Abstract / Summary
Evidence-based pre-hospital trauma care can improve morbidity and mortality after an injury. In rural Nepal, where there is no systematic pre-hospital trauma care available, community health responders (CHRs) serve as primary pre-hospital providers. A novel two-day pre-hospital trauma training program, adapted from the World Health Organization’s Basic Emergency Care Course, was piloted for CHRs in April 2023. This study was a qualitative assessment of the program to better understand the experiences, perspectives, opportunities, and barriers of the training program. Three months after the initial trauma training program implementation, semi-structured interviews were conducted with participants. Interview topics included overall feedback on the training program, program administration and training materials, pre-hospital trauma activities by CHRs, and participants’ recommendations. Interviews were conducted in Nepali and translated into English. Analysis was conducted using the immersion-crystallization method to identify topical categories and patterns, and to come to final interpretation of the data. Fourteen participants (out of 35 total trained) were interviewed, representing diverse CHR roles: teachers, ambulance drivers, community health workers, and health post workers. Participating CHRs indicated that the training program had a positive impact on participants’ ability to provide patient care in the pre-hospital setting, enhanced their knowledge and skills, and instilled confidence in their ability to provide pre-hospital care. Identified barriers included transportation challenges for participants to get to the training site, limited understanding of some medical terminology, and a reliable access of pre-hospital care supplies to conduct the skills they had learned. Participants requested refresher trainings and improvements to the training handbook to ensure ongoing education and skill retention. This qualitative assessment indicates that the pilot pre-hospital training program for CHRs was well-received and practical among our interview participants in rural Nepal. Ongoing education and enhancements to training materials were deemed necessary to empower diverse community members to be effective first responders and to address the challenges of providing care in resource-constrained settings. The future design of CHR-targeted trauma programs can use the findings of this assessment to improve upon the proposed programs.