Article Text
Abstract
Community members in developing areas can effectively learn first responder training, and skill decay afterwards is not continuous. It is critical that training be done in the trainees' primary language, even if they speak other languages fluently. Making first responder training obligatory for employees and students may be an effective way to generate first responders.
- Pre-hospital care
- education
- global health
- emergency ambulance systems
- first responders
- care systems
- major incident planning
- emergency care systems
- emergency departments
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- Pre-hospital care
- education
- global health
- emergency ambulance systems
- first responders
- care systems
- major incident planning
- emergency care systems
- emergency departments
Introduction
In an effort to address emergency needs in developing countries, several studies have suggested the use of community members as first responders.1–9 However, even though one of the most critical prerequisites for first responders to reduce morbidity and mortality is that they have to learn and retain the skills long after certification, very little is known about how lay-persons in low-resource, developing areas learn and retain first responder training.
Methods
In 2010, a single instructor taught the Emergency First Aid Responder (EFAR) training course to 628 community members from crime-violent, low-resource townships in Cape Town, South Africa. The course curriculum and format is elaborately described elsewhere.10 The course was taught in English. Some trainees were recruited by voluntary sign-up, and others were required to attend the training by their employers or school principals.
Trainees completed a skill examination both before and after each training session, and those scoring at least 75% on the post-course examination qualified for EFAR certification; they were re-tested 4 and 6 months later. Examination scores were correlated using SASV.9.1 with a 95% CI using univariate and multivariate regressions, which controlled for voluntary status, reported first language, education level and prior medical training. Ethics approval was granted by the Stanford University and University of Cape Town ethics committees.
Results
The EFAR training course significantly improved all trainees' basic life support skills (see table 1). After training, enough EFARs were followed-up to represent all certified EFARs with a confidence level of over 90%, and they had statistically similar pre- and post-training test scores and demographics compared with those we could not follow-up. Certified EFARs tested experienced significant skill decay by 4 months, but experienced no decay thereafter (see figure 1 and table 2).
In addition, trainees who were required to attend the course by an authority experienced no negative effect on pass rates or scores. By contrast, though all trainees spoke English fluently as a common language, those who did not report English as a first language had much lower pass rates and scores, and were the only population where certified EFARs continued to have skill decay between 4 and 6 months post-certification (p=0.0018).
Discussion
It is evident that community members in a developing area are able to adequately learn and retain a first responder training course. In addition, the clearest trend in our study was that the decay of basic life support skills after training was not continuous. We recommend further research to confirm this trend for periods longer than 6 months.
Our data also show that it is critical for first responder training to be done in a trainee's primary language, even if they speak another language fluently. Finally, because trainees who were required to take the course scored just as well if not better than voluntary trainees, we believe that making first responder training a requirement at schools or workplaces would be an effective way to generate large numbers of people in developing communities who know how to provide effective basic life support in emergency situations.
Acknowledgments
The authors wish to thank the Manenberg Health Committee for allowing them to be a part of the community, the Manenberg People's Centre for providing them a teaching venue, the Fulbright Scholarship for providing funding and support, and Jia Chan at Stanford University for helping with the statistical analysis. The authors also greatly appreciate all the trained Emergency First Aid Responders whose desire to help their own communities was truly inspirational.
Footnotes
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Funding This study was sponsored by the Fulbright Scholarship, which did not have any active role in the study. The authors had full access to all the data in the study and had final responsibility for the decision to submit it for publication.
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Competing interests None.
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Ethics approval Ethics approval was provided by the Stanford University and University of Cape Town ethics committees.
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Provenance and peer review Not commissioned; externally peer reviewed.