Evidence for international first aid guidelines predominantly comes from studies conducted in western contexts during peacetime and/or healthcare settings. Yet, internationally the burden of trauma falls on low- and middle-income countries where lay responders might have to act in fragile contexts, where first aid and healthcare resources are limited or not available.
This study focuses on the principles and practices that govern first aid education (FAE), versus clinical evidence of first aid interventions. Accepting that application of first aid may vary according to context, we sought to understand educational principles according to contextual resources of fragile and non-fragile environments.
We interviewed educators, from six countries where conflict, geography or resources deemed them to be fragile, to explore which educational approaches were used and found effective in educating potential lay responders.
Through qualitative analysis, we identified educational approaches and themes including:
We connected a similar set of educational approaches in non-fragile contexts, as reflected in the International First Aid and Resuscitation Guidelines 2016. Recognizing common educational approaches provides educators with a common base on which to develop their educational approach and build future recommendations with global applicability. This also allows for mutual research and application between FAE in fragile and non-fragile environments.
Evaluating the Impact of Simulated Patients on Knowledge, Skills and Attitudes of Laypeople Following a Basic First Aid Course: Protocol for a Cluster-Randomized Controlled Trial05/09/2019
Background: Teaching first aid to laypeople is a cost-effective way to improve public health. However, it is currently unclear what the most effective ways are to teaching first aid. It has already been shown that simulated patients have an added value in teaching emergency care to healthcare professionals. This paper describes the protocol for a cluster-randomized controlled trial that will investigate the influence of using a simulated patient during basic first aid training for laypeople on their knowledge, skills and self-efficacy.
Hypothesis: The null hypothesis of this research is that the use of simulated patients during basic first aid training does not result in a statistically significant change in knowledge, skills and self-efficacy concerning the first aid topics for which a simulated patient is used. The alternative is that knowledge, skills and self-efficacy will be influenced by using simulated patients during training.
Methods: This study will be a cluster-randomized controlled trial, that will take place from September 2018 to June 2020. The study population will consist of employees from several organisations taking a three day first aid certification course with the Belgian Red Cross. The organisations requesting a first aid course will be randomised in receiving a course with or without simulated patient. The simulated patient will only be used for the topics “first aid for burns” and “first aid for stroke” in the intervention group. The participants will complete a questionnaire to measure their knowledge and self-efficacy, and complete a practical skills test after the course testing these first aid topics. To test whether the retention of first aid knowledge and self-efficacy is influenced by using a simulated patient during a certification course, participants following a refresher course one year after the certification course will complete a follow-up questionnaire.
Conclusion: This cluster-randomized controlled trial will be, to our knowledge, the first to investigate the added value of simulated patients during first aid courses for laypeople.
Submitted below as full text of submission
Bleeding from traumatic injury is a major source of morbidity and mortality, however, little data is available to aid guidelines and curriculum developers in best practice of applying direct pressure when treating or teaching how to stop life-threatening hemorrhage.
Hypothesis: This study investigated the use of two-handed pressure with bent arms versus two-handed pressure with straight arms to apply direct pressure to a hemorrhage model.
Methods: Participants, recruited as a convenience sample, were randomized and instructed to use either two hands overlapping using arm strength only, or two hands overlapping with arms straight in a “CPR-like” position to apply force to a standardized hemorrhage control trainer with electronic feedback (Z-Medica), set to record a minimum pressure of 3-psi (155 mmHg); representing as satisfactory pressure to occlude blood flow. Participants were allowed to train for 30 seconds and then were asked to hold pressure at or above 3-psi for a three-minute time period. Participants were not given any feedback during testing. The program output reported the percent of time above the 3-psi pressure following participant completion of the three-minute time period.
Results: Thirty participants were enrolled and had data available for analysis. Demographics were statistically similar across groups. When using bent arms, participants provided pressure at or above 3-psi 63.7 % (SD 33.1) of the time. Participants using the “CPR posture” were above 3-psi 100% (SD 0) of the time [mean difference 36.27% (95% CI 18.78-53.75%). The difference between the two experimental arms remained statistically significant when examined by age, gender, or medical experience.
Conclusions: A straight-armed “CPR posture” allowed participants to successfully apply pressure to stop simulated bleeding, according to study parameters, 100% of the time. This information provides evidence about the most efficient way to provide high quality direct pressure to stop life-threatening hemorrhage. This method appears applicable to a broad demographic. As this posture is already widely taught in CPR classes, it can be readily adopted for teaching or controlling hemorrhage.
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