Evaluation of a Lay First Responder Program in Sierra Leone as a Scalable Model for Prehospital Trauma Care

Eisner, Zachary J.; Delaney, Peter G.; Thullah, Alfred H.; Yu, Amanda J.; Timbo, Sallieu B.; Koroma, Sylvester; Sandy, Kpawuru; Sesay, Abdulai Daniel; Turay, P; Scott, John W.; Raghavendran, Krishnan

doi:10.1016/j.injury.2020.09.001

Cited by 16 publications

(36 citation statements)

References 24 publications

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“…18 Other studies have documented similar trauma training courses in austere prehospital settings. 19,20 A third dimension is developing in-country expertise with strategic thinking and innovations in low resource settings. Capacity building efforts should focus on emergency and mass casualty response but also CBRNE teaching opportunities for new experts in Ukraine to address current and future threats.…”

Section: Pre/post Test Results and Confidence Scoresmentioning

confidence: 99%

Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War

Erickson,

Harvin,

Schmid

et al. 2023

Disaster med. public health prep.

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Objective: The aim of this study was to evaluate the change in knowledge and skill confidence after implementation of a chemical, biological, radiological, nuclear, and explosive (CBRNE) training course during the Russia-Ukraine War. Methods: Pre/post-test study in the Ukrainian cities of Kyiv, Dnipro, Zaporizhzhia, and Odesa. Fifteen CBRNE courses were conducted over a 3-mo period, August to October 2022. Change in knowledge and skills confidence were evaluated with pre/post-course written exams and practical skill assessments that were observed during the training exercises. Changes were analyzed based on nonparametric Wilcoxon matched-pairs signed-rank testing. Pre/post self-efficacy surveys were analyzed with McNemar’s test for paired data. Course evaluations were conducted with standardized questions which assessed instruction quality, teaching relevance, knowledge gained, and post-course skills confidence. Results: A total of 523 participants registered and completed 1 of the 15 courses. Overall mean pre-course test score: 57.8% (SD 20.7%); mean post-course test score: 81.4% (SD 11.3%); participants with increasing test scores: 90.7%; mean difference in score (95% confidence interval) 23.6% (21.2%-25.9%), P < 0.0001. Pre/post self-efficacy surveys (4-point Likert scale) noted participants recognized signs and symptoms of a CBRNE incident, and necessary skills to manage CBRNE exposures, P < 0.0001. Conclusions: The implementation of this CBRNE course for front-line providers in Ukraine was successful. To our knowledge, it was the first implementation of a field course during the current Russian-Ukraine war. Future research should evaluate knowledge retention and impact of our innovative Train-the-Trainer model. Further iterations should emphasize expanding the quantity of training equipment and practical skill sessions.

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Section: Pre/post Test Results and Confidence Scoresmentioning

confidence: 99%

Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War

Erickson,

Harvin,

Schmid

et al. 2023

Disaster med. public health prep.

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“…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 ].…”

Section: Discussionmentioning

confidence: 99%

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

Eisner

Delaney

Widder

et al. 2021

African Journal of Emergency Medicine

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Introduction Traumatic spinal cord injury (TSCI) constitutes a considerable portion of the global injury burden, disproportionately affecting low- and middle-income countries (LMICs). Prehospital care can address TSCI morbidity and mortality, but emergency medical services are lacking in LMICs. The current standard of prehospital care for TSCI in sub-Saharan Africa and other LMICs is unknown. Methods This review sought to describe the state of training and resources for prehospital TSCI management in sub-Saharan Africa and other LMICs. Articles published between 1 January 1995 and 1 March 2020 were identified using PMC, MEDLINE, and Scopus databases following PRISMA-ScR guidelines. Inclusion criteria spanned first responder training programs delivering prehospital care for TSCI. Two reviewers assessed full texts meeting inclusion criteria for quality using the Newcastle-Ottawa Scale and extracted relevant characteristics to assess trends in the state of prehospital TSCI care in sub-Saharan Africa and other LMICs. Results Of an initial 482 articles identified, 23 met inclusion criteria, of which ten were set in Africa, representing eight countries. C-spine immobilization precautions for suspected TSCI patients is the most prevalent prehospital TSCI intervention for and is in every LMIC first responder program reviewed, except one. Numerous first responder programs providing TSCI care operate without C-collar access (n = 13) and few teach full spinal immobilization (n = 5). Rapid transport is most frequently reported as the key mortality-reducing factor (n = 11). Despite more studies conducted in the Southeast Asia/Middle East (n = 13), prehospital TSCI studies in Africa are more geographically diverse, but responder courses are shorter, produce fewer professional responders, and have limited C-collar availability. Discussion Deficits in training and resources to manage TSCI highlights the need for large prospective trials evaluating alternative C-spine immobilization methods for TCSI that are more readily available across diverse LMIC environments and the importance of understanding resource variability to sustainably improve prehospital TSCI care.

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“…During the initial six months, LFRs treated 1,850 patients, most frequently controlling hemorrhage in 61.2% of encounters, immobilizing fractures in 55.6%, managing airway and breathing in 17.2%, and extricating patients from vehicles in 11.2% of encounters. LFRs transported patients to definitive care via motorcycle in 98.9% of encounters [16]. This longitudinal impact on prehospital care expansion provided the basis for PETCAT evaluation in Makeni with a control for secular trends in Kenema, 125 miles apart.…”

Section: Methodsmentioning

confidence: 99%

“…The WHO recommends training lay first responders (LFRs) as the first step toward developing formal EMS [14,15]. During the implementation of an LFR program in Makeni, Sierra Leone with 4,529 LFRs [16], we aimed to develop a Prehospital Emergency Trauma Care Assessment Tool (PETCAT) and evaluate its ability to assess LFR programs by measuring changes in the prevalence of prehospital care provided by LFRs over fourteen months.…”

Section: Introductionmentioning

confidence: 99%

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

Delaney

Eisner

Thullah³

et al. 2021

World j. surg.

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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.

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Evaluation of a Lay First Responder Program in Sierra Leone as a Scalable Model for Prehospital Trauma Care

Cited by 16 publications

References 24 publications

Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War

Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War

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

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

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