LFR International

Uganda

In 2016, Delaney launched an early iteration of what would eventually become the LFR model with the Uganda Red Cross Society in Iganga, Uganda.^[11] A lay first responder program of 154 motorcycle taxi responders was created to explore its capacity to provide prehospital emergency care for victims of road traffic injury in a municipality of 100,000 people.^[4] Encountering nearly 10% mortality, first responders assisted 250 victims in the first few months (83% of which were road traffic injury-related) and utilized bleeding control skills in over half of encounters.^[4]

Three years later in 2019, LFR investigators explored the social and financial implications of first responder trainings for initial participants. Though the World Health Organization had recommended training laypeople as the first step toward developing formal emergency medical services since 2004, there had previously been no investigations of the effects of trainings for laypeople. As the first to do so, LFR researchers found 75% of initial participants continued to voluntarily participate and described various apparent benefits to training, namely in an increase in social stature and income, in Emergency Medicine Journal.^[3]

Chad

In 2018, LFR collaborated with trainers from the Red Cross of Chad to develop a lay first responder program in Am Timan, located in the rural Salamat Region, which had previously claimed the title of “poorest region” globally as measured by a multidimensional poverty index by the World Bank and International Monetary Fund.^[12] Under extreme resource limitations, an LFR program was launched by training 108 motorcycle taxi drivers to provide care for 36,000 people. Curriculum efficacy was evaluated using pre- and post-course tests, which demonstrated significant knowledge acquisition in participants.^[5]

In 2019, during follow-up interviews with initial participants after 12 months of providing emergency care, trainees reported sustained voluntary participation due the ability to care for the injured, new knowledge/skills, and the resultant gain in social stature and customer acquisition. Findings suggested LFR programs appear feasible and cost-effective in rural, resource-limited sub-Saharan African settings.^[5]

Guatemala

Prehospital trauma management training with DIFEP (Division of Special Police Forces) and PNC (Policia Nacional Civil) in Guatemala, 2019

In 2019, LFR deployed to Guatemala to investigate the development of first responder programs in a middle-income, Central American setting. LFR worked with affiliates of the Guatemalan Ministry of the Interior to train hundreds of members of the Policia Nacional Civil and CVB across the Escuintla, Sacatepéquez, and Chimaltenango departments in prehospital trauma management.^[13] A study conducted alongside the trainings found a single-day, five-hour training course effectively trained participants to provide effective prehospital emergency care.^[1]

Sierra Leone

In 2019, LFR was a co-founding member of the First Responder Coalition of Sierra Leone (FRCSL) with the Sierra Leone Red Cross Society, Agency for Rural Community Transformation, the Holy Spirit Hospital of Makeni, and the University of Makeni, its national partners.^[14] With the launch of the coalition, the FRCSL committed to training more than 1,000 community members in Makeni as LFRs.^[15] Between July and December 2019, 4,529 LFRs were trained by local LFR instructors. LFRs were later found to have treated 1,850 patients over the following six months, demonstrating significant emergency care knowledge improvement and retention in LFR participants.^[16]

Over a 14-month period, impact was assessed using the Prehospital Emergency Trauma Care Assessment Tool (PETCAT), a novel survey instrument LFR designed and administered to first-line hospital-based healthcare providers, to independently assess the frequency and quality of prehospital intervention by LFRs.^[17] Change in emergency care was controlled for by using a difference-in-differences approach and comparing change in Makeni, where the intervention had been launched, to Kenema, a control city 125 miles away without an LFR program. While controlling for secular trends, prehospital care in Makeni was demonstrated to have improved significantly over the 14-month study period, while also validating PETCAT as a robust tool for independent EMS quality assessment in resource-limited settings.^[17]