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Sustainability First: Evaluating a Digital Training of Trainers Approach for Lay First Responders in a Post-COVID-19 World
- Zachary Eisner, Nathanael Smith, Peter Delaney, Aswhin Kulkarni, Paschal Achunine, Francis Shiada, Krishnan Raghavendran
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue S1 / May 2023
- Published online by Cambridge University Press:
- 13 July 2023, p. s17
- Print publication:
- May 2023
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- Article
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Introduction:
Road traffic injuries (RTIs) are the largest individual contributor to the global burden of injury and were among the five leading causes of global disability-adjusted life years (DALYs) in 2016. In regions with limited emergency medical services, training lay first responders (LFRs) has been shown to increase availability of prehospital care for RTIs, but sustainable mechanisms to scale these programs remain unstudied.
Method:Using a training of trainers (TOT) model, a six-hour LFR training program was launched in Lagos, Nigeria. The course was taught in a hybrid fashion with primary didactics over Zoom and practical in-person breakout sessions. Thirty TOTs proceeded to train 350 transportation providers as LFRs over one month. A previously validated, 23 question, pre-/post- assessment was administered digitally to assess knowledge acquisition. Participants responded to five-point Likert survey assessing instruction quality and post-course confidence.
Results:TOTs scored a median of 56.5% (IQR: 43.5%, 71.7%) and 91.3% (IQR: 88.0%, 95.7%) on the pre- and post-assessments, respectively, with bleeding control scores increasing most (+69.4%). Course trainees scored a median of 34.8% (IQR: 26.0%, 43.5%) and 73.9% (IQR: 65.2%, 82.6%) on the pre- and post-assessments, respectively, with airway and breathing increasing most (+48.6%). All score increases were statistically significant with p<0.001 and did not differ by trainer. Participants rated confidence 5/5 (IQR: 5,5) in first aid skills and 5/5 (IQR: 4,5) in emergency transportation, increasing from pre-course confidences of 3/5 (IQR: 3,4) and 4/5 (IQR: 3,5), respectively (p<0.001). Participants rated the quality of education content and TOT instructors to be 5/5 (IQR:5,5).
Conclusion:This is the first time the efficacy of digital instruction for first responder trainers in LMICs has been investigated and demonstrates knowledge acquisition equivalent to that of prior in-person courses. Future work will examine the cost-effectiveness of the training of LFRs and the effect of LFRs on trauma outcomes.
Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program
- Canaan J. Hancock, Peter G. Delaney, Zachary J. Eisner, Eric Kroner, Issa Mahamet-Nuur, John W. Scott, Krishnan Raghavendran
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- Journal:
- Prehospital and Disaster Medicine / Volume 35 / Issue 5 / October 2020
- Published online by Cambridge University Press:
- 29 July 2020, pp. 546-553
- Print publication:
- October 2020
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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.