Lay First Responder Training in Eastern Uganda: Leveraging Transportation Infrastructure to Build an Effective Prehospital Emergency Care Training Program

Delaney, Peter G.; Bamuleke, Richard; Lee, Yang Jae

doi:10.1007/s00268-018-4467-3

Cited by 32 publications

(42 citation statements)

References 36 publications

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“…Technicians (NREMT; Columbus, Ohio USA) developed the LFR course, adapting a WHO-informed curriculum previously implemented in Uganda, consisting of five components: principles and definitions of first aid, scene safety, airway management/ hemorrhage control (ABCs), fracture splinting, and victim transport ( Table 1). 17 The final curriculum was translated and revised in collaboration with a local physician, given his knowledge of local mechanisms of injury. To ensure local ownership of the course and cultural appropriateness, investigators collaborated with the local Red Crescent chapter and co-taught the course with a local Red Crescent instructor.…”

Section: Course Development Two American National Registry Of Emergenmentioning

confidence: 99%

“…Based on a local needs assessment and findings from a previous study conducted in Uganda, motorcycle taxi drivers (locally known as "clandos") were chosen for trainings because of their strategic self-dispersion, profession-driven proximity to road trauma, and the potential scalability of the program post-implementation by leveraging the pre-existing network infrastructure of transportation providers. 17 Correct answers on the pre-and post-test were assigned a score of one point while incorrect, blank, or multiple answers were assigned a score of zero points. A pre-test/post-test difference index (PPDI) was assigned to each question to quantify participant improvement.…”

Section: Study Participantsmentioning

confidence: 99%

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

Hancock

Delaney

Eisner

et al. 2020

Prehosp. Disaster med.

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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.

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Section: Course Development Two American National Registry Of Emergenmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

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

Hancock

Delaney

Eisner

et al. 2020

Prehosp. Disaster med.

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“…Two American national registry-certified emergency medical technicians and a National Association of EMS Educatorscertified emergency medical responder instructor developed the lay first responder course, building on prior experience studying, developing, and launching lay first responder programs in Chad and Uganda. 17 The final curriculum was revised in collaboration with two local Guatemalan physicians from Jocotenango Municipal Clinic (located in Antigua Guatemala), given their experience and knowledge of local trauma and injury mechanisms. The curriculum was informed by the WHO's guidelines, the Red Cross, and the American College of Surgeons Prehospital Trauma Life Support Course and "Stop The Bleed" Initiative.…”

Section: Course Developmentmentioning

confidence: 99%

Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala

Delaney

Figueroa

Eisner

et al. 2020

Trauma Surg Acute Care Open

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BackgroundInjury disproportionately affects low-income and middle-income countries, yet robust emergency medical services are often lacking to effectively address the prehospital injury burden. A half-day prehospital emergency trauma care curriculum was designed for first responders and piloted in the Sacatepéquez, Chimaltenango, and Escuintla departments in Guatemala.MethodsThree hundred and fifty-four law enforcement personnel, firefighters, and civilians volunteered to participate in a 5-hour emergency care course teaching scene safety, triage, airway management, cardiopulmonary resuscitation, fracture management, and victim transport. A validated 26-question pretest/post-test study instrument was contextually adapted and used to measure overall test performance, the primary study outcome, as well as test performance stratified by occupation, the secondary study outcome. Pretest/post-test score distributions were compared using a Wilcoxon signed-rank test. For test evaluation, knowledge acquisition on a by-question and by-category basis was examined using McNemar’s χ² test, whereas item difficulty indices used frequency-of-distribution tests and item discrimination indices used point biserial correlation.ResultsTwo hundred and eighty-seven participants qualified for inclusion. Participant mean pretest versus post-test scores improved 24 percentage points after course completion (43% vs 68%, p<0.001). Cronbach’s alpha yielded values of 0.86 (pretest) and 0.94 (post-test), suggesting testing instrument reliability. Between-group analyses demonstrated law enforcement and civilian participants improved more than firefighters (p<0.001). Performance on 23 of 26 questions improved significantly. All test questions except one showed an increase in their PPDI.DiscussionA 1-day, contextually adapted, 5-hour course targeting laypeople demonstrates significant improvements in emergency care knowledge. Future investigations of similar curricula should be trialed in alternate low-resource settings with increased civilian participation to evaluate efficacy and replicability as adequate substitutes for longer courses. This study suggests future courses teaching emergency care for lay first responders may be reduced to 5 hours duration.Level of evidenceLevel II.

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“…The importance of a prehospital system care (which involves the ability to quickly obtain care, rapid and appropriate referrals, and the safe transportation of patients) for a better outcome of injured children is no longer demonstrated. It has been shown today that, wholesale, poorly planned imitations of high-income countries-type prehospital systems in low- and middle-income countries often result in expensive, inefficient systems [18, 19] and, that alternatively, low-cost interventions, for example, first responder training programs in Uganda and Mexico, have resulted in excellent outcomes for relatively low costs [19, 20].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo

Egbohou

Mouzou

Tchètikè

et al. 2019

Anesthesiology Research and Practice

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Introduction. Severe pediatric traumatic brain injury (pTBI) is a leading cause of disability and death in children worldwide. Children victims of pTBI are admitted to the Sylvanus Olympio University Hospital (SOUH) at the multipurpose Intensive Care Unit (ICU). We aimed in this study to describe the epidemiologic characteristics and outcomes of pTBI patients admitted in this ICU. Patients and Methods. This study was conducted at the ICU of SOUH of Lome. It was a retrospective study based on patients’ records from 0 to 15 years old admitted during the period from 1 January 2012 to 30 June 2018 (5 years and 6 months). Results. We recorded 91 pTBI included in the study. The mean age was 7.7 ± 4.3 years. The male predominated with 67.0%. Road traffic accidents were the most common cause (79.1%), followed by falls (19.8%). The average pediatric Glasgow Coma Scale (pGCS) was 6.6 ± 1.4, with a mean Injury Severity Score (ISS) of 23.1 ± 8.4. The most common brain injuries found in the CT scan were brain edema (72.9%), skull fracture (69.5%), and brain contusion (55.9%). The average duration under mechanical ventilation was 2.1 ± 2.9 days, and the mean ICU stay was 4.9 ± 4.4 days. Overall mortality was 31.9% (29 cases). Factors significantly associated (p<0.05) with death were hypotension (51.7%), anemia (43.1%), hyperthermia (46.7%), GCS < 6 (64%), and ISS > 20 (48.9%). Conclusion. pTBI mortality remains high in SOUH ICU. Factors associated with mortality were secondary systemic insults, worse GCS < 6, and ISS > 20.

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Lay First Responder Training in Eastern Uganda: Leveraging Transportation Infrastructure to Build an Effective Prehospital Emergency Care Training Program

Abstract: A prehospital care system composed of lay first responders can be developed leveraging existing transport organizations, offering a scalable alternative for LMICs, demonstrating usefulness in practice and measurable educational improvements in trauma skills for non-clinical lay responders.

Cited by 32 publications

References 36 publications

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

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

Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala

Epidemiology of Pediatric Traumatic Brain Injury at Sylvanus Olympio University Hospital of Lomé in Togo

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