Zachary J Eisner1, Peter G Delaney2, Alfred H Thullah3, Amanda J Yu1, Sallieu B Timbo4, Sylvester Koroma5, Kpawuru Sandy4, Abdulai Daniel Sesay6, Patrick Turay7, John W Scott8, Krishnan Raghavendran8. 1. Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, United States; LFR International Encino, California, United States. 2. LFR International Encino, California, United States; University of Michigan Medical School, 1301 Catherine St., Ann Arbor, Michigan, United States; Michigan Center for Global Surgery, Ann Arbor, Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, United States. Electronic address: petergde@med.umich.edu. 3. LFR International Encino, California, United States; Agency for Rural Community Transformation, Plot 4, Lunsar-Makeni Highway, Makeni, Sierra Leone. 4. Sierra Leone Red Cross Society, 6, Liverpool St., Freetown, Sierra Leone. 5. University of Makeni, Lunsar-Makeni Highway, Makeni, Sierra Leone. 6. City Garden Hospital, 4 Arabic College Road, Makeni, Sierra Leone. 7. LFR International Encino, California, United States; Holy Spirit Hospital, Makeni, Sierra Leone. 8. Michigan Center for Global Surgery, Ann Arbor, Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, United States; University of Michigan Health System, Department of Surgery, 1500 E Medical Center Dr, Ann Arbor, MI, United States.
Abstract
INTRODUCTION: Few countries in Sub-Saharan Africa have robust emergency medical services (EMS). The World Health Organization (WHO) recommends scaling-up lay first responder programs as the first step toward formal EMS development. MATERIALS AND METHODS: We trained and equipped 4,529 lay first responders (LFRs) between June-December 2019 in Bombali District, Sierra Leone, with a 5-hour hands-on, contextually-adapted prehospital trauma course to cover 535,000 people. Instructors trained 1,029 LFRs and 50 local trainers in a training-of-trainers (TOT) model, who then trained an additional 3,500 LFRs. A validated, 23-question pre-/post-test measured knowledge improvement, while six- and nine-month follow-up tests measured knowledge retention. Incident reports tracked patient encounters to assess longitudinal impact. RESULTS: Median pre-/post-test scores improved by 43.5 percentage points (34.8% vs. 78.3%, p<0.0001). Knowledge retention was assessed at six months, with median score dropping to 60.9%, while at nine months, median score dropped to 43.5%. Lay first responders participating in courses led by TOT trainers had a pre-/post-test median score improvement of 30.4 percentage points (21.7% vs. 52.2%, p<0.0001). LFRs treated 1,850 patients over six months, most frequently utilizing hemorrhage control skills in 61.2% of encounters (1,133/1,850). The plurality of patients were young adult males (36.8%) and 48.7% of encounters were motorcycle injury-related. CONCLUSION: A 5-hour first responder course targeting laypeople demonstrates significant emergency care knowledge improvement and retention. By training networks of transportation providers, lay first responder programs represent a robust and scalable prehospital emergency care alternative for low-resource settings.
INTRODUCTION: Few countries in Sub-Saharan Africa have robust emergency medical services (EMS). The World Health Organization (WHO) recommends scaling-up lay first responder programs as the first step toward formal EMS development. MATERIALS AND METHODS: We trained and equipped 4,529 lay first responders (LFRs) between June-December 2019 in Bombali District, Sierra Leone, with a 5-hour hands-on, contextually-adapted prehospital trauma course to cover 535,000 people. Instructors trained 1,029 LFRs and 50 local trainers in a training-of-trainers (TOT) model, who then trained an additional 3,500 LFRs. A validated, 23-question pre-/post-test measured knowledge improvement, while six- and nine-month follow-up tests measured knowledge retention. Incident reports tracked patient encounters to assess longitudinal impact. RESULTS: Median pre-/post-test scores improved by 43.5 percentage points (34.8% vs. 78.3%, p<0.0001). Knowledge retention was assessed at six months, with median score dropping to 60.9%, while at nine months, median score dropped to 43.5%. Lay first responders participating in courses led by TOT trainers had a pre-/post-test median score improvement of 30.4 percentage points (21.7% vs. 52.2%, p<0.0001). LFRs treated 1,850 patients over six months, most frequently utilizing hemorrhage control skills in 61.2% of encounters (1,133/1,850). The plurality of patients were young adult males (36.8%) and 48.7% of encounters were motorcycle injury-related. CONCLUSION: A 5-hour first responder course targeting laypeople demonstrates significant emergency care knowledge improvement and retention. By training networks of transportation providers, lay first responder programs represent a robust and scalable prehospital emergency care alternative for low-resource settings.
Authors: Zachary J Eisner; Peter G Delaney; Patricia Widder; Ilyas S Aleem; Denise G Tate; Krishnan Raghavendran; John W Scott Journal: Afr J Emerg Med Date: 2021-06-06