Strengthening EMS in Malawi Piloting World Health Organization Basic Emergency Care for Prehospital Providers in Zomba, Malawi
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Abstract
Background: Malawi has no country-wide emergency medical services, with prehospital care majorly provided by laypersons. Transport is typically provided by private car or taxi with less than 2% of emergency patients receiving transport by ambulance. Zomba Private Ambulances is currently the only private ambulance group operating in south-eastern Malawi. Despite not having formal prehospital provider education in Malawi, Zomba Private Ambulances makes use of mid-level care practitioners, nurses, and first-aid-only providers to provide prehospital care. This study examined the use of an existing emergency training course to educate prehospital providers in Zomba, Malawi.
Methodology: This study used a pilot study, consisting of an educational intervention trial conducted in Zomba, Malawi. Prehospital providers from Zomba Private Ambulances underwent training in WHO Basic Emergency Care including lectures and skills workshops led by an emergency medicine registrar. Participants completed a pre- and post-course survey and assessment measuring demographic information and knowledge and confidence of basic emergency skills.
Results: 9 total prehospital providers underwent training, consisting of nurses, mid-levels, and providers with first-aid-only. Overall confidence increased significantly after completing the course (83.3 to 96.8% confidence). Knowledge retention varied across participant training levels (post-course scores being: mid-levels 80%, nurses 73%, and first-aid-only 42.6%). Overall, providers displayed increased knowledge post-course, however, post-course knowledge varied amongst domains (e.g., trauma, altered mental status, shock). Barriers to training were identified including lack of transport, other occupational responsibilities, and lack of understanding of course applicability for first-aid-only providers.
Conclusion: Using education tools such as WHO BEC assists in the knowledge and confidence of prehospital providers in Malawi. Further studies are required to assess the retention of knowledge and effective use in the field. Additional training should be more easily accessible to improve prehospital triage in Malawi. The expansion of prehospital care in Malawi should utilize contextually relevant training.
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