Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control
Background Out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate of victims. While great efforts for bystander training have yiel...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/8/1/e001132.full |
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| author | Junaid Razzak Zia ul Haq Rizwan Naseer Noor Baig Asma Altaf Hussain Merchant Sana Mahmood Sheza Hassan Huba Atiq Ann Doll Deeba Shehnaz Adil H. Haider |
| author_facet | Junaid Razzak Zia ul Haq Rizwan Naseer Noor Baig Asma Altaf Hussain Merchant Sana Mahmood Sheza Hassan Huba Atiq Ann Doll Deeba Shehnaz Adil H. Haider |
| author_sort | Junaid Razzak |
| collection | DOAJ |
| description | Background Out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate of victims. While great efforts for bystander training have yielded positive results in high-income countries, the same has not been replicated in low and middle-income countries (LMICs) due to resources constraints. This article describes a replicable implementation model of a nationwide program, aimed at empowering 10 million bystanders with basic knowledge and skills of hands-only cardiopulmonary resuscitation (CPR) and bleeding control in a resource-limited setting.Methods Using the EPIS (Exploration, Preparation, Implementation and Sustainment) framework, we describe the application of a national bystander training program, named ‘Pakistan Life Savers Programme (PLSP)’, in an LMIC. We discuss the opportunities and challenges faced during each phase of the program’s implementation and identify feasible and sustainable actions to make them reproducible in similar low-resource settings.Results A high mortality rate owing to OHCA and traumatic life-threatening bleeding was identified as a national issue in Pakistan. After intensive discussions during the exploration phase, PLSP was chosen as a potential solution. The preparation phase oversaw the logistical administration of the program and highlighted avenues using minimal resources to attain maximum outreach. National implementation of bystander training started as a pilot in suburban schools and expanded to other institutions, with 127 833 bystanders trained to date. Sustainability of the program was targeted through its addition in a single national curriculum taught in schools and the development of a cohesive collaborative network with entities sharing similar goals.Conclusion This article provides a methodological framework of implementing a national intervention based on bystander response. Such programs can increase bystander willingness and confidence in performing CPR and bleeding control, decreasing preventable deaths in countries having a high mortality burden.Level of evidence Level VI. |
| format | Article |
| id | doaj-art-2455fe6dd0eb4e0ba59161153d7c265c |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-2455fe6dd0eb4e0ba59161153d7c265c2025-08-20T02:10:03ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762023-11-018110.1136/tsaco-2023-001132Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding controlJunaid Razzak0Zia ul Haq1Rizwan Naseer2Noor Baig3Asma Altaf Hussain Merchant4Sana Mahmood5Sheza Hassan6Huba Atiq7Ann Doll8Deeba Shehnaz9Adil H. Haider109 Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USADepartment of Public Health, Khyber Medical University, Peshawar, PakistanRescue 1122, Lahore, Punjab, PakistanCentre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, PakistanMedical College, The Aga Khan University, Karachi, PakistanCITRIC Health Data Science Center, The Aga Khan University, Karachi, Sindh, Pakistan2 Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, Pakistan2 Centre of Excellence for Trauma and Emergencies, The Aga Khan University, Karachi, Sindh, PakistanResuscitation Academy Foundation, Seattle, Washington, USARescue 1122, Lahore, Punjab, Pakistan1 Dean`s Office, The Aga Khan University, Karachi, Sindh, PakistanBackground Out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate of victims. While great efforts for bystander training have yielded positive results in high-income countries, the same has not been replicated in low and middle-income countries (LMICs) due to resources constraints. This article describes a replicable implementation model of a nationwide program, aimed at empowering 10 million bystanders with basic knowledge and skills of hands-only cardiopulmonary resuscitation (CPR) and bleeding control in a resource-limited setting.Methods Using the EPIS (Exploration, Preparation, Implementation and Sustainment) framework, we describe the application of a national bystander training program, named ‘Pakistan Life Savers Programme (PLSP)’, in an LMIC. We discuss the opportunities and challenges faced during each phase of the program’s implementation and identify feasible and sustainable actions to make them reproducible in similar low-resource settings.Results A high mortality rate owing to OHCA and traumatic life-threatening bleeding was identified as a national issue in Pakistan. After intensive discussions during the exploration phase, PLSP was chosen as a potential solution. The preparation phase oversaw the logistical administration of the program and highlighted avenues using minimal resources to attain maximum outreach. National implementation of bystander training started as a pilot in suburban schools and expanded to other institutions, with 127 833 bystanders trained to date. Sustainability of the program was targeted through its addition in a single national curriculum taught in schools and the development of a cohesive collaborative network with entities sharing similar goals.Conclusion This article provides a methodological framework of implementing a national intervention based on bystander response. Such programs can increase bystander willingness and confidence in performing CPR and bleeding control, decreasing preventable deaths in countries having a high mortality burden.Level of evidence Level VI.https://tsaco.bmj.com/content/8/1/e001132.full |
| spellingShingle | Junaid Razzak Zia ul Haq Rizwan Naseer Noor Baig Asma Altaf Hussain Merchant Sana Mahmood Sheza Hassan Huba Atiq Ann Doll Deeba Shehnaz Adil H. Haider Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control Trauma Surgery & Acute Care Open |
| title | Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control |
| title_full | Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control |
| title_fullStr | Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control |
| title_full_unstemmed | Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control |
| title_short | Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control |
| title_sort | methodological analysis of a community based training initiative using the epis framework an ongoing initiative to empower 10 million bystanders in cpr and bleeding control |
| url | https://tsaco.bmj.com/content/8/1/e001132.full |
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