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The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need
  1. Jared H Sun1,
  2. Lee A Wallis2
  1. 1Stanford Health Policy, Stanford University, Stanford, California, USA
  2. 2Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
  1. Correspondence to J Sun, Stanford University, 117 Encina Commons, Room 179, Stanford, CA 94305, USA; jared.sun{at}


Background As many as 90% of all trauma-related deaths occur in developing nations, and this is expected to get worse with modernisation. The current method of creating an emergency care system by modelling after that of a Western nation is too resource-heavy for most developing countries to handle. A cheaper, more community-based model is needed to establish new emergency care systems and to support them to full maturity.

Methods A needs assessment was undertaken in Manenberg, a township in Cape Town with high violence and injury rates. Community leaders and successfully established local services were consulted for the design of a first responder care delivery model. The resultant community-based emergency first aid responder (EFAR) system was implemented, and EFARs were tracked over time to determine skill retention and usage.

Results The EFAR system model and training curriculum. Basic EFARs are spread throughout the community with the option of becoming stationed advanced EFARs. All EFARs are overseen by a local organisation and a professional body, and are integrated with the local ambulance response if one exists. On competency examinations, all EFARs tested averaged 28.2% before training, 77.8% after training, 71.3% 4 months after training and 71.0% 6 months after training. EFARs reported using virtually every skill taught them, and further review showed that they had done so adequately.

Conclusion The EFAR system is a low-cost, versatile model that can be used in a developing region both to lay the foundation for an emergency care system or support a new one to maturity.

  • community networks
  • developing countries
  • education
  • emergency ambulance systems
  • emergency medical services
  • first aid
  • first responders
  • major incident planning
  • military
  • non-accidental injury
  • paediatric emergency med
  • paediatric injury
  • paediatric orthopaedics
  • paediatric resuscitation
  • paediatrics
  • prehospital care
  • trauma
  • violence

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  • Funding JS received a Fulbright Scholarship. The study sponsors had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the University of Cape Town and Stanford University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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