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First Aid Training

Question Type:
Full Question:
Among adults and children receiving first aid (P), does  care from a trained first aid provider (I), compared with care from an untrained person (C), change increase survival rates, recognition of acute injury or illness, prevent further illness or injury (i.e., harm), time to resolution of injury, the likelihood of harm (eg infection), time to resolution of symptoms (O)?
Consensus on Science:
For the critical outcome of increased survival rates from trauma, we identified low-quality evidence (downgraded for risk of bias) from 1 observational study(Murad 2010, 533) enrolling 1341 patients showing a reduced mortality rate among patients initially managed by trained first aid providers of 9.8% (32/325) compared with 15.6% (158/101) for patients without trained first aid support (OR, 0.59; 95% CI, 0.40–0.89). For the important outcome of time to resolution of symptoms, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 observational study(Caglar 2010, 383) with 125 subjects with burns of less than 20% total body surface area showing benefit from first aid training, with 88.5% of patients who received first aid treatment of cooling the burn with water requiring hospitalization of less than 10 days, compared with only 67.2% who received no treatment requiring less than 10 days’ hospitalization (RR, 0.35; 95% CI, 0.16–0.76). For the important outcome of preventing further injury, we identified very-low-quality evidence (downgraded for indirectness and imprecision) from 1 observational study(Lekic 1998, 137) with 244 patients (121 precampaign, 123 postcampaign) with acute burn injury treated either before or after a burn first aid treatment public education campaign, showing benefit with burn first aid treatment by reduction of the percent of those burned requiring inpatient wound care or surgery from 64.2% (78/121) precampaign compared with 35.6% (44/123) postcampaign (OR, 0.307; 95% CI, 0.18–0.52). Furthermore, we identified very-low-quality evidence (downgraded for risk of bias and imprecision) from 1 observational study(Ditty 2010, 357) with 39 subjects without formal/advanced medical training who performed reduction of shoulder dislocations in a wilderness environment. This study found no statistically significant difference in the rate of successful reduction by laypersons without first aid training (17/24, 70.8%) compared with the successful reduction rate when individuals with either wilderness first aid or first responder training were present or performed the reduction (11/15, 73%; OR, 0.88; 95% CI, 0.21–3.74). For the critical outcome of recognition of acute injury or illness, and the important outcome of the likelihood of harm, there were no studies identified.
Treatment Recommendation:
We suggest that education and training in first aid is undertaken to improve morbidity and mortality from injury and illness (weak recommendation, low-quality evidence). Values, Preferences, and Task Force Insights Positive outcomes were identified in both public health campaigns for specific injuries and course-based training for general trauma. Although no other formal PICO questions related to first aid education were evaluated, the review of stroke assessment systems (above) incidentally discovered that training of lay providers in a stroke assessment system led to improved ability to identify the signs of a stroke when assessed immediately after training (94.4% in those trained versus 76.4% in untrained lay providers), and that 96.9% of the trained lay providers were able to identify signs of stroke when assessed 3 months after training.(Wall 2008, A49) This study supports the recommendation in this review, and specifically shows that public health campaigns aimed at first aid for specific illnesses and injuries, as well as course-based first aid training, can positively impact outcomes of morbidity and mortality.
CoSTR Attachments:
Ditty, J.pdf    
FA training GRADE Sum of Findings final 4_6_15.pdf    
Murad, MK.pdf    
Skinner_Adrian_M 2004.pdf    

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