Evaluating a Novel Prehospital Emergency Trauma Care Assessment Tool (PETCAT) for Low‐ and Middle‐Income Countries in Sierra Leone

Abstract

Background WHO recommends training lay first responders (LFRs) as the first step toward formal emergency medical services development, yet no tool exists to evaluate LFR programs. Methods We developed Prehospital Emergency Trauma Care Assessment Tool (PETCAT), a seven‐question survey administered to first‐line hospital‐based healthcare providers, to independently assess LFR prehospital intervention frequency and quality. PETCAT surveys were administered one month pre‐LFR program launch (June 2019) in Makeni, Sierra Leone and again 14 months post‐launch (August 2020). Using a difference‐in‐differences approach, PETCAT was also administered in a control city (Kenema) with no LFR training intervention during the study period at the same intervals to control for secular trends. PETCAT measured change in both the experimental and control locations. Cronbach's alpha, point bi‐serial correlation, and inter‐rater reliability using Cohen's Kappa assessed PETCAT reliability. Results PETCAT administration to 90 first‐line, hospital‐based healthcare providers found baseline prehospital intervention were rare in Makeni and Kenema prior to LFR program launch (1.2/10 vs. 1.8/10). Fourteen months post‐LFR program implementation, PETCAT demonstrated prehospital interventions increased in Makeni with LFRs (5.2/10, p < 0.0001) and not in Kenema (1.2/10) by an adjusted difference of + 4.6 points/10 (p < 0.0001) (“never/rarely” to “half the time”), indicating negligible change due to secular trends. PETCAT demonstrated high reliability (Cronbach's α = 0.93, Cohen's K = 0.62). Conclusions PETCAT measures changes in rates of prehospital care delivery by LFRs in a resource‐limited African setting and may serve as a robust tool for independent EMS quality assessment.

Bystander intervention is associated with reduced early mortality among injury victims in Cameroon

“…As road traffic injuries constitute the injury mechanism for nearly three quarters of the patients in our cohort, and commercial vehicles transport over half of injured patients, our findings suggest taxi and mototaxi drivers potentially represent an ideal target for LFR training in Cameroon. Mototaxi drivers have been trained as first responders elsewhere in sub-Saharan Africa, including Uganda, Chad, Nigeria, and Sierra Leone, with associated evidence of increase in access to prehospital care [ 8 – 11 ]. However, cultural context varies greatly between settings and buy-in from LFR trainees is critical to intervention feasibility.…”

“…Trainee populations have included mototaxi drivers, taxi drivers, police officers, and firefighters [ 7 – 9 ]. LFR programs have been piloted in sub-Saharan Africa, but, to date, evaluations have largely focused on educational outcomes, program cost effectiveness, and reported utilization [ 8 , 10 – 12 ]. The paucity of prospective clinical data collection in these settings has limited formal evaluation of the relationship between bystander intervention and clinical trauma outcomes.…”

Bystander intervention is associated with reduced mortality among injury victims in Cameroon

“…4 Among LFR programs piloted across multiple sub-Saharan African countries, evaluations have been restricted to LFR educational outcomes, program cost effectiveness, and prehospital patient analyses without longitudinal clinical outcomes due to the lack of prospective data following LFR implementation. 8, 10-12 Without longitudinal clinical data to measure patient outcomes following prehospital LFR care, evaluation of LFR program efficacy has been limited.…”

“…Such trainee populations have included mototaxi drivers, taxi drivers, police officers, and firefighters. [7][8][9] Implementation of LFR programs may reduce 45% of all-cause mortality across LMIC. 4 Among LFR programs piloted across multiple sub-Saharan African countries, evaluations have been restricted to LFR educational outcomes, program cost effectiveness, and prehospital patient analyses without longitudinal clinical outcomes due to the lack of prospective data following LFR implementation.…”

“…4 Among LFR programs piloted across multiple sub-Saharan African countries, evaluations have been restricted to LFR educational outcomes, program cost effectiveness, and prehospital patient analyses without longitudinal clinical outcomes due to the lack of prospective data following LFR implementation. 8,[10][11][12] Without longitudinal clinical data to measure patient outcomes following prehospital LFR care, evaluation of LFR program efficacy has been limited. In 2015, we developed the Cameroon Trauma Registry (CTR), a prospective, ongoing, multisite trauma registry that has since collected data on over 30,000 patients across four medical centers: Laquintinie Hospital, Regional Hospital of Limbe, Catholic Hospital of Pouma, and Regional Hospital of Edea.…”