Adapting and implementing a pre-hospital trauma program for community health responders: A pilot study from rural Nepal.

Abstract

Introduction: Effective pre-hospital care is critical for improving trauma outcomes, yet pre-hospital systems are underdeveloped in low-and middle-income countries (LMICs) like Nepal, where trauma-related deaths are rising. Community health responders (CHRs) have the potential to reduce time to post-injury care in rural settings, where other health infrastructure may be unavailable. This pilot study assessing the feasibility and preliminary impact of CHR based program in rural Nepal.

Methods: This quasi-experimental study adapted and implemented a trauma training intervention for CHRs in Achham, Nepal. The program adapting the trauma portion of the World Health Organization's (WHO) Basic Emergency Care (BEC) course for the Achham context through a modified Delphi process. The final implemented program included three items: initial two-day skills-based training, a pictorial guide handbook for CHR's quick reference, and a one-day refresher training at three months. Two rural municipalities of Achham district were assigned into intervention or control. All CHRs from the intervention municipality underwent the training program. Assessment includes the program's impact on CHRs' knowledge and confidence, and impact on pre-hospital trauma care metrics, which was assessed through pre-, immediately, and six-months post-course evaluations, and pre-hospital service metrics data, respectively. A repeated measures ANOVA was used to assess change in knowledge over time by study groups. Bivariate analysis was performed to explore differences in pre-hospital patient metrics of trauma care by study group.

Results: The intervention group showed a significant increase in knowledge and confidence immediately post-course and sustained over six months. There was no significant difference in mean patient age (26.5 years versus. 22.1) and trauma mechanism (p = 0.14) across two groups. The most common mechanism was falls (n = 165, 77.5 %). Intervention municipalities had higher rates of pre-hospital care provision, including fracture immobilization (51.4 % versus. 17.1 %, p < .001) and cervical collar use, compared to controls.

Conclusion: This study adapted and implemented a contextual trauma training program for CHRs in rural Nepal. Results shows early feasibility and appropriateness in this context. The program leverages existing community networks and offers a potential approach in LMICs to bridge the existing critical gaps in rural pre-hospital trauma care that requires further investigation.