Development and implementation of a first responder program in rural Haiti: The involved citizen project

Abstract

Background: Northeast Haiti lacks comprehensive prehospital emergency medical services (EMS). Most patients requiring medical care are transported via motorcycle taxis or on foot. This project evaluates the feasibility and impact of a train-the-trainer program designed to improve capacity of community members to provide initial emergency care through contextually adapted first aid skills. Methods: This observational cohort study identified a geographically representative cohort of leaders to serve as trainers. These leaders were trained to teach a locally oriented first aid curriculum designed in concert with Haitian partners. This curriculum emphasized use of readily available materials in provision of care and was aimed at locally prevalent conditions. An accompanying Haitian Creole course manual with embedded teaching guides was developed. These trainers in turn trained local community members, with recruitment focused on local drivers who can ultimately act as de facto first responders in the region. Results: Thirty-five individuals were recruited, of which 51.4% achieved criteria to become independent trainers. Within 6 months of the initial training course, 44.8% of trainers reported using the skills they had been taught. The trainers taught 271 community members first aid skills within the study period. Of these, 33.1% of participants reached in follow-up surveys reported providing first aid in their communities and 19.8% had transported persons in need of emergency care to a healthcare facility since completion of the course. Conclusions: This train-the-trainer model is an effective method for strengthening the capacity of communities to care for medical emergencies in the Northeast region of Haiti. This program may be important to building a future formal EMS system in the region and may be applicable to similar resource-limited settings. The following core competencies are addressed in this article: Patient Care, Medical Knowledge, System-Based Practice.