Lay First Responder Model
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, it was initially demonstrated in Uganda in 2016.{{Cite journal|last1=Delaney|first1=Peter G.|author-link1=Peter G. Delaney|last2=Bamuleke|first2=Richard|last3=Lee|first3=Yang Jae|date=2018-08-01|title=Lay First Responder Training in Eastern Uganda: Leveraging Transportation Infrastructure to Build an Effective Prehospital Emergency Care Training Program|url=https://doi.org/10.1007/s00268-018-4467-3|journal=World Journal of Surgery|language=en|volume=42|issue=8|pages=2293–2302|doi=10.1007/s00268-018-4467-3|pmid=29349487 |s2cid=25105908 |issn=1432-2323|url-access=subscription}} Since its creation, the lay first responder model has also been deployed across Chad and Sierra Leone.{{Cite journal|last1=Hancock|first1=Canaan J.|last2=Delaney|first2=Peter G.|author-link2=Peter G. Delaney|last3=Eisner|first3=Zachary J.|author-link3=Zachary J. Eisner|last4=Kroner|first4=Eric|last5=Mahamet-Nuur|first5=Issa|last6=Scott|first6=John W.|last7=Raghavendran|first7=Krishnan|author-link7=Krishnan Raghavendran|date=October 2020|title=Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program|url=https://www.cambridge.org/core/journals/prehospital-and-disaster-medicine/article/abs/developing-a-lay-first-responder-program-in-chad-a-12month-followup-evaluation-of-a-rural-prehospital-emergency-care-program/410EC7AB52EA35337ABB352F1E74A71C|journal=Prehospital and Disaster Medicine|language=en|volume=35|issue=5|pages=546–553|doi=10.1017/S1049023X20000977|pmid=32723421 |s2cid=220848454 |issn=1049-023X|url-access=subscription}}{{Cite journal|last1=Eisner|first1=Zachary J.|author-link1=Zachary J. Eisner|last2=Delaney|first2=Peter G.|author-link2=Peter G. Delaney|last3=Thullah|first3=Alfred H.|last4=Yu|first4=Amanda J.|last5=Timbo|first5=Sallieu B.|last6=Koroma|first6=Sylvester|last7=Sandy|first7=Kpawuru|last8=Sesay|first8=Abdulai Daniel|last9=Turay|first9=Patrick|last10=Scott|first10=John W.|last11=Raghavendran|first11=Krishnan|author-link11=Krishnan Raghavendran|date=2020-11-01|title=Evaluation of a Lay First Responder Program in Sierra Leone as a Scalable Model for Prehospital Trauma Care|url=https://www.injuryjournal.com/article/S0020-1383(20)30708-7/abstract|journal=Injury|language=English|volume=51|issue=11|pages=2565–2573|doi=10.1016/j.injury.2020.09.001|issn=0020-1383|pmid=32917385|s2cid=221637243 |url-access=subscription}}
History
The global injury burden, representing 10% of global mortality, is disproportionately borne by low- and middle-income countries.{{Cite web|title=WHO {{!}} Injuries and violence: the facts|url=https://www.who.int/violence_injury_prevention/key_facts/en/|archive-url=https://web.archive.org/web/20130330191420/http://www.who.int/violence_injury_prevention/key_facts/en/|url-status=dead|archive-date=March 30, 2013|access-date=2021-05-13|website=WHO}} 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.{{Cite journal|last1=Krug|first1=E. G.|last2=Sharma|first2=G. K.|last3=Lozano|first3=R.|date=2000-04-01|title=The global burden of injuries|journal=American Journal of Public Health|volume=90|issue=4|pages=523–526|doi=10.2105/AJPH.90.4.523|issn=0090-0036|pmc=1446200|pmid=10754963}} As motorization increases in low- and middle-income countries, the global burden of injury is projected to expand in these settings.{{Cite web|title=WHO {{!}} Injuries: the neglected burden in developing countries|url=https://www.who.int/bulletin/volumes/87/4/08-052290/en/|archive-url=https://web.archive.org/web/20150325120532/http://www.who.int/bulletin/volumes/87/4/08-052290/en/|url-status=dead|archive-date=March 25, 2015|access-date=2019-08-14|website=WHO}} 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,{{Cite journal|date=2004|title=Guidelines for Essential Trauma Care|url=https://www.who.int/violence_injury_prevention/publications/services/en/guidelines_traumacare.pdf|journal=World Health Organization}} 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.