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Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala
  1. Peter G Delaney1,2,3,
  2. Jose A Figueroa4,
  3. Zachary J Eisner3,5,
  4. Rudy Erik Hernandez Andrade6,
  5. Monita Karmakar7,
  6. John W Scott2,7,
  7. Krishnan Raghavendran2,7
  1. 1University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2Michigan Center for Global Surgery, Ann Arbor, Michigan, USA
  3. 3LFR International, Los Angeles, California, USA
  4. 4Department of Anthropology, Washington University in Saint Louis, Saint Louis, Missouri, USA
  5. 5Department of Biomedical Engineering, Washington University in Saint Louis School of Engineering and Applied Science, Saint Louis, Missouri, USA
  6. 6Ministerio de Salud Pública y Asistencia Social Republica de Guatemala, Guatemala City, Guatemala
  7. 7Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Peter G Delaney, University of Michigan Medical School, Ann Arbor, MI 48109, USA; petergde{at}


Background Injury disproportionately affects low-income and middle-income countries, yet robust emergency medical services are often lacking to effectively address the prehospital injury burden. A half-day prehospital emergency trauma care curriculum was designed for first responders and piloted in the Sacatepéquez, Chimaltenango, and Escuintla departments in Guatemala.

Methods Three hundred and fifty-four law enforcement personnel, firefighters, and civilians volunteered to participate in a 5-hour emergency care course teaching scene safety, triage, airway management, cardiopulmonary resuscitation, fracture management, and victim transport. A validated 26-question pretest/post-test study instrument was contextually adapted and used to measure overall test performance, the primary study outcome, as well as test performance stratified by occupation, the secondary study outcome. Pretest/post-test score distributions were compared using a Wilcoxon signed-rank test. For test evaluation, knowledge acquisition on a by-question and by-category basis was examined using McNemar’s χ² test, whereas item difficulty indices used frequency-of-distribution tests and item discrimination indices used point biserial correlation.

Results Two hundred and eighty-seven participants qualified for inclusion. Participant mean pretest versus post-test scores improved 24 percentage points after course completion (43% vs 68%, p<0.001). Cronbach’s alpha yielded values of 0.86 (pretest) and 0.94 (post-test), suggesting testing instrument reliability. Between-group analyses demonstrated law enforcement and civilian participants improved more than firefighters (p<0.001). Performance on 23 of 26 questions improved significantly. All test questions except one showed an increase in their PPDI.

Discussion A 1-day, contextually adapted, 5-hour course targeting laypeople demonstrates significant improvements in emergency care knowledge. Future investigations of similar curricula should be trialed in alternate low-resource settings with increased civilian participation to evaluate efficacy and replicability as adequate substitutes for longer courses. This study suggests future courses teaching emergency care for lay first responders may be reduced to 5 hours duration.

Level of evidence Level II.

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  • Contributors All authors made substantial contributions to the conception/design of the study, acquisition/analysis of data, and in drafting and revising the article.

  • Funding Washington University in St. Louis funded the study and project implementation with LFR International. Seguros Universales, an insurance company based in Guatemala City, subsidized the costs for all first aid kits but had no involvement in the study.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for this study was received by the Washington University in St. Louis School of Medicine Institutional Review Board and Human Research Protections Office (ID: 201904088). All participants provided written and verbal informed consent before participation in this research study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data is available from PGD, who can be reached at peter.delaney1995@gmail.comRe-use is permitted for additional follow-up studies or meta-analyses.

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