Washington University in St. Louis, Department of Biomedical Engineering, USA.
University of Michigan Medical School, USA; Michigan Center for Global Surgery, USA.
Injury. 2022 Jan;53(1):176-182. doi: 10.1016/j.injury.2021.09.064. Epub 2021 Oct 6.
Few countries in Sub-Saharan Africa have robust emergency medical services (EMS). The WHO recommends training lay first responders (LFRs) as the first step toward EMS development while Disease Control Priorities (DCP) suggests training 0.5%-1% of a population for adequate emergency catchment. After launching three LFR programs in Africa, this study investigated subsequent skill usage and conducted demographic analyses to inform future recruitment of high-responding LFRs.
Demographic characteristics and individual LFR intervention frequencies were collected from a pooled sample of 887 of 1,291 total LFRs (68.7%) trained across programs launched in a staggered fashion between 2016-2019 in Uganda, Chad, and Sierra Leone. A Kruskal-Wallis Rank-Sum test assessed between-group differences among demographics in each location. Spearman's r was used to determine the relationship between response frequency and LFR characteristics.
Most LFRs trained did not use skills post-training (median LFR interventions=0.0 interventions/year [IQR:0.0,5.0]). Right-skewed intervention frequency distributions demonstrate high-responding outlier responder groups do exist in all locations (p<0.0001). Median LFR interventions of the top quartile of these active LFRs ("super-responders") was 26.0 interventions/year (IQR:16.7,35.0). "Super-responders" witnessed more road traffic injuries (RTIs) prior to training (p=0.033). LFRs who never responded were significantly younger (p=0.0020). Significant correlations were demonstrated between pooled RTIs witnessed and intervention frequency (r=0.13, p=0.032) and age and intervention frequency in Sierra Leone (r=-0.15, p=0.019).
Current DCP-recommended training of 0.5-1% of a given population for adequate emergency catchment may be an inefficient means of building emergency care capacity. Recruiting "super-responders" with select characteristics may achieve similar coverage while conserving valuable training resources in resource-limited African settings.
撒哈拉以南非洲的少数国家拥有强大的紧急医疗服务（EMS）。世界卫生组织（WHO）建议培训非专业急救人员（LFR）作为 EMS 发展的第一步，而疾病控制优先事项（DCP）则建议为适当的紧急救护范围培训 0.5%-1%的人口。在非洲启动了三个 LFR 项目后，本研究调查了随后的技能使用情况，并进行了人口统计学分析，以为未来招募高反应 LFR 提供信息。
从 2016 年至 2019 年分阶段在乌干达、乍得和塞拉利昂启动的三个 LFR 项目中培训的总共 1291 名 LFR 中，收集了一个 887 名的汇总样本的人口统计学特征和个体 LFR 干预频率。Kruskal-Wallis 秩和检验评估了每个地点人口统计学特征之间的组间差异。Spearman 的 r 用于确定响应频率与 LFR 特征之间的关系。
大多数接受培训的 LFR 培训后并未使用技能（中位数 LFR 干预次数=0.0 次/年[IQR：0.0，5.0]）。偏态分布的干预频率分布表明，在所有地点都存在高反应的异常值反应者群体（p<0.0001）。这些活跃的 LFR 中处于前四分位数的 LFR 干预中位数（“超级反应者”）为 26.0 次/年（IQR：16.7，35.0）。在培训前，“超级反应者”目睹了更多的道路交通伤害（RTI）（p=0.033）。从未响应的 LFR 明显更年轻（p=0.0020）。在汇总的 RTI 见证与干预频率之间显示出显著相关性（r=0.13，p=0.032），并且在塞拉利昂的年龄与干预频率之间也存在显著相关性（r=-0.15，p=0.019）。
目前 DCP 建议为适当的紧急救护范围培训给定人群的 0.5-1%，可能是建立紧急护理能力的一种低效手段。在资源有限的非洲环境中，招募具有特定特征的“超级反应者”可能会达到类似的覆盖率，同时节省宝贵的培训资源。
