All hospitals in this study performed regular trauma team training using a homogenous approach, but with varying frequency.
In 2013, it was found that 37 (95%) of 39 Norwegian hospitals performed regular trainings, also with varying frequency [15]. Our findings confirm that there has not been any training fatigue, and suggest that Norwegian hospitals still view trauma team training useful and as a priority. There have likely been minor changes and adaptations to adjust training to the clinical real-life needs and possibilities during recent years. Although the available data does not allow the conclusion that there have been improvements over the past five years, trauma team training has been performed more regularly over the past decade. In 2006, Isaksen et al. concluded that Norway had efficiently implemented an improved trauma system compared to in 2000 [13]. At that time, half (54%) of the hospitals performed regular trauma team training, leaving ample room for improvement.
In 2000, Nathens reported that it takes decades to identify significant effects on mortality after implementation of organized trauma systems [3]. This must be remembered when assessing the effects of more regular trauma team training in the Norwegian trauma system. Our results illustrate a prominent shift in the frequency of trauma team training over recent years, particularly in the groups that trained less than 5 or over 15 times per year. Several hospitals reported that they performed trauma team trainings more often in 2020 compared to in 2013. This higher frequency of training may have a greater impact on maintaining trauma care skills.
Jeppesen et al. report that as of 2020, few studies have examined trauma team training in the Nordic countries [18]. The majority of such studies have been observational studies that lack significant evidence. Our present study is an observational study that addressed the status of trauma team training in Norway in 2020. The last time this theme was well examined was in 2015 [15].
The participating hospitals reported rather homogenous methods for trauma team training, including realistic simulation sessions based on real-life cases. A systematic review of trauma team training found it difficult to compare the studies due to variations in training durations, combinations of methods, focus areas, and numbers of participants [19]. The authors concluded that simulation-based trauma team training results in significant improvement of the trauma team, and discussed the need for more comprehensive randomized studies to evaluate the optimal approach for trauma team training [19]. Notably, multiple studies have shown positive effects and benefits from trauma team training [19–22].
It is difficult to define the best approach for trauma team training. The vast majority of studies have individually assessed the effects of various trauma team training programs. There is a lack of studies on determining the optimal approach, or that compare alternative approaches to trauma team training. The National Trauma Plan recommends that relevant personnel should participate in trauma team training at least once a year [10]. The majority of hospitals in our study arranged more than one trauma team training per year, but our data do not show whether each individual team member participated in multiple trainings per year. However, our results indicate that most hospitals arranged enough trauma team trainings per year for individuals possibly to participate in multiple sessions per year. The National Trauma Plan recommends trauma team training at least once annually for the purposes of compensating for a lack of real-life experience, and maintaining a satisfactory level of competence [10]. Falcone et al. demonstrated that monthly simulation-based trauma team training over a year resulted in a significantly improved trauma team function [21]. According to Miller et al., all of the observed improvements declined following cessation of the trauma team training simulation program [23]. Thus, on-going trauma team training is necessary to sustain the improvements. Some important factors that help to maintain regular trauma team training include local enthusiasts, administrative support, strategic planning, and facilitators [19, 24]. Future research should focus on determining the optimal duration, methods, and frequency of regular trauma team training [19, 20].
Limitations
The present respondents were limited to one local trauma team coordinator at each hospital, and the answers were not validated against other possible relevant sources. This methodology has previously been used for similar purposes in Norway. Our study had a somewhat lower response rate of 87%, but our findings were consistent with previous reports. Finally, the answers were not followed-up after data collection.