Background Trauma represents a significant and increasing challenge to health care

Background Trauma represents a challenge to healthcare systems worldwide, particularly in low-and middleincome countries. Positive effects can be achieved by improving trauma care at the scene of the accident and throughout hospitalization and rehabilitation. Therefore, we assessed the long-term effects of national implementation of a training program for multidisciplinary trauma teams in a southern African country. Methods From 2007 to 2009, an educational program for trauma, ''Better and Systematic Team Training,'' (BEST) was implemented at all government hospitals in Botswana. The effects were assessed through interviews, a structured questionnaire, and physical inspections using the World Health Organization's ''Guidelines for Essential Trauma Care.'' Data on human and physical resources, infrastructure, trauma administrative functions, and qualityimprovement activities before and at 2-year follow-up were compared for all 27 government hospitals. Results A majority of hospitals had formed local trauma organizations; half were performing multidisciplinary trauma simulations and some had organized multidisciplinary trauma teams with alarm criteria. A number of hospitals had developed local trauma guidelines and local trauma registries. More equipment for advanced airway management and stiff cervical collars were available after 2 years. There were also improvements in the skills necessary for airway and breathing management. The most changes were seen in the northern region of Botswana. Conclusions Implementation of BEST in Botswana hospitals was associated with several positive changes at 2-year follow-up, particularly for trauma administrative functions and quality-improvement activities. The effects on obtaining technical equipment and skills were moderate and related mostly to airway and breathing management.

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