Post-Crash Trauma Care: First-Responder Training for the Traffic Police in Makwanpur, Nepal; A Pre and Post-Intervention Cross-Sectional Survey

Abstract

BackgroundThe World Health Organisation has estimated Nepal's road traffic fatality rate as one of the highest in South-East Asia. Road-crashes are the 7th leading cause of mortality in Nepal, but there is currently a lack of nationwide emergency medical services. We developed, designed and evaluated the feasibility of a first responder training programme for the traffic police in Nepal.Methods39 traffic police officers in Makwanpur District participated in the study and 29 attended the 3-day first response course. A training needs assessment survey was conducted with participants prior to course design. A knowledge and confidence pre-test was followed-up by post-testing. Participants were supplied with a trauma-pack and asked to complete a report form when first-responder skills were used. Post-testing and follow-up survey were conducted at 6-months which explored experiences of applying first response skills.ResultsPre-course needs assessment showed that 97% of the participants believed that giving first-aid was their responsibility;95% had experience of transporting road-crash victims to hospital with a range of injuries. Low levels of first-aid training and a lack of standardisation were reported. Knowledge and confidence levels were low in pre-test. Post-test knowledge scores improved by 40% to 75%. Confidence levels improved post-course but were reduced at 6-months. In the 6-month study period, participants attended 303 road-crashes. 44% of the participants had used at least one first-response skill from the course; applying skills on 92 occasions, though incident report-forms were frequently not completed. ConclusionsDelivering a first-response programme for the traffic-police is feasible. Knowledge could be retained and used, and skills were in frequent demand. Barriers to providing treatment included; patient already en-route to hospital; resistance from relatives or bystanders and competing police duties. Further studies will need to reinforce the need to capture the use of incident report forms when first responder skills are applied. It is feasible practically and financially to extend the training to cover other districts/all of Nepal as a low-cost measure to combat road traffic injury in the absence of formal emergency medical services.