title: Layperson trauma training in low- and middle-income countries: a review.
abstract: BACKGROUND
  Prehospital trauma systems are rudimentary in many low- and middle-income countries (LMICs) and require laypersons to stabilize and transport injured patients. The World Health Organization recommends educating layperson first responders as an essential step in the development of Emergency Medical Services systems in LMICs. This systematic review examines trauma educational initiatives for layperson first responders in resource-poor settings.
  
  
  METHODS
  Layperson first-responder training and education program publications were identified using PubMed MEDLINE and Scopus databases. Articles addressing physicians, professional Emergency Medical Services training, or epidemiologic descriptions were excluded. Publications were assessed by independent reviewers, and those included underwent thematic analysis.
  
  
  RESULTS
  Thirteen publications met inclusion criteria. Four themes emerged regarding the development of layperson first-responder training programs: (1) An initial needs assessment of a region's existing trauma system of care and laypersons' baseline emergency care knowledge focuses subsequent educational interventions; (2) effective programs adapt to and leverage existing resources; (3) training methods should anticipate participants with low levels of education and literacy; and (4) postimplementation evaluation allows for curriculum improvement. Technology, such as online and remote learning platforms, can be used to operationalize each theme.
  
  
  CONCLUSIONS
  Successful training programs for layperson first responders in LMICs identify and maximize existing resources are adaptable to learners with little formal education and are responsive to postimplementation evaluation. Educational platforms that leverage technology to deliver content may facilitate first-responder trauma education in underresourced areas. Themes identified can inform the development of trauma systems of care to decrease mortality and physiological severity scores in trauma patients in LMICs.
authors.affiliation: Division of Trauma and Critical Care Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illionis.
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Callese
authors.affiliation: Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: c-richards@northwestern.edu.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Richards
authors.affiliation: Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Pamela
authors.initials: P
authors.lastname: Shaw
authors.affiliation: Division of Trauma and Critical Care Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illionis.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Schuetz
authors.affiliation: Division of Trauma and Critical Care Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illionis.
authors.forename: Nabil
authors.initials: N
authors.lastname: Issa
authors.affiliation: Department of Emergency Medicine, State University of New York Downstate School of Medicine, New York, New York.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Paladino
authors.affiliation: Division of Trauma and Critical Care Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illionis.
authors.forename: Mamta
authors.initials: M
authors.lastname: Swaroop
mesh_terms: D003479:Curriculum; D003906:Developing Countries; D004493:Education; D004632:Emergency Medical Services; D006801:Humans; D020380:Needs Assessment; D015397:Program Evaluation; D014947:Wounds and Injuries / Q000628:therapy*
keywords: Education; First-responder; Global surgery; International; LMIC; Layperson; Resource-poor; Systematic review; Trauma; Trauma system development