Prior Aid Research Articles

A novel learner driver first aid eLearning program: a mixed-method pre-post pilot test and evaluation

BackgroundApproximately 1.35 million people worldwide are killed in road accidents every year. Mandatory first aid training for learner drivers has been introduced in some European countries but no such requirements are in effect in Australia. The current study aimed to pilot and evaluate a first aid eLearning program for Australian learner drivers undertaking their mandated supervised driving hours.MethodsA total of 103 participants (M age = 20.57; 52.4% female, 96% completion rate) responded to an online survey immediately before and two weeks after completing the Learner Driver First Aid program. Participants completed measures of first aid self-efficacy, first aid knowledge, and attitudes towards first aid, and provided qualitative feedback on the program. Paired samples t-tests and Mann-Whitney U tests assessed improvements in first aid self-efficacy, knowledge, and attitudes, and qualitative feedback were analysed thematically.ResultsParticipants showed significant pre-post program improvements in first aid self-efficacy (p < .001) and first aid knowledge (p < .001); however, there were no significant changes in attitudes towards first aid (p = .028). Self-efficacy and knowledge improvements were significantly greater for those without prior first aid training (p < .001). Participants rated the usability of the online program favourably and most (93.2%) were satisfied or extremely satisfied with the program. Qualitative feedback suggested participants found the program to be accessible and interactive but noted concerns about the transfer of skills to the real-world context.ConclusionsThe findings provide support for the efficacy of online first aid training for Australian learner drivers. However, further improvements to the eLearning program based on participant feedback should be considered. This study recommends the Learner Driver First Aid program be refined and rolled out to the Australian public.

Awareness of school teachers about students common emergencies during school time in the eastern region, Saudi Arabia: A cross-sectional study.

Schools have to ensure student safety and well-being. However, medical emergencies involving injuries are common, requiring teachers to provide prompt first aid before professional care arrives. This study assessed knowledge and awareness of first aid among school teachers to identify areas needing improvement. This cross-sectional study surveyed 371 teachers from the eastern region primary schools using a standardized questionnaire assessing first aid knowledge across areas like bleeding control, fractures, seizures, choking, and burns. Demographic factors were analyzed for correlations with knowledge levels. Pearson's Chi-square tests analyzed bivariate relationships comparing correct knowledge identification percentages across teacher sociodemographic. The level of statistical significance was at a P value <0.05 across tests. Only 157 teachers felt able to appropriately handle medical emergencies. Major knowledge gaps existed regarding airway obstruction and chemical injuries, with 168 unable to identify correct responses for choking first aid and 105 unsure of chemical burn management steps. Appropriate fracture management was lacking, with just 70 correctly endorsing nose pinch for nosebleeds. Cardiopulmonary resuscitation knowledge was inadequate, with 57 of teachers unaware of the basics. Teachers demonstrating higher knowledge levels overwhelmingly had prior first aid training (153, 66.5%) compared to untrained counterparts (89, 63.1%). The study revealed poor first aid knowledge among elementary school teachers for effectively managing child emergencies. Strategies enhancing delivery must address barriers around training access, knowledge attrition, and variability in baseline skills through sustainable system-wide policies applied nationally. Fulfilling schools' ethical obligations toward maintaining student safety requires urgent reforms to bolster emergency preparedness.

Impact of age at the second implantation, experience of amplification use, and long-term binaural experience on sound localization of children with bilateral cochlear implants

