Evaluating lay first responder (LFR) first aid kit supplies usage and appropriateness in Western Kenya

Abstract

Introduction: low- and middle-income countries (LMICs) disproportionately bear 90% of global mortality from trauma, yet robust emergency medical services (EMS) are often lacking to address the prehospital injury burden. Training lay-first responders (LFRs) is the first step toward formal (EMS) development in (LMICs). However, a gap remains as LFR first aid kit supply usage, appropriateness, and decay rates have yet to be studied but remain critical information for building sustainable LFR programs.

Methods: we trained and equipped 101 LFRs in Kakamega County, Kenya in December 2023. During 3-month follow-up post-training, LFRs were surveyed with a 24-question multiple choice and free-response cross-sectional survey. Survey items included LFR demographics, patient encounters, first aid kit supplies usage, supply appropriateness, and local capacity for re-supply. Demographic data, usage statistics, appropriateness of current and potential kit additions, and local manufacturing capacity were collected and analyzed. Likert scales were utilized for categories consisting of "recommendation", "potential recommendation", and "not recommended" based on 100% - 75.0%, 74.9% - 60%, and 59.9% - 0% agreement, thresholds used in prior Delphi studies and meta-analyses. The survey design followed the Checklist for Reporting of Survey Studies (CROSS) guidelines to ensure quality standards.

Results: of 101 total LFRs, 82 participated (82/101= 81.2% response rate). Participating LFRs were 80.5% men, and 65.9% had transportation-related occupations. LFRs reported 394 assisted incidents over three months (median= 4.0, IQR: 3.0, 5,0). Gloves, gauze/bandages, and towels were the most used supplies employed in 88.9%, 61.3%, and 34.7% of incidents, respectively. For current first aid kit item appropriateness, LFRs reached a consensus agreement on gloves (92.7%), gauze/bandages (91.5%), and towels (79.3%). For potential first aid kit additions, LFRs recommended alcohol wipes/hand sanitizer (89.0%) and tape (77.2%) but did not recommend water bottles or traffic cones. Lay-first responders (LFRs) agreed (90.2%) on the importance of local supply production and desired a streamlined resupply protocol.

Conclusion: a survey on first aid kit supplies usage and appropriateness from Western Kenya demonstrated materials for body substance isolation, wound care, and hemorrhage management are critical to supply. Organized protocols for local materials resupply are essential to ensure program sustainability and continuity.

Keywords: Emergency medical services; Kenya; first aid; first responders; prehospital care.

Figure 1

appropriateness of current kit items

Figure 2

appropriateness of potential kit items