Development of an Evidence-Based First Aid Guideline for First Responders in Sub-Saharan Africa

Abstract

Background: Many Sub-Saharan African countries lack effective emergency medical services. In response, Red Cross and Red Crescent National Societies, amongst other organizations implement first responder training programs across Africa. The current paper describes the development of an advanced manual for first responders (FAFR) in Sub-Saharan Africa. Methods: This FAFR manual was developed according to the principles of Evidence-Based Practice accounting for scientific evidence, expert opinion, and preferences of the target audience (i.e., Sub-Saharan African first responders). The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach was used to assess the certainty of evidence. A geographically balanced expert panel of African field and academic experts set the scope and defined the research questions. The best available evidence was systematically collected and presented to independent and dedicated content writers, drafting the manual. The expert panel discussed these draft recommendations during a two-day meeting and validated the final version of the manual. Results: The systematic literature addressed 87 research questions. Of these, 52 could be supported by scientific evidence, in thirteen cases by a Cochrane systematic review. We determined the GRADE certainty of the evidence as low (38%) or very low (53%). Where no evidence was found, good practice points were formulated based on expert opinion. Conclusions: The FAFR manual is used by Red Cross and Red Crescent National Societies across Africa and will be updated every five years by the Belgian Red Cross. The manual is freely available to anyone interested (https://www.rodekruis.be/en/what-do-we-do/first-aid-and-support/first-aid-for-first-responders/). Résumé Contexte: De nombreux pays de l’Afrique subsaharienne ne bénéficient pas d’aide médicale d’urgence efficace. Pour y remédier, les Sociétés Nationales de la Croix-Rouge et du Croissant-Rouge, entre autres, ont mis en place des programmes de formation pour les premiers répondants en Afrique. Ce document décrit la création d’un manuel avancé pour les premiers répondants (FAFR) en Afrique subsaharienne. Méthodes: Ce manuel FAFR intègre les principes des pratiques fondées sur des données probantes tenant compte de preuves scientifiques, de l’avis d’experts et des préférences d’un groupe cible (ici, les premiers répondants d’Afrique subsaharienne). L’approche GRADE (Grading of Recommendations Assessment, Development, and Evaluation) a été utilisée pour évaluer la certitude des preuves. Un panel géographique équilibré d’experts africains de terrain et universitaires ont défini les objectifs et les questions de l’étude. Les meilleures preuves disponibles étaient systématiquement collectées et présentées aux rédacteurs de contenus indépendants chargés de rédiger la première version du manuel. Le panel d’experts a examiné les recommandations lors d’une réunion de deux jours et a validé la version finale du manuel. Résultats: La revue systématique de la littérature s’est basée sur 87 questions de recherche. Parmi elles, 52 ont pu être appuyées par des preuves scientifiques, et dans treize cas par une revue systématique Cochrane. Nous avons déterminé une certitude GRADE de la preuve comme étant faible (38 %) ou très faible (53 %). Si aucune preuve n’était trouvée, des points de bonne pratique étaient formulés basés sur l’avis des experts. Conclusions: Ce manuel FAFR a été utilisé par les Sociétés Nationales de la Croix-Rouge et du Croissant-Rouge en Afrique et sera mis à jour tous les cinq ans par la Croix-Rouge de Belgique - Communauté flamande. Ce manuel est disponible en libre accès à toute personne intéressée (https://www.rodekruis.be/en/what-do-we-do/first-aid-and-support/first-aid-for-first-responders/). [Translation by: Aurélia Feyssaguet Voluntary translator for the Global First Aid Reference Centre] Resumo Enquadramento: Muitos países da África Subsariana carecem de serviços médicos de emergência eficazes. Em resposta, as Sociedades Nacionais da Cruz Vermelha e do Crescente Vermelho, entre outras organizações, implementam programas de formação de primeiros socorros em toda a África. O presente artigo descreve o desenvolvimento de um manual avançado para socorristas (FAFR) na África Subsariana. Metodologia: Este manual do FAFR foi desenvolvido de acordo com os princípios da Prática Baseada em Evidência, contabilizando evidências científicas, opinião de especialistas e preferências do público-alvo (ou seja, socorristas da África Subsaariana). A abordagem GRADE (Grading of Recommendations Assessment, Development, and Evaluation) foi utilizada para avaliar o nível de evidência. Um painel de especialistas geograficamente equilibrado de especialistas africanos e académicos definiu o âmbito e definiu as questões de investigação. As melhores provas disponíveis foram sistematicamente recolhidas e apresentadas a redatores de conteúdos independentes e dedicados, elaborando o manual. O painel de peritos debateu essas recomendações preliminares durante uma reunião de dois dias e validou a versão final do manual. Resultados: A literatura sistemática abordou 87 questões de pesquisa. Destas, 52 poderiam ser apoiados por evidências científicas, em treze casos por uma revisão sistemática Cochrane. Determinou-se que a o nível de evidência GRADE era reduzida (38%) ou muito reduzia (53%). Nos casos em que não foram encontrados elementos de prova, foram formulados pontos de boas práticas com base no parecer de peritos. Conclusões: O manual do FAFR é utilizado pelas Sociedades Nacionais da Cruz Vermelha e do Crescente Vermelho em toda a África e será atualizado de cinco em cinco anos pela Cruz Vermelha Belga. O manual está disponível gratuitamente para qualquer pessoa interessada (https://www.rodekruis.be/en/what-do-we-do/first-aid-and-support/first-aid-for-first-responders/). [Translation by: Fábio Oliveira Centro Hospitalar do Tâmega e Sousa Porto, Portugal https://orcid.org/0000-0002-6545-3364]

Keywords

• africa
• emergency responders
• evidence-based practice
• first aid
• guideline as topic