Evidence-Based First Aid Education in Africa

Teaching the general public first aid as a means to increase communities’ resilience is one of the main goals of the International Red Cross/Red Crescent movement. Research has shown that this is a very cost-effective way to improve the wellbeing of communities (Laxminarayan 2006). Globally, Red Cross/Red Crescent National Societies train over 20 million people in first aid each year (IFRC 2020). The Belgian Red Cross has been supporting its partner National Societies in Sub-Saharan Africa in teaching first aid, by assisting in the development of an evidence-based first aid manual and supporting materials, for over 10 years (Van de Velde 2011). 

The manual is updated every five years, and a brand-new edition of “Basic First aid in Africa”, updated according to the principles of Evidence-Based Practice, is available since the 1st of August 2021. A total of 7 African Red Cross National Societies (Malawi, Rwanda, Uganda, South Africa, Tanzania, Zambia, Zimbabwe) have contributed to the development of the 2021 update, together with academic experts from Kenya, Tanzania and South Africa. Red Cross National Societies from many African countries will use the manual to train laypeople in first aid. It is thereby expected that they will reach tens of thousands of people. Furthermore, anyone interested can access the manual for free. 

The unique collaboration between the African Red Cross National Societies and the Belgian Red Cross creates a true Evidence Ecosystem in the field of first aid within the global Red Cross/Red Crescent movement (Vandvik 2020). The partners thereby engage to collaborate in the development, dissemination, implementation and evaluation of evidence-based first aid. This clearly demonstrates that there is a strong belief in the value of working in an evidence-based manner at the policy-making level. 

The Evidence Ecosystem cycle starts with the composition of a multidisciplinary and geographically balanced panel of African experts. Both experts with an academic background in emergency medicine and experts with field expertise in first aid and first aid training are being invited to join the expert panel. This panel defines the themes to be discussed in the first aid manual, and the most pertinent practical questions within these themes that need to be answered by the best available scientific evidence.

The Centre for Evidence-Based Practice of the Belgian Red Cross collects this best available evidence through systematic literature searches in electronic databases of medical literature and collects the evidence in structured evidence summaries. These evidence summaries contain an overview of the main characteristics and findings of the scientific studies that were identified in the searches, as well a critical appraisal of the studies’ quality and an overall assessment of the credibility of the scientific evidence that was found (Atkins 2004).

During expert panel meetings, the experts formulate practical recommendations related to the different practical questions they asked. They discuss the scientific evidence, taking into account the credibility of the evidence, the balance between benefits and harms of certain practices, values and preferences of the target audience, feasibility and resource use related to these practices (Alonso-Coello 2016).

As such, the recommendations provide guidance on the best way to provide first aid for different emergency situations, taking into the context of the African layperson. Practical recommendations made by the expert panel are being disseminated to the end users, first aid trainers and their students, in the form of a clear and visually attractive first aid manual. The expert panel validated text and illustrations for accuracy, clarity and appropriateness. The African Red Cross/Red Crescent National Societies facilitate the implementation of the first aid manual in first aid trainings across Africa via a train-the-trainer model.

The Belgian Red Cross provides support during the training of master trainers. The master trainers in their turn train other trainers within their society, thus spreading expertise exponentially. In addition, innovative approaches to teach first aid in a cost-efficient manner are being developed. In a so-called blended learning approach, trainees will learn first aid theory online, by completing a mobile app-based online electronic learning module, followed by an in-class training, focusing on practicing first aid techniques.

The performance of the newly developed materials and trainings is planned to be evaluated in a controlled trial. Trainees will be randomly allocated to a first aid course taught via blended learning or a waitlist control. Trainees’ knowledge, skills, self-efficacy and helping behavior will be assessed at baseline, immediately after following training and 6 months after following training and compared between those following the course and those on the waitlist. Findings from the evaluation will be used in further development and implementation efforts, thereby closing the Evidence Ecosystem cycle.

To conclude, the existence of a first aid-related Evidence Ecosystem within the Red Cross/Red Crescent movement is the result of an evidence-based mindset at policy-making level within the Red Cross National Societies involved. It results in a cycle of continuous improvement in first aid education within the global leader in first aid education across a large part of Sub-Saharan Africa. More and better first aid training benefits not only the people trained, but also those receiving first aid, who are often the most vulnerable in a society.

Acknowledgement:
We sincerely thank all the expert panel members for their invaluable contribution to the development of ‘Basic First Aid in Africa’: Prof. Dr. Jimmy Volmink (chair), Mr. Kheri Issa, Prof. Dr. Walter Jaoko, Ms. Simphiwe Kubeka, Ms. Jeanne Mukeshimana, Mr. Alick Msusa, Mr. Admire Mugambiwa, Mr. Mabvuto Ng’ambi, Dr. Navindhra Naidoo, Mr. Paul Okot, Dr. Patrick Shao, Mr. Fabian Van Hoyweghen, Dr. Ben-jamin Wachira. 

Authors

• Bert Avau from the Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross 
• Elke Weyenbergh from the International Cooperation, Humanitarian Services, Belgian Red Cross
• Emmy De Buck from the Centre for Evidence-Based Practice (CEBaP), Belgian Red Cross; Cochrane First Aid and the Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.