Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-22T05:54:43.107Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  29 July 2020

Canaan J. Hancock ,
Peter G. Delaney Open the ORCID record for Peter G. Delaney [Opens in a new window] ,
Zachary J. Eisner Open the ORCID record for Zachary J. Eisner [Opens in a new window] ,
Eric Kroner ,
Issa Mahamet-Nuur ,
John W. Scott  and
Krishnan Raghavendran
Canaan J. Hancock
Affiliation:
Washington University in St. Louis, St. Louis, MissouriUSA
Peter G. Delaney*
Affiliation:
University of Michigan Medical School, Ann Arbor, MichiganUSA
Zachary J. Eisner
Affiliation:
Washington University in St. Louis, St. Louis, MissouriUSA
Eric Kroner
Affiliation:
TEAM Chad, Am Timan, Chad
Issa Mahamet-Nuur
Affiliation:
Chadian Red Cross Society, Am Timan, Chad
John W. Scott
Affiliation:
University of Michigan, Department of Surgery, Ann Arbor, MichiganUSA
Krishnan Raghavendran
Affiliation:
University of Michigan, Department of Surgery, Ann Arbor, MichiganUSA
*
Correspondence: Peter G. Delaney, 1301 Catherine Street, Ann Arbor, Michigan48109USA, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

emergency careEmergency Medical Servicelow-income populationprehospital emergency carewounds and injuries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 546 - 553
Copyright
© World Association for Disaster and Emergency Medicine 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Mould-Millman, N-K, Dixon, JM, Sefa, N, et al. The state of Emergency Medical Services (EMS) systems in Africa. Prehosp Disaster Med. 2017;32(3):273–283.CrossRefGoogle ScholarPubMed
Nielsen, K, Mock, C, Joshipura, M, Rubiano, AM, Zakariah, A, Rivara, F. Assessment of the status of prehospital care in 13 low- and middle-income countries. Prehosp Emerg Care. 2012;16(3):381–389.CrossRefGoogle ScholarPubMed
Mock, CN, Jurkovich, GJ, nii-Amon-Kotei, D, Arreola-Risa, C, Maier, RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804–812; discussion 812-814.Google ScholarPubMed
Jamison, DT, World Bank, Disease Control Priorities Project, (eds). Disease Control Priorities in Developing Countries. 2nd ed. New York/Washington, DC USA: Oxford University Press/World Bank; 2006.Google ScholarPubMed
World Health Organization, (ed). Prehospital Trauma Care Systems. Geneva, Switzerland: WHO; 2005.Google Scholar
Mock, C, Essential Trauma Care Project (World Health Organization), World Health Organization, International Society of Surgery, International Association for the Surgery of Trauma and Surgical Intensive Care, (eds). Guidelines for Essential Trauma Care. Geneva, Switzerland: World Health Organization; 2004.Google Scholar
LaGrone, L, Riggle, K, Joshipura, M, et al. Uptake of the World Health Organization’s trauma care guidelines: a systematic review. Bull World Health Organ. 2016;94(8):585–598C.CrossRefGoogle ScholarPubMed
Callese, TE, Richards, CT, Shaw, P, et al. Trauma system development in low- and middle-income countries: a review. J Surg Res. 2015;193(1):300–307.CrossRefGoogle ScholarPubMed
Callese, TE, Richards, CT, Shaw, P, et al. Layperson trauma training in low- and middle-income countries: a review. J Surg Res. 2014;190(1):104–110.CrossRefGoogle ScholarPubMed
Sakran, JV, Greer, SE, Werlin, E, McCunn, M. Care of the injured worldwide: trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med. 2012;20:64.CrossRefGoogle ScholarPubMed
Suryanto, , Plummer, V, Boyle, M. EMS Systems in lower-middle income countries: a literature review. Prehosp Disaster Med. 2017;32(1):64–70.Google ScholarPubMed
Tannvik, TD, Bakke, HK, Wisborg, T. A systematic literature review on first aid provided by laypeople to trauma victims. Acta Anaesthesiol Scand. 2012;56(10):1222–1227.CrossRefGoogle ScholarPubMed
Orkin, AM, Curran, JD, Fortune, MK, et al. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol. BMJ Open. 2016;6(5):e010609.CrossRefGoogle ScholarPubMed
Murad, MK, Husum, H. Trained lay first responders reduce trauma mortality: a controlled study of rural trauma in Iraq. Prehosp Disaster Med. 2010;25(6):533–539.CrossRefGoogle Scholar
Husum, H, Gilbert, M, Wisborg, T, Van Heng, Y, Murad, M. Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma. 2003;54(6):1188–1196.CrossRefGoogle ScholarPubMed
World Bank. Global Monitoring Report 2007 (Overview): Confronting the Challenges of Gender Equality and Fragile States. Washington, DC USA: The World Bank; 2007.Google Scholar
Delaney, PG, Bamuleke, R, Lee, YJ. Lay first responder training in Eastern Uganda: leveraging transportation infrastructure to build an effective prehospital emergency care training program. World J Surg. 2018;42(8):2293–2302.Google ScholarPubMed
Delaney, PG, Figueroa, JA, Eisner, ZJ, et al. Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala. Trauma Surg Acute Care Open. 2020;5(1):e000409.CrossRefGoogle ScholarPubMed
Jayaraman, S, Mabweijano, JR, Lipnick, MS, et al. Current patterns of prehospital trauma care in Kampala, Uganda and the feasibility of a lay-first-responder training program. World J Surg. 2009;33(12):2512–2521.Google ScholarPubMed
Kisaalita, W, Sentongo-Kibalama, J. Delivery of urban transport in developing countries: the case for the motorcycle taxi service (boda-boda) operators of Kampala. Development Southern Africa. 2007;24(2):345–357.CrossRefGoogle Scholar
Galukande, M, Jombwe, J, Fualal, J, Gakwaya, A. Boda-boda injuries a health problem and a burden of disease in Uganda: a tertiary hospital survey. East and Central African Journal of Surgery. 2009;14(2).Google Scholar
Arreola-Risa, C, Mock, CN, Lojero-Wheatly, L, et al. Low-cost improvements in prehospital trauma care in a Latin American city. J Trauma. 2000;48(1):119–124.CrossRefGoogle Scholar
Mock, CN, Tiska, M, Adu-Ampofo, M, Boakye, G. Improvements in prehospital trauma care in an African country with no formal Emergency Medical Services. TRAUMA. 2002;53(1):9.Google Scholar
Razzak, JA, Kellermann, AL. Emergency medical care in developing countries: is it worthwhile? Bull World Health Organ. 2002;80(11):900–905.Google ScholarPubMed
Hall, A, Horton, S, de Silva, N. The costs and cost-effectiveness of mass treatment for intestinal nematode worm infections using different treatment thresholds. PLoS Negl Trop Dis. 2009;3(3):e402.CrossRefGoogle ScholarPubMed