T. E. Callese1,2, S. K. Nelson1, M. Boeck2,3,4, S. J. Schuetz5, C. F. Bazan6, J. Mauricio P. Saavedra Laguna7, M. B. Shapiro5, N. M. Issa5, M. Swaroop2,5 1Wake Forest University School Of Medicine,Winston-Salem, NC, USA 2Northwestern University,Center For Global Health, Feinberg School Of Medicine,Chicago, IL, USA 3Brigham And Women’s Hospital, Center For Surgery And Public Healt,Boston, MA, USA 4New York Presbyterian Hospital, Columbia Department Of Surgery,New York City, NY, USA 5Northwestern University,Division Of Trauma And Critical Care, Feinberg School Of Medicine,Chicago, IL, USA 6Arco Iris Hospital,La Paz, LA PAZ, Bolivia 7Bolivian National Police,La Paz, LA PAZ, Bolivia
Introduction: Trauma is a significant cause of death and disability worldwide; especially in low- and middle-income countries (LMICs) where over 90% of injury mortalities occur. Bolivia is a LMIC that lacks a cohesive emergency response system and accessible pre-hospital care, including adequately trained first-responders. The World Health Organization (WHO) considers layperson first-responders as an essential component of effective trauma systems in low-resource settings to increase the emergency medical workforce capacity. This study sought to analyze participant evaluations on a novel trauma first-responder course (TFRC) offered in La Paz, Bolivia.
Methods: The TFRC was offered for a nominal fee to adults in the department of La Paz. An American surgeon and medical student led nine separate eight-hour sessions in March and April 2013. There were didactic and practical components that built upon existing training course models with local stakeholder input, ensuring the covered material accounted for local area needs and treatment resources. At the conclusion of the course participants completed a program evaluation, which included a self-assessment of knowledge and skill acquisition, course reflections and individual session ratings.
Results: One hundred fifty-nine participants completed evaluations for analysis, of which 97.5% rated the course as useful and 96.7% believed they would apply the skills learned in the future. Median participant self-confidence ratings in first aid skills (range 0-5) showed an upward trend from baseline to post-course (4 vs. 5). Ninety-one percent of participants deemed the depth of training appropriate, with only 3.2% and 5.8% rating it as too basic or overly technical, respectively. The majority of respondents were in favor of introducing more topics and increasing the length of practical sessions in future course offerings. The 13 didactic and four practical sessions were individually graded on quality, resulting in median scores of 4 or higher on a five-point scale, where five indicates excellent.
Conclusion: This study represents the first offering of a novel TFRC in a resource-limited setting that received largely positive evaluations from course participants. Responses were almost unanimously affirmative on course usefulness, as well as suitable subject depth and coverage of context-appropriate topics. Participant feedback suggests offering more didactic sessions on locally relevant topics and increasing the length of practical sessions in future iterations. While a majority of medical personnel attended these initial TFRCs, future work will aim to expand enrollment to layperson first-responders whom the WHO identifies as critical components of pre-hospital care in LMICs. All of which strongly support the further development and expansion of this TFRC throughout Bolivia, filling the gap in basic trauma training and moving towards improved care of the injured.