ObjectivesTo assess the influence of three factors using retrospective chart review: age at which 2nd cochlear implant (CI) is implanted, prior hearing aid (HA) experience in the 2nd CI ear, and long-term experience with bilateral cochlear implants (BICIs) on sound localization in children with sequential BICIs. MethodsMean absolute error (MAE) in localizing speech noise of 60 children with sequential BICIs was compared across four age groups of the 2nd CI (1–5.0; 5.1–10.0; 10.1–14.0; & 14.1–19.0 years) and two extents of prior HA experience (more than and less than one year). MAE was also longitudinally analyzed after 4–6 years of experience with BICI involving 18 participants out of 60. ResultsChildren who received 2nd CI before five years of age demonstrated significantly better localization than those who received it after ten years of age. More than one year of prior HA experience in the 2nd CI ear and extensive experience with sequential BICIs significantly enhanced localization performance. Inter-implant intervals and age at the 2nd CI showed a significant positive correlation with the MAE (poorer localization). ConclusionThe results indicate that age at 2nd CI is important in developing sound localization skills. Based on the results, obtaining 2nd CI within the first five years of life and no later than ten years old is recommended. The results also suggest that longer use of amplification before 2nd CI and prolonged BICI experience significantly fosters localization development.

Economic Insights to Optimize Chain of Survival in Emergency Response

Background: Since economics is a social science studying individuals&amp;apos; behavior, it is plausible to employ its relevant concepts to study human behavior in the immediate response of lay citizens towards emergency incidents. In this context, economics has identified three types of policy lags in fiscal decisions that are of great interest to our study: recognition lag, decision lag, and implementation lag. Objectives: This study aims to apply the three policy lags in economics to the concept of ‘chain of survival&amp;apos; (CoS), in the hope of enticing rethinking its first link, and to seek solutions for CoS&amp;apos;s optimal activation. Methods: This cross-sectional study explores immediate responses to prehospital emergencies through a global online survey in four languages. It assesses how lay citizens recognize medical emergencies and activate the EMS system. Data is analyzed with SPSS v26 while summarizing qualitative variables via frequencies and percentages. Results: A total of 239 respondents were recruited in the survey from multiple countries. About 32% of the sample had recognition lag 95% CI of [26.3%, 38.2%]. Lower recognition lag scores were significantly associated with male gender, residing in Europe and Oceania, European and North American nationalities, and first aid training in last 5-10 years. Around 70% of our sample had decision lag 95% CI of [63.6%, 75.3%]. The most statistically significant factor contributing to successful decision to calling for an ambulance was prior first aid training. The average implementation lag score was 46%, which was defined as five minutes delay in calling for an ambulance or more. Conclusion: Applying concise terminology to the CoS&amp;apos;s first link (i.e. calling EMS) reveals behavioral constrains to an effective and timely activation of the CoS. These findings clarify immediate behaviors at times of emergencies, and inform targeted awareness programs addressing behavioral elements for a successful activation of the EMS system.

Silent lifesavers: Breaking barriers with a sign language health education video for students with deafness on school first aid

BackgroundStudents with deafness often face barriers to accessing health education materials, underscoring the need for tailored interventions like sign language health education videos to ensure inclusivity. Expert consensus plays a vital role in enhancing the relevance and effectiveness of educational content for individuals with sensory impairments. AimDesign a sign language health education video for students with deafness on school first aid. DesignUsing a qualitative research design, the study incorporated elements of phenomenology and expert consensus through the Delphi method. MethodsAdministrative approvals were secured, and ethical considerations were addressed prior to data collection. A literature review informed the development of study tools, which were pilot-tested for face validity. The health education video, meticulously produced and translated into sign language, adhered to best practices in visual communication. Feedback from 30 students and 17 expert panelists, obtained through structured scales and Delphi rounds, respectively, guided evaluation. Two distinct tools were developed for data collection: one for assessing student experiences and feedback, and another for expert panelists evaluation. ResultsThe study included 152 students with deafness, primarily aged 15–20 years (81%), with 57% boys and 69% from rural areas. Approximately 46% lacked prior first aid knowledge, with only 6% attending courses. Among those exposed to first aid situations (32%), 19% administered aid for nosebleeds, primarily by holding the nose (15%) or applying a cold compress (8%), while 5% treated minor burns with water. Expert panelists, 17 in total, were mainly aged 35–45 years (47%) and predominantly women (76%), with diverse professional backgrounds. Strong agreement was observed among students (mean: 4.9, SD: 0.08) and expert panelists (mean: 4.87, SD: 0.197). ConclusionThe study underscores the potential of visual-based health education interventions, particularly for individuals with sensory impairments like deafness. Integrating sign language and expert consensus in the health education video emerged as promising for enhancing first aid knowledge and skills among students with deafness. Continued refinement and dissemination of such resources can significantly improve health literacy and inclusivity in educational settings. RecommendationsFuture research should explore the long-term effects of incorporating sign language health education videos into school curricula for students with deafness. Investigating similar interventions on different health-related topics specific to individuals with sensory impairments could inform comprehensive health education programs for this population.

