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

• Published in: Prehospital and disaster medicine 2020-10, Vol.35 (5), p.546-553
• Main Authors: Hancock, Canaan J., Delaney, Peter G., Eisner, Zachary J., Kroner, Eric, Mahamet-Nuur, Issa, Scott, John W., Raghavendran, Krishnan
• Format: Article
• Language: English
• Subjects: Airway management; Cardiopulmonary resuscitation; Community; CPR; Curricula; Emergency medical care; Emergency medical services; Emergency services; First aid; Health technology assessment; Investigations; Knowledge acquisition; Low income groups; Original Research; Qualitative research; Rural areas; Sensitivity analysis; Social classes; Trauma
• ISSN: 1049-023X; 1945-1938
• DOI: 10.1017/S1049023X20000977

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