Impact of community-based first responder development for the management of drowning casualties in rural areas of Bangladesh

Barriers and facilitators to global access to life-saving skills training: an international cross-sectional survey

INTRODUCTION

Emergency care begins in the community, who are often the first on the scene. Where emergency care systems are nascent or absent, bystanders represent the only prehospital emergency care that victims might receive. It is important to equip bystanders through life-saving skills training (LST). The aim of this study was to describe access to LST for laypersons globally and to determine barriers or facilitators for access to LST globally.

METHODS

A global cross-sectional, online survey was undertaken with stakeholders involved in LST programmes and policies through purposive, snowball sampling. The invitation for participation was distributed to local, regional and international emergency care and resuscitation organisations and their membership. Data were collected using a custom-designed survey, based on the literature and following pilot testing. Data were analysed descriptively and visualised according to countries and regions. Logistic regression was used to identify variables predictive of LST.

RESULTS

A total of 302 responses from 67 countries were analysed. Majority of responses were from high- or upper-middle income countries (61.2%) compared with low- or lower-middle income countries (38.8%). All respondents from Europe reported reliable access to LST. Of respondents who reported no LST is delivered, the highest proportion of these represented the Eastern Mediterranean (18.2%), Africa (17.1%) and South America (16.9%). The most common barrier to accessing LST were cultural views surrounding LST (69.2%), while the most common facilitator was interpersonal relationships to encourage the uptake of LST (71.9%). Country level of income (adjusted OR (AOR) 4.31 (95% CI 1.62 to 11.45), p<01), urban location (AOR 10.57 (95% CI 3.32 to 33.66), p<0.001) and level of EMS development (OR 5.73 (95% CI 1.47 to 22.30), p=0.01) were predictive of access to LST.

CONCLUSION

This study highlights considerable inequity in LST access globally. Future work should seek to mitigate barriers and leverage facilitators through participatory and community-oriented approaches to LST.

Effectiveness of interventions to prevent drowning among children under age 20 years: a global scoping review

Background

Drowning is a leading cause of death among young children. The United Nations Resolution on global drowning prevention (2021) and World Health Assembly Resolution in 2023 have drawn attention to the issue. This scoping review synthesizes the current evidence on the effectiveness of child drowning prevention interventions since the 2008 World Report on Child Injury Prevention and implications for their implementation.

Methods

Quantitative studies published between 2008 and 2023 focusing on interventions targeting unintentional injuries, including drowning, among children and adolescents under age 20 years were searched on Cochrane Database of Systematic Reviews, Epistemonikos, PubMed, and Embase. Relevant data on interventions were extracted using a pre-defined template on Microsoft Excel. This scoping review focuses on the interventions addressing drowning.

Results

Overall, 12 studies fulfilled the inclusion criteria. Evidence generated between 2008 and 2023 support the effectiveness of introducing barriers around water bodies, immediate resuscitation and first-responder training, and use of personal floatation devices (PFDs). Basic swimming and water safety skills training for children ages 6 years and older, and enacting and enforcing regulations on pool fencing and PFD use were found to be promising based on new evidence published since 2008. This scoping review also found evidence on new interventions studied since 2008, such as close adult supervision, inspections of safety standards of pools, and the use of door barriers and playpens, all of which demand further research to ensure context-specific implementation in LMICs.

Conclusion

While there is evidence to support both existing and new interventions, most of the available interventions are still classified as promising and emerging, underlining the need for further evaluation of those interventions in diverse settings (including low and middle- income) through effectiveness studies and implementation research. In addition, it is important to highlight the nexus between drowning prevention and the Sustainable Development Goals to advocate multisectoral and interdisciplinary collaboration, to influence the broader child health agenda.

Ten years of the community-based emergency first aid responder (EFAR) system in the Western Cape of South Africa: What has happened, what has changed, and what has been learned

The emergency first aid responder (EFAR) system was designed as a low-cost and adaptable community-based prehospital emergency care system, and was first published after conducting a study in the township of Manenberg, South Africa, in 2010. EFARs are laypersons who are trained to respond to emergencies in their communities, and can provide support to the emergency medical services (EMS) by providing early clinical care, reporting back about the scene, and assisting with local scene management and logistics. Over the past ten years in South Africa, the Western Cape Government Health (WCGH) EMS and the Western Cape Government (WCG) College of Emergency Care have implemented the EFAR system in multiple communities and have trained over 10,000 community members across the Western Cape. This report is a ten-year update on what has happened since the EFAR system started, and to candidly show how the system has evolved, what has been learned, and what challenges remain so that others could look ahead and plan accordingly as they develop similar community-based first aid responder systems in resource-constrained areas. Core pillars to the EFAR system's success have included community involvement and adaptation, collaboration with the WCGH EMS and WCG College of Emergency Care, opportunities for community and EMS development, and emphasis on the sustainability of local EFAR systems. Multiple challenges also remain that others may likely face.