The prevalence of COVID-19 among healthcare professionals at primary healthcare centers

Background: The SARS-CoV-2 infection typically triggers discernible immunological responses in most reported cases. Employing a serological test could identify prior asymptomatic infections and aid in evaluating an individual's immune status. Given that healthcare professionals face a higher risk of COVID-19 exposure, the utilization of personal protective equipment remains the foremost approach in averting disease transmission within healthcare facilities. Objectives: To ascertain the prevalence of COVID-19 among healthcare professionals working in primary healthcare centers located within the AL-Sader city district. Method: During the period between November 1st, 2020, and December 31st, 2020, a cross-sectional study was carried out in nine primary healthcare centers, chosen through a cluster random sampling method. Result: Out of the 470 participants included in the study, 101 (21.5%) had a documented history of COVID-19 infection, with 76 confirmed through polymerase chain reaction analysis. Notably, a notable correlation between a positive rapid immunological test result and a prior history of COVID-19 infection (p-value &lt; 0.001). The rapid test showed a sensitivity of 56.6% and a specificity of 79.2%. Specifically, 125 participants (26.6%) tested positive using the rapid test, with 104 (83.2%) exhibiting IgG antibodies, 5 (4%) displaying IgM, and 16 (12.8%) showing both IgG and IgM antibodies. Conclusion: The prevalence of COVID-19 infection among participants exceeded the anticipated levels. Significantly, there was a discernible correlation between positive rapid test results and COVID-19 infection, as well as factors such as smoking, comorbidities, PPE training, and household infections.

Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

IntroductionPrehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research. MethodsWe conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data. ResultsCourse participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p < 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted. ConclusionA CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.

Knowledge, Attitude, and Practice of First Aid for Epistaxis Among the General Population in the Jazan Region of Saudi Arabia.

Background Epistaxis, or nosebleeds, is a widespread medical condition that can be effectively managed with appropriate first aid. Understanding the general public's knowledge and practices about this is crucial. Objectives This study sought to evaluate the awareness and practice regarding first aid for epistaxis within the general population of the Jazan region in Saudi Arabia. Methods A cross-sectional survey was administered from April through June 2023, using a questionnaire that covered sociodemographic factors, knowledge of epistaxis, first aid practices for epistaxis, and any previous training received. Statistical analysis was performed using SPSS (IBM Corp., Armonk, NY), with chi-square tests to evaluate the variables' associations. Results The questionnaire was completed by 622 participants, predominantly females, Saudis, and individuals from the age group of 18 to 25 years. It was found that 60% of the participants had experienced epistaxis, but only 52% had received prior first aid training. Although the majority (91.8%) accurately defined epistaxis, a mere 40.8% correctly identified all the steps for first aid management of epistaxis. There was a notable insufficiency in understanding the causes, risk factors, and appropriate first aid steps. Participants' knowledge was evenly split, with approximately half exhibiting low knowledge (49.70%) and the remainder showing high knowledge (50.30%). Certain sociodemographic factors such as older age (p=0.028), Saudi nationality (p=0.045), and higher education (p=0.001) were linked with more experiences of epistaxis. Conversely, younger age (p=0.002), female gender (p=0.036), single status (p=0.001), prior experience with epistaxis (p=0.001), and higher overall knowledge (p=0.001) were associated with a higher likelihood of having received first aid training. Conclusions The study reveals significant gaps in the knowledge and practices of first aid for epistaxis among the general population in the Jazan region. Public awareness campaigns and educational programs are urgently needed, particularly for specific groups. Enhancing first aid knowledge could help alleviate the impacts of epistaxis. Further research is required to develop effective educational interventions.

