University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI, 48109, USA.
Washington University in St. Louis, St. Louis, MO, USA.
World J Surg. 2021 Aug;45(8):2370-2377. doi: 10.1007/s00268-021-06140-1. Epub 2021 Apr 28.
WHO recommends training lay first responders (LFRs) as the first step toward formal emergency medical services development, yet no tool exists to evaluate LFR programs.
We developed Prehospital Emergency Trauma Care Assessment Tool (PETCAT), a seven-question survey administered to first-line hospital-based healthcare providers, to independently assess LFR prehospital intervention frequency and quality. PETCAT surveys were administered one month pre-LFR program launch (June 2019) in Makeni, Sierra Leone and again 14 months post-launch (August 2020). Using a difference-in-differences approach, PETCAT was also administered in a control city (Kenema) with no LFR training intervention during the study period at the same intervals to control for secular trends. PETCAT measured change in both the experimental and control locations. Cronbach's alpha, point bi-serial correlation, and inter-rater reliability using Cohen's Kappa assessed PETCAT reliability.
PETCAT administration to 90 first-line, hospital-based healthcare providers found baseline prehospital intervention were rare in Makeni and Kenema prior to LFR program launch (1.2/10 vs. 1.8/10). Fourteen months post-LFR program implementation, PETCAT demonstrated prehospital interventions increased in Makeni with LFRs (5.2/10, p < 0.0001) and not in Kenema (1.2/10) by an adjusted difference of + 4.6 points/10 (p < 0.0001) ("never/rarely" to "half the time"), indicating negligible change due to secular trends. PETCAT demonstrated high reliability (Cronbach's α = 0.93, Cohen's K = 0.62).
PETCAT measures changes in rates of prehospital care delivery by LFRs in a resource-limited African setting and may serve as a robust tool for independent EMS quality assessment.
世界卫生组织建议对非专业急救人员（LFR）进行培训，作为向正规紧急医疗服务发展的第一步，然而目前尚无工具可用于评估 LFR 项目。
我们开发了院前急救创伤评估工具（PETCAT），这是一种对一线医院医护人员进行的七项调查，用于独立评估 LFR 院前干预的频率和质量。PETCAT 调查于 2019 年 6 月（LFR 项目启动前一个月）在塞拉利昂马克尼进行，并于 2020 年 8 月（项目启动后 14 个月）再次进行。采用差异中的差异方法，在研究期间没有 LFR 培训干预的对照城市（凯内马）同时在相同的时间间隔内进行 PETCAT 调查，以控制季节性趋势。PETCAT 测量了实验组和对照组的变化。采用克朗巴赫的阿尔法、点二项相关和科恩的 Kappa 进行的评分者间信度评估 PETCAT 的信度。
对 90 名一线医院医护人员进行的 PETCAT 管理发现，在 LFR 项目启动之前，马克尼和凯内马的院前干预很少见（1.2/10 对 1.8/10）。在 LFR 项目实施 14 个月后，PETCAT 显示 LFR 使马克尼的院前干预增加（5.2/10，p<0.0001），而凯内马则没有增加（1.2/10），调整差异为+4.6 分/10（p<0.0001）（从不/很少到一半时间），表明由于季节性趋势导致的变化微不足道。PETCAT 表现出很高的可靠性（克朗巴赫的阿尔法=0.93，科恩的 K=0.62）。
PETCAT 测量了在资源有限的非洲环境中 LFR 提供院前护理的比率变化，并且可以作为独立的 EMS 质量评估的有力工具。
