Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program

Abstract

Introduction: The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs. Study Objective: A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs. Methods: An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results. Results: A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses. Conclusion: Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

Prehospital care for traumatic spinal cord injury by first responders in 8 sub-Saharan African countries and 6 other low- and middle-income countries: A scoping review

“…With recent expansion of LFR programs across LMICs using transportation providers to make prehospital TSCI treatment feasible where it had not been previously [ 20 , 43. , [44] , [45] ], the near-absent rehabilitation of people with TSCI should be addressed simultaneously or post-injury rehabilitations resources may be overwhelmed as an unintended consequence of improving prehospital TSCI care [ 2 ].…”

Prehospital Care System in Low-Resource Setting: Experiences Learned from Newly Established System in Jimma City, Southwest of Ethiopia

“…A hospital-based or local (municipality level fire department or legal enforcement) model can also be used to organize a tier-two system that provides professional prehospital care within a defined jurisdiction and will be linked to the tier-one system (3,6). Moreover, Mould-Millman et al (18) have clearly Perspective PAJEC outlined the steps towards establishing such a two-tier emergency medical dispatch system in small-and large-scale areas in the African context, while success stories have been reported in a few countries on the continent (7,(19)(20)(21)(22)(23)(24) and countries on other continents such as Pakistan (25). Nevertheless, organizing and sustaining PHC systems, in particular a large-scale two tier system continued to be challenging both technically and financially in resource-limited settings, primarily in many African countries (26)(27)(28)(29).…”

TraumaLink: A Community-Based First-Responder System for Traffic Injury Victims in Bangladesh

“…They have to be at least 18 years old, but there are no minimum literacy or educational requirements. Although other programs have targeted training commercial drivers, [15][16][17][18][31][32][33] we did not regard this as a viable option in Bangladesh, where any driver involved in a crash can become a target of violence from bystanders, so many drivers quickly flee the scene if they are well enough to do so.…”