Current prehospital trauma care in Kampala, Uganda and a pilot training program for lay-first responders

Objectives: Up to 50% of injury deaths in developing countries may occur in the prehospital setting. At this time, Uganda does not have an organized pre-hospital emergency system. We aimed to describe the current injury patterns in Kampala and determine if lay people can be effectively trained to deliver basic pre-hospital trauma care.

Methods: Police officers, taxi drivers and local officials were selected by convenience for a one-day modified basic first-aid course. Before training, a cross-sectional survey was conducted to describe the current injury epidemiology and assess first-aid training history, knowledge and access to equipment. The curriculum was developed based on published reports. Fund of knowledge tests were used to determine effectiveness.

Results: 307 lay people participated. They saw a mean of 19 injury emergencies per person (95% CI 16-21) over the previous 6 months, most commonly from road crashes (89%, 95% CI 84-92%), assault (66%, 95% CI 60-71%) and burns (44%, 95% CI 39-50%). 31% (n=92) of trainees had seen a death (95% CI 26-36%) and, of these, 87% reported seeing 1-5 deaths per person (95%CI 43-59%). The most common aid given was lifting (82%, 95% CI 77-87) or transport (76%, 95% CI 71-80). Reasons for not providing aid were lack of: knowledge (37%, 95% CI 18-57) or equipment (44%, 95% CI 24-65). Before this study, 52% had some first-aid training (95% CI 47-58) and 43% had some access to equipment (95% CI 37-49). At pre-test, trainees knew little about: moving, transport or bleeding control (29, 32 and 38% correct, respectively). After training, fund of knowledge increased from 45% to 86% (p<0.0001). 

Conclusion: Lay people see a large number of emergencies and deaths in Kampala, Uganda. A context-appropriate, modified basic first-aid course for lay people can improve fund of knowledge and may be a step towards formal prehospital care.