spent a week visiting the hospital and clinics and discussing our ideas for practical implementation with local health workers and our Ethiopian partners. They provided abundant feedback, insight, and suggestions for integrating the obstetric emergency drills in the hospital and its network of primary health centers.
Conducting Obstetric Emergency Drills Training in Ethiopia
After an extremely informative and enriching first trip, our next challenge was to develop a training kit that would fulfill local needs and expectations. Guided by the qualitative data we gathered in Ethiopia, our team developed a strategy for implementing the obstetric emergency drills with our partners in Ethiopia. We created a presentation and wrote various scripts, adapting each to a different scenario or cultural context. Our team then video recorded role-plays of the drill exercises and debriefing sessions.
In the spring of 2013, we returned to Addis to train teams of nurses, midwives, and physicians. Teams practiced implementing the drills scenarios in a classroom set designed to replicate a hospital setting as well as in hospitals and health clinics.
After our informative field experience in Ethiopia, we further refined and adapted the training materials, including the trainer’s manual, videos, drill scenarios, and debriefing guide.
Training the Trainers in India
As part of a program supported by the MHTF and India’s St. John’s Research Institute that included obstetric emergency and newborn care training, IECS was asked to “train the trainers” on the use of emergency obstetric drills. The program was implemented in four First Referral Units located in the northern regions of Karnataka State, India. IECS designed the training so that our partner organizations could utilize emergency drills in their research and quality improvement efforts, even in the absence of external support. During our first site visit in April 2013, we learned how to adapt the obstetric emergency drills training materials (manual, videos, drill scenarios, and debriefing guide) to this specific setting.
In September 2013, we traveled to Bangalore, India to conduct another round of obstetric emergency drills training. During the 4-day training we collaborated with Anne Austin (then with the MHTF) to create sample cases and then practice conducting drill exercises with trainers in simulated settings at Saint John’s Hospital.
A large audience attended the lectures provided during the first day. The following days included hands-on training where all the attendees had the opportunity to observe or practice the obstetric emergency drills. A total of 28 health professionals – 14 from Bangalore and 14 from the cities of Bagalkot, Belgaum, Saragur, Manipal, and Kuppam – completed the training. These professionals were trained to later replicate the training in their own settings. A post-lecture survey indicated that over 90% of participants found the training to be highly useful and would recommend this training to other health professionals.
After a productive training and assessment, we left our partners with a trainer’s manual, videos, obstetric emergency drills scenarios, and debriefing guide to carry out the obstetric emergency drills in their local hospital and clinics.
Our formative research and field experience helped inform the Obstetric Emergency Drills Training Kit, featuring video footage of the site visits in Ethiopia and India.
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Download and Share the Obstetric Emergency Drills Training Kit!
We encourage the maternal health community to utilize the Obstetric Emergency Drills Training Kit, a free resource for clinicians seeking ways to prepare for obstetric emergencies.
Read more on the development and release of the Obstetric Emergency Drills Training Kit.
Has your facility implemented obstetric emergency drills? We would love to hear about your experience! Please send feedback to mhtf@hsph.harvard.edu.