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J Surg Res. 2016 Jun 1;203(1):22-7. doi: 10.1016/j.jss.2016.03.026. Epub 2016 Mar 31.

Prehospital care training in a rapidly developing economy: a multi-institutional study.

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Department of Surgery, Texas Tech University, Odessa, Texas. Electronic address:
Department of Pediatric Urology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Surgery, Michigan State University, Lansing, Michigan.
Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Department of Asian Studies, Michigan State University, Lansing, Michigan.
Department of Surgery, Virginia Commonwealth University, Richmond, Virginia.
Emergency Medicine, Dr. S.N. Medical College, Jodhpur, India.
Arogyaa Healthcare Private Limited, Vyas Global Pre-hospital Care Education Initiative, Jodhpur, India.



The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality.


An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels.


Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur.


These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise.


Education; First responder; Global health; Prehospital care; Trauma burden

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