{{Cite journal|last1=Sun|first1=Jared H.|last2=Wallis|first2=Lee A.|author-link2=Lee A. Wallis|date=2012-08-01|title=The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need|url=https://emj.bmj.com/content/29/8/673|journal=Emergency Medicine Journal|language=en|volume=29|issue=8|pages=673–678|doi=10.1136/emermed-2011-200271|issn=1472-0205|pmid=22011973|s2cid=23871044 |url-access=subscription}} Community members arrived earlier to accidents than professionally dispatched emergency medical providers, suggesting formal programs training community members was worth exploring.{{Cite journal|last1=Wallis|first1=Lee A.|author-link1=Lee A. Wallis|last2=Sun|first2=Jared H.|date=2012-08-01|title=The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need|url=https://emj.bmj.com/content/29/8/673|journal=Emergency Medicine Journal|language=en|volume=29|issue=8|pages=673–678|doi=10.1136/emermed-2011-200271|issn=1472-0205|pmid=22011973|s2cid=23871044|url-access=subscription}}{{Cite web|title=Podcast#21(Part2): "Africa's Best Practice?" « HarrisCPD|url=https://harriscpd.co.uk/wordpress/archives/5949|access-date=2019-08-14|language=en-US}} 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.{{Cite web|last=Holtzman|first=Jessie|date=2012-02-09|title=No Time to Waste: Community Emergency Responder Programs in South Africa|url=https://www.stanford.edu/group/sjph/cgi-bin/sjphsite/no-time-to-waste-community-emergency-responder-programs-in-south-africa/|access-date=2019-08-14|website=Stanford Journal of Public Health|language=en-US}}{{Cite journal|last1=Wallis|first1=Lee A.|author-link1=Lee A. Wallis|last2=Kafwamfwa|first2=Muhumpu|last3=Cunningham|first3=Charmaine|last4=Pigoga|first4=Jennifer L.|date=2017-12-01|title=Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting|url=|journal=BMJ Open|language=en|volume=7|issue=12|pages=e018389|doi=10.1136/bmjopen-2017-018389|issn=2044-6055|pmc=5778307|pmid=29229657}}
= Lay First Responder Model =
In 2016, similar issues with a lack of prehospital response that had been recognized in Uganda by Peter G. Delaney 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. 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.{{Cite journal|last1=Delaney|first1=Peter G.|author-link1=Peter G. Delaney|last2=Eisner|first2=Zachary J.|author-link2=Zachary J. Eisner|last3=Blackwell|first3=T. Scott|last4=Ssekalo|first4=Ibrahim|last5=Kazungu|first5=Rauben|last6=Lee|first6=Yang Jae|last7=Scott|first7=John W.|last8=Raghavendran|first8=Krishnan|author-link8=Krishnan Raghavendran|date=2021-01-01|title=Exploring the factors motivating continued Lay First Responder participation in Uganda: a mixed-methods, 3-year follow-up|url=https://emj.bmj.com/content/38/1/40|journal=Emergency Medicine Journal|language=en|volume=38|issue=1|pages=40–46|doi=10.1136/emermed-2020-210076|issn=1472-0205|pmid=33127741|s2cid=226217068 |url-access=subscription}} In later studies, findings were replicated in Chad and Sierra Leone by LFR International with thousands of other motorcycle taxis, with results demonstrating training lay first responders significantly expanded prehospital care availability cost-effectively.{{Cite journal|last1=Delaney|first1=Peter G.|author-link1=Peter G. Delaney|last2=Eisner|first2=Zachary J.|author-link2=Zachary J. Eisner|last3=Thullah|first3=Alfred H.|last4=Muller|first4=Benjamin D.|last5=Sandy|first5=Kpawuru|last6=Boonstra|first6=Philip S.|last7=Scott|first7=John W.|last8=Raghavendran|first8=Krishnan|author-link8=Krishnan Raghavendran|date=2021-04-28|title=Evaluating a Novel Prehospital Emergency Trauma Care Assessment Tool (PETCAT) for Low- and Middle-Income Countries in Sierra Leone|url=https://doi.org/10.1007/s00268-021-06140-1|journal=World Journal of Surgery|volume=45 |issue=8 |pages=2370–2377 |language=en|doi=10.1007/s00268-021-06140-1|pmid=33907897 |s2cid=233417002 |issn=1432-2323|url-access=subscription}}
See also
References
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