Perceptions of University Students on Using Quizlet in Self-Study

After the COVID-19 outbreak, the method of self-study using technological devices and the Internet truly took off. The creation of learning tools has helped people actively learn and review what they know. Quizlet has helped a lot of students reach their educational goals. The research aims to find out how students feel about utilizing Quizlet for independent study. Both quantitative and qualitative methods are used to find out how often students use Quizlet, how happy they are with the service, and what its benefits and drawbacks are for students. 159 students took part in the study, which processed data via questionnaires and semi-structured interviews. The results show that students use Quizlet for self-study usually for 2–3 hours per week. Also, the rating of student satisfaction is fairly favorable. The flashcard function attracts the greatest attention and delight because it efficiently aids pupils in topic review. While some students are dissatisfied with several elements like Match, as well as some typos and definition problems, as well as odd pronunciation, others favor Quizlet because of its efficiency and ease. It is predicted that students will favor Quizlet as a practical tool to organize prior knowledge and aid in long-term memory. Quizlet's developers can also add new features to make it a better learning tool.

Aural (Re)habilitation Outcomes among Children with Unilateral Cochlear Implants in India: A Systematic Review

Introduction: Cochlear implantation has now existed as an intervention for prelingual childhood hearing loss in our country for over two and a half decades. There is a significant need to understand the outcomes achieved in our context to promote the optimization of cochlear implant (CI) as a strategy for early intervention among children with prelingual hearing impairment. The aim of this study was to report auditory, speech-language, and educational outcomes among children with unilateral CIs in India based on the age of implantation and duration of implant use. Methods: Three primary databases (PubMed [including MEDLINE], SCOPUS, and Google Scholar) were searched using predetermined search strategies. This review included studies that described outcomes of children who underwent unilateral cochlear implantation under the age of 12 years. Studies with a minimum sample size of 10, published between 2000 and 2022 in English language, and reporting data from India were included. Cross-sectional, cohort, case–control, and randomized control study designs reporting quantitative data were considered. Results: A total of 32 studies qualified for the systematic review. The majority of studies reported that the age of cochlear implantation among their participants was between 3 and 6 years (72%). There were limited data on the postimplant timelines when sentence-level auditory comprehension and spontaneous connected speech were achieved. There was no data from any study on the integration of children with CI into mainstream schools. Factors such as prior hearing aid use, age of implantation, or duration of implantation were not taken into consideration as confounders. Conclusion: This systematic review suggests that aural re/habilitation outcomes in relation to CI are primarily limited to 1-year post-CI follow-ups. The success rate of open-set sentence/word auditory comprehension, verbal language outcomes with regard to connected speech as well as integration to mainstream education is unknown. Since the number of studies was so less, studies with high bias were not excluded based on quality evaluation. However, it is advised for readers to exercise caution when interpreting the data from these studies. In order to fully understand the value of cochlear implantation as an early intervention strategy in our country, future studies on outcomes should address these methodological flaws and restrictions, improve reporting (publications) of outcomes, conduct long-term follow-up studies, multi-center studies, and use appropriate research designs.

The Impact of First Aid Training Program on School Health Staff Knowledge, Attitude and Practice at National Guard Girl Schools in Riyadh-Saudi Arabia

Aim of the study was to evaluate the impact of the first aid training program on school health staff knowledge, attitude, and practice at the National Guard girl schools, Riyadh-Saudi Arabia. Materials and Methods: Quasi-experimental design was used. A purposive sample was conducted to enroll the study participants, the total number was 103 school health staff. A structured self-administered questionnaire was designed. Results: The findings pointed out the mean age of the participants was (38.32 + 5.08). Sixty percent of the participants had less than 5 years of experience as school health staff and only 11.7% of them had received prior first aid training. There was a statistically significant difference between the total mean scores of the participants’ knowledge and practice in pre/post-test. There was a substantial shift in participants’ positive attitudes towards the training program in the post-test compared to the pretest. Conclusion: Based on the results of the present investigation, there was an improvement in school health staff (advisors) knowledge, practices, and attitude towards first aid after application of the program. Recommendation: A national initiative is highly recommended to make all schools in Saudi Arabia a safer environment through the provision of a national first aid program for school health advisors (staff).

