The Lay First Responder Model, or LFR Model, uses motorcycle taxi drivers trained as first responders to provide basic prehospital emergency care in resource-limited settings of low- and middle-income countries. First published in the World Journal of Surgery in 2018 by Peter G. Delaney, it was initially demonstrated in Uganda in 2016.[1] Since its creation, the lay first responder model has also been deployed across Chad and Sierra Leone.[2][3]

History

The global injury burden, representing 10% of global mortality, is disproportionately borne by low- and middle-income countries.[4] In high-income countries, emergency medical services address injured patients in the prehospital setting, but these systems are absent or non-robust in resource-limited settings, exacerbated by poorly resourced and trained personnel.[5] As motorization increases in low- and middle-income countries, the global burden of injury is projected to expand in these settings.[6] Replicating high-income country emergency medical services in resource-limited settings of low- and middle-income countries has failed due to financial inviability, predicating the need for an alternative strategy to provide prehospital emergency care in resource-limited settings of low- and middle-income countries. In 2004, the World Health Organization recommended training bystanders as the first step toward establishing formal emergency medical services,[7] but no systematic model existed to support scaling up prehospital care using bystanders or development into mature systems.

EFAR System Model

Initial work by Jared Sun and Lee A. Wallis training community members as emergency first aid responders in Manenberg, South Africa eventually led to the creation of the EFAR System Model in 2012.[8] Community members arrived earlier to accidents than professionally dispatched emergency medical providers, suggesting formal programs training community members was worth exploring.[9][10] Though it was designed to support the development of formal emergency care systems, the EFAR system model has primarily served to alleviate inconsistent and unreliable response times of emergency services in the Cape Town area, with some expansion into Zambia in 2015.[11][12]

Lay First Responder Model

In 2016, similar issues with a lack of prehospital response that had been recognized in Uganda prompted the search for a sustainable alternative, which could affordably provide prehospital emergency care. Motorcycle taxi drivers who were closest to road traffic injuries, possessed a means of transport, and self-dispersed in search of customers (providing wide geographic coverage) were then trained as lay first responders.[1] After three years, 75% of initial trainees continued to respond to emergencies voluntarily reportedly because of increased social stature, customer acquisition, and confidence as lay first responders.[13] In later studies, findings were replicated in Chad and Sierra Leone by LFR International with thousands of other motorcycle taxis,[2][3] with results demonstrating training lay first responders significantly expanded prehospital care availability cost-effectively.[14]

See also

References

  1. 1 2 Delaney, Peter G.; Bamuleke, Richard; Lee, Yang Jae (2018-08-01). "Lay First Responder Training in Eastern Uganda: Leveraging Transportation Infrastructure to Build an Effective Prehospital Emergency Care Training Program". World Journal of Surgery. 42 (8): 2293–2302. doi:10.1007/s00268-018-4467-3. ISSN 1432-2323. PMID 29349487. S2CID 25105908.
  2. 1 2 Hancock, Canaan J.; Delaney, Peter G.; Eisner, Zachary J.; Kroner, Eric; Mahamet-Nuur, Issa; Scott, John W.; Raghavendran, Krishnan (October 2020). "Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program". Prehospital and Disaster Medicine. 35 (5): 546–553. doi:10.1017/S1049023X20000977. ISSN 1049-023X. PMID 32723421. S2CID 220848454.
  3. 1 2 Eisner, Zachary J.; Delaney, Peter G.; Thullah, Alfred H.; Yu, Amanda J.; Timbo, Sallieu B.; Koroma, Sylvester; Sandy, Kpawuru; Sesay, Abdulai Daniel; Turay, Patrick; Scott, John W.; Raghavendran, Krishnan (2020-11-01). "Evaluation of a Lay First Responder Program in Sierra Leone as a Scalable Model for Prehospital Trauma Care". Injury. 51 (11): 2565–2573. doi:10.1016/j.injury.2020.09.001. ISSN 0020-1383. PMID 32917385. S2CID 221637243.
  4. ↑ "WHO | Injuries and violence: the facts". WHO. Archived from the original on March 30, 2013. Retrieved 2021-05-13.
  5. ↑ Krug, E. G.; Sharma, G. K.; Lozano, R. (2000-04-01). "The global burden of injuries". American Journal of Public Health. 90 (4): 523–526. doi:10.2105/AJPH.90.4.523. ISSN 0090-0036. PMC 1446200. PMID 10754963.
  6. ↑ "WHO | Injuries: the neglected burden in developing countries". WHO. Archived from the original on March 25, 2015. Retrieved 2019-08-14.
  7. ↑ "Guidelines for Essential Trauma Care" (PDF). World Health Organization. 2004.
  8. ↑ Sun, Jared H.; Wallis, Lee A. (2012-08-01). "The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need". Emergency Medicine Journal. 29 (8): 673–678. doi:10.1136/emermed-2011-200271. ISSN 1472-0205. PMID 22011973. S2CID 23871044.
  9. ↑ Wallis, Lee A.; Sun, Jared H. (2012-08-01). "The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need". Emergency Medicine Journal. 29 (8): 673–678. doi:10.1136/emermed-2011-200271. ISSN 1472-0205. PMID 22011973. S2CID 23871044.
  10. ↑ "Podcast#21(Part2): "Africa's Best Practice?" « HarrisCPD". Retrieved 2019-08-14.
  11. ↑ Holtzman, Jessie (2012-02-09). "No Time to Waste: Community Emergency Responder Programs in South Africa". Stanford Journal of Public Health. Retrieved 2019-08-14.
  12. ↑ Wallis, Lee A.; Kafwamfwa, Muhumpu; Cunningham, Charmaine; Pigoga, Jennifer L. (2017-12-01). "Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting". BMJ Open. 7 (12): e018389. doi:10.1136/bmjopen-2017-018389. ISSN 2044-6055. PMC 5778307. PMID 29229657.
  13. ↑ Delaney, Peter G.; Eisner, Zachary J.; Blackwell, T. Scott; Ssekalo, Ibrahim; Kazungu, Rauben; Lee, Yang Jae; Scott, John W.; Raghavendran, Krishnan (2021-01-01). "Exploring the factors motivating continued Lay First Responder participation in Uganda: a mixed-methods, 3-year follow-up". Emergency Medicine Journal. 38 (1): 40–46. doi:10.1136/emermed-2020-210076. ISSN 1472-0205. PMID 33127741. S2CID 226217068.
  14. ↑ Delaney, Peter G.; Eisner, Zachary J.; Thullah, Alfred H.; Muller, Benjamin D.; Sandy, Kpawuru; Boonstra, Philip S.; Scott, John W.; Raghavendran, Krishnan (2021-04-28). "Evaluating a Novel Prehospital Emergency Trauma Care Assessment Tool (PETCAT) for Low- and Middle-Income Countries in Sierra Leone". World Journal of Surgery. 45 (8): 2370–2377. doi:10.1007/s00268-021-06140-1. ISSN 1432-2323. PMID 33907897. S2CID 233417002.
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