Data-Driven Lay First Responder Program in Cameroon

Injury accounts for a substantial proportion of preventable mortality in Cameroon, where no organized prehospital emergency medical system currently exists. Evidence suggests that effective prehospital care could prevent up to 45% of injury-related deaths. Lay First Responder (LFR) programs represent a pragmatic strategy for improving early trauma care in resource-limited settings by training lay persons who are frequently present at injury scenes.

Despite promising early results in other settings, rigorous evaluation of LFR programs has been limited, particularly regarding their impact on patient-level outcomes. This study aim to test the contextual feasibility of the lay first responder program in Cameroon, after it has been successful in other Sub-Saharan nations.

This study seeks to address these gaps by implementing a data-driven LFR program informed by trauma registry analysis and stakeholder engagement, and by evaluating feasibility, acceptability, and effectiveness within Cameroonian context.

The Cameroon Trauma Registry (CTR) gathers prospective data on patient demographics, injury characteristics, receipt of prehospital care, clinical findings and management, disposition and outcomes on patients admitted for injuries at ten trauma hospitals in Cameroon. Each hospital has a full-time research assistant overseen by an MPH-level field supervisor. Patients are followed from presentation through hospital discharge. This study will be implemented in Limbe municipality, Cameroon and will utilize data from the Limbe Regional Hospital site of the CTR.

The LFR intervention: An LFR curriculum adapted for the Cameroon context using a two-stage, mixed-methods approach (quantitative analysis of prospective CTR data and qualitative semi-structured interviews of target stakeholders) will be used to train LFR providers (commercial drivers and community members) over a 3-month training and transition period.

The primary metric of program feasibility will be percent change in the proportion of trauma patients receiving prehospital care in the post-intervention cohort compared to pre-intervention historical controls. The secondary outcomes for program effectiveness will be injury severity-stratified percentage change in the proportion of CTR patients presenting with normal vital signs (systolic blood pressure, heart rate, respiratory rate) in the post-intervention cohort compared to the pre-intervention cohort.

• Lay First Responder (LFR) training (Behavioral): Training of LFR providers using a data driven, pretested curriculum adapted for the Cameroon context over a 3-month training and transition period.

Primary outcomes

• Prehospital care rate [From enrollment through the 18-month post implementation period.]: Proportion of hospitalized trauma patients who received prehospital care prior to arrival at participating hospitals, compared between pre- and post implementation LFR cohorts.

Secondary outcomes

• Systolic blood pressure at presentation [From enrollment through the 18-month post implementation period.]: Median systolic blood pressure (mmHg) measured at hospital presentation among injured patients, compared between pre- and post implementation LFR cohorts
• Respiratory rate greater than 8 and less than 20 breaths per minute [From enrollment through the 18-month post-implementation period]: Percentage change in the proportion of CTR patients presenting with respiratory rate greater than 8 and less than 20 breaths per minute compared between pre- and post implementation LFR cohorts.
• Proportion of trauma patients with heart rate between 60 and 100 beats per minute [From enrollment through the 18-month post implementation period.]: Percent change in the proportion of trauma patients with heart rate between 60 and 100 beats per minute compared between pre- and post implementation LFR cohorts.
• In-hospital mortality [From enrollment through the 18-month post-implementation period.]: All-cause in-hospital mortality among injured patients, compared between pre- and post implementation LFR cohorts.
• 24-hour mortality [From enrollment through the 18-month post implementation period.]: All-cause mortality within 24 hours of hospital presentation among injured patients, compared between pre- and post implementation LFR cohorts.
• Blood transfusion [From enrollment through 18-month post implementation period.]: Proportion of injured patients receiving blood transfusion during hospitalization, compared between pre- and post implementation LFR cohorts.
• Operative intervention [From enrollment through 18-month post implementation period.]: Proportion of injured patients requiring surgical intervention during hospitalization, compared between pre- and post implementation LFR cohorts.

Sex: All

Inclusion Criteria:

\- Trauma patients presenting to Limbe Regional Hospital and enrolled in the Cameroon Trauma Registry

Exclusion Criteria

\- Trauma patients not included in the Cameroon trauma registry at Limbe regional hospital.

• Study Protocol and Statistical Analysis Plan (PDF, 2024-10-23)

NIH grants: K01TW012689