Interventions
envenoming, acute kidney injury, necrosis
REFRACTORY SHOCK, COAGULOPATHY, COMPLICATIONS, NECROSIS
A full-day interactive teaching session, including group discussions, lectures, role-play, and demonstrations, was conducted at a central location in the district. The workshop was designed and delivered by experts (locally known senior consultant physicians, the principal researchers, and a herpetologist) and covered topics such as identification of the offending snakes, epidemiology and manifestations of envenoming, complications, appropriate transfer referrals, appropriate use of antivenom (AV), and management of AV reactions and resuscitation as per SLMA guidelines. Anticipated ventilatory problems, the requirement for intensive care unit care, severe coagulopathy, impending acute kidney injury, the necessity for surgical procedures for local necrosis and refractory shock, a lack of resuscitation facilities, AV, and emergency medicines were the accepted indicators for transfers.The participants' knowledge was evaluated at the beginning and end of the session using pre- and post-tests, respectively.Participants in the intervention workshop were encouraged to share their newly acquired knowledge and skills with the rest of their treating facility's staff as soon as possible. To support this activity, the research team visited each intervention hospital within a period of one week from the day of the workshop to facilitate the intended interactive discussions between the session participants and the rest of the medical staff at their respective treating facilities. The entire management team of each hospital in the intervention group was invited for a guided discussion. The study team provided the multimedia and other facilities to convene these interactive discussions. If any staff were absent on these occasions due to their commitments, arrangements were made to brief them on the subject on another day at their convenience. The procedure was reinforced throughout the study.Each intervention hospital received the SLMA treatment guidelines [Components of the educational InterventionThe control group did not participate in the workshop and received neither the printed version of the freely available online SLMA treatment guidelines nor any other components of the intervention. The study team did not offer any training to the staff of the control hospitals.