Research Article: The Impact of First Aid Training Program on School Health Staff Knowledge, Attitude and Practice at National Guard Girl Schools in Riyadh-Saudi Arabia

Aim of the study was to evaluate the impact of the first aid training program on school health staff knowledge, attitude, and practice at the National Guard girl schools, Riyadh-Saudi Arabia. Materials and Methods: Quasi-experimental design was used. A purposive sample was conducted to enroll the study participants, the total number was 103 school health staff. A structured self-administered questionnaire was designed. Results: The findings pointed out the mean age of the participants was (38.32 + 5.08). Sixty percent of the participants had less than 5 years of experience as school health staff and only 11.7% of them had received prior first aid training. There was a statistically significant difference between the total mean scores of the participants’ knowledge and practice in pre/post-test. There was a substantial shift in participants’ positive attitudes towards the training program in the post-test compared to the pretest. Conclusion: Based on the results of the present investigation, there was an improvement in school health staff (advisors) knowledge, practices, and attitude towards first aid after application of the program. Recommendation: A national initiative is highly recommended to make all schools in Saudi Arabia a safer environment through the provision of a national first aid program for school health advisors (staff).

CheckMyFit

Putting on hearing aids (HAs) is a regular and crucial task for every hearing aid wearer. A sub-optimal insertion can impact user adoption and audiological benefit. Ability to visually evaluate the insertion can be helpful to achieve a proper physical fit of hearing aids or similar devices, but this is currently a challenging task. In this work we present CheckMyFit, a smartphone-based, automated solution enabling users to quickly take a photo of their hearing aid placement, and compare it with a reference ideal insertion. To evaluate the tool's usability and potential benefit we conducted two user studies: a) a pilot lab study with 7 participants, and b) a field study with 17 participants. In the two-week field study, older participants with no prior hearing aid experiences were instructed on hearing aid insertion remotely and performed daily insertions independently at home. We found that CheckMyFit is easy and quick to use for almost all participants. Ear-photo-aided insertions tend to have higher quality than insertions without the tool. This correlation was significant and persisted throughout the 2 weeks of the study, and is retained after a short break. This suggests that CheckMyFit tool can provide real-world benefit to new users learning to insert their hearing aids. We also used CheckMyFit to remotely facilitate the field study, demonstrating its potential usefulness in tele-medicine.

The willingness to perform first aid among high school students and associated factors in Hue, Vietnam.

BackgroundAdolescents who are willing to perform first aid can help prevent injuries and ultimately death among themselves and others involved in accidents or injuries. This study aims to estimate the prevalence of students’ willingness to perform first aid procedures and additionally examine associated factors among high school students in Hue, Vietnam.MethodsA cross-sectional study utilizing multi-stage stratified random sampling was conducted between April to July 2020 by investigating 798 high school students in Hue, Vietnam. Participants were invited to complete a self-reported questionnaire pertaining to individual demographic characteristics, personal perception of self-efficacy, and willingness to perform first aid. To better interpret these findings, both multivariable linear and Poisson regression models were fitted to evaluate the association between individual student characteristics and the willingness to perform first aid.ResultsThe prevalence of having willingness to perform first aid (defined as ≥4 points out of 5 to all three questions) was 49.9% (95%CI:28.6–71.2%). The major reported barriers in performing first aid were fear of making mistakes and hurting victims (34.4%, 95%CI:31.9–37.0%), no prior first aid training (29.8%, 95%CI:25.9–33.9%), and forgetting first aid steps (23.0%, 95%CI:15.8–32.2%). By employing the multivariable linear regression model, it was identified that students with high (β = 0.614, 95%CI:0.009–1.219) or very high (β = 1.64, 95%CI:0.857–2.422) levels of self-efficacy appeared to be more willing to perform first aid. Similarly, in the Poisson regression models, compared to neutral students, students who reported high (PR = 1.214, 95%CI:1.048–1.407) or very high (PR = 1.871, 95%CI:1.049–3.337) levels of self-efficacy were more willing to perform first aid.ConclusionsThe level of willingness to perform first aid among high school students in this study population was found to be moderate. Therefore, integrating activities to promote self-efficacy in first aid training could be considered a progressive step towards improving a student’s willingness to provide such life-saving procedures.

