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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

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: petergde@med.umich.edu
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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

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