International Third Parties and the Implementation of Comprehensive Peace Agreements After Civil War

Comprehensive peace agreements (CPAs) are the most impactful negotiated settlements ending civil wars, but their implementation varies across post-conflict countries and over time. To explain varying implementation, this study identifies central challenges in CPA implementation and suggests that international third parties are uniquely positioned to overcome them. (1) IGOs with high economic leverage, and (2) prior foreign aid both set incentives that reduce domestic barriers to implementation. Quantitative evidence on the implementation of CPAs from 1989-2015 supports this argument. Both post-conflict countries’ participation in IGOs with high economic leverage and higher volumes of prior foreign aid are associated with higher rates of CPA implementation. Multiple estimation approaches, including instrumental variables, support this finding. Case evidence from the 2007 CPA in Ivory Coast tracks the processes by which IGOs and donors help overcome stakeholder resistance and facilitate implementation. This finding encourages more concerted efforts by policymakers to advance CPA implementation.

Assessment of knowledge, attitude and practice of first aid among taxi operators in a Kampala City Taxi Park, Uganda: A cross-sectional study.

IntroductionRoad traffic accidents are among the leading causes of death in Uganda. Taxi operators are at a high risk of RTA and can potentially be first responders. This study, aimed to assess knowledge, attitude, and practice of first aid among taxi operators in the new taxi park, Kampala Uganda.MethodsA descriptive cross-sectional study was conducted in 2021 among taxi drivers and conductors in the New Taxi Park, Kampala City, Uganda. A semi-structured questionnaire was used to collect quantitative data from taxi operators after informed consent. Chi-square or Fisher's exact test and logistic regression were performed in STATA 16 to assess the association between first aid knowledge and demographics. P < 0.05 was statistically significant.ResultsA total of 345 participants, majority males (n = 338, 98%) aged between 18 and 45 years (76.5%), were recruited. Although 97.7% (n = 337) had heard about first aid, only 19.4% (n = 67) had prior first aid training. Overall mean knowledge score was 40.1% (SD = 14.5%), with 29.9% (n = 103) having good knowledge (≥50%). Participants who had witnessed more than five accidents (aOR = 2.9, 95% CI = 1.7–4.8, p < 0.001), those with first aid kits (aOR = 1.7, 95% CI = 1.0–3.0, p = 0.38) were more likely to have good knowledge while those below post-secondary education level i.e., Primary (AOR = 0.2, 95% CI = 0.1–0.5, p ≤0.001) and secondary (aOR = 0.2, 95% CI = 0.1–0.6, p = 0.001), were less likely to have good knowledge. About 97% and 93% perceived first aid as important and were willing to undergo training, respectively; however, only 69% were willing to give first aid. Only 181(52.5%) had ever attended to accident victims.ConclusionMajority of taxi operators had poor first aid knowledge. Factors associated with good knowledge included level of education, number of accidents witnessed, having first aid kits. Although their attitudes were favorable, practice was poor. Comprehensive training and refresher courses can help increase first aid knowledge, and improving practice.

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study.

School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11–13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students’ role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student's age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.

818 A Ghost from the Past: Unmasked Insomnia Affecting Hypoglossal Nerve Stimulation Therapy Adherence

Abstract Introduction Hypoglossal nerve stimulation (HNS) is an efficacious option for treating moderate to severe obstructive sleep apnea (OSA). However, there is sparse evidence regarding tolerance and adherence to HNS therapy in patients with a diagnosis of insomnia. Report of case(s) A 57-year-old man with well-controlled depression presented for evaluation for HNS therapy. He had been diagnosed with moderate OSA with an apnea-hypopnea index of 22/hour, intolerant of continuous positive airway pressure and mandibular advancement device. He underwent uvulopalatopharyngoplasty without significant improvement. At the time of initial evaluation, he denied history of insomnia and prior sleep aid use. He subsequently underwent successful HNS device implantation and activation. One week after HNS initiation, the patient reported new symptoms of significant difficulty with sleep onset and inability to fall back asleep, which was worse than his untreated OSA symptoms. Device interrogation did not reveal any hardware problems. Adjustments to start delay, pause time and device configuration with awake endoscopy did not improve tolerance. Subsequently, the patient disclosed a remote history of insomnia, which was treated with multiple hypnotics in addition to cognitive-behavioral therapy for insomnia (CBTi) and had resolved. He was diagnosed with recurrent chronic insomnia, for which eszopiclone was initiated without significant improvement. He eventually agreed to CBTi, with partial improvement in device tolerance and improvement in insomnia symptoms. Conclusion This case highlights that HNS therapy adherence can be affected by prior history of, or a current diagnosis of insomnia. Our patient had a predisposition for insomnia that was well controlled prior to HNS therapy initiation. The onset of recurrent insomnia with HNS activation suggests that HNS was a precipitating factor for his now chronic insomnia. Although there is insufficient evidence to suggest whether history of insomnia should affect the decision to initiate HNS therapy, this case illustrates the importance of screening for insomnia at pre-implant evaluation. Our center is now routinely screening for a history of insomnia to identify patients who may benefit from treatment prior to HNS implantation. Larger studies are needed to explore a possible relationship between insomnia and HNS adherence. Support (if any):

Adequacy of cool running water first aid by healthcare professionals in the treatment of paediatric burns: Across-sectional study of 4537 children.

ObjectiveTo determine the adequacy of cool running water first aid provided by healthcare professionals in the early management of children with thermal burn injuries.MethodsA cross‐sectional study was undertaken using a prospectively collected registry of children who presented with a thermal burn to the only major paediatric burns centre in Queensland, Australia, from January 2013 to December 2018. Main outcome measures included the type and duration of first aid administered by paramedics, general practitioners and emergency providers at local general hospitals and a children's hospital. In accordance with current Australian guidelines, adequate cooling was defined as 20 min of cool running water within 3 h of the injury.ResultsOf the 4537 children who presented to the paediatric burns centre, 3261 (71.9%) received adequate first aid, including 1502 (33.1%) at the scene of injury. Paramedics and general practitioners administered adequate cooling to 184 (25.0%) and 52 (24.2%) of their patients, respectively. ED clinicians adhered to guidelines in the treatment of 1019 (56.3%) children at general hospitals and 411 (76.0%) at the children's hospital. Among ED patients who presented with incomplete prior first aid, the risk of inadequate cooling was significantly greater for those transported via ambulance (P < 0.001).ConclusionDeficiencies remain in the cooling of paediatric burns patients at all levels of initial management. There is a need in the healthcare community for improved education regarding the parameters and clinical benefits of cool running water first aid.

Development Aid, Drought, and Coping Capacity

Climate change is a major threat to sustained economic growth and wellbeing in the Global South. To what extent does official development assistance (ODA) strengthen recipient communities’ capacity to cope with climatic extremes? Here, we investigate whether inflow of development aid mitigates adverse health impacts of subsequent drought among children under 5 years of age, drawing on survey data of nearly 140,000 respondents across 16 countries in Sub-Saharan Africa in combination with georeferenced data on World Bank-sponsored ODA projects and historical weather statistics. A coarsened exact matching analysis reveals little benefit of development aid on child nutritional status under normal meteorological conditions. However, among children exposed to drought, prior aid allocation is associated with significantly reduced weight loss. While the merit of ODA in facilitating long-term growth remains debated, this study finds consistent indication that multilateral development aid improves recipient communities’ capacity to cope with future drought.