First Aid Education in Fragile Environments

British Red Cross What we do: We are part of a global voluntary network, responding to people in crisis. In the U.K. we provide emergency response support, help to return home from hospital, support for refugees, asylum seekers and victims of trafficking, and education. Internationally, we work around the world to help people facing hunger, who are caught up in conflict, and who had to flee their homes. A quick introduction to who we are and what we do – this isn’t an exhaustive list but gives an idea of the breadth of work we undertake both in the UK and around the world.

First Aid Research, Advocacy, Education and Delivery Conduct research into clinical and educational approaches to first aid Contribute to the development of international guidelines for first aid Advocate for changes to legislation e.g. including first aid on the school curriculum Educate people through our face to face workshops and first aid apps Provide first aid at events or in emergencies Today I’m going to be focussing on the FAE aspect of our work. This manifests in lots of ways for us, from research to advocacy and education.

The new IJFAE has been created so there is a platform dedicated to first aid education research. Rigorous peer review International editorial board Open access Adheres to COPE guidelines Independent

One of the things highlighted on the previous slide is our contribution to the International FA Guidelines. These are produced every 5 years and involve a lot of people putting in a huge amount of work. We are part of a global network (RCRC Movement), and we found that some of our colleagues working for other parts of the Movement didn’t want to use these guidelines as they said they didn’t work for them and their contexts. These people are working in what we have termed ‘fragile environments’, places where conflict is present, where resources are low or non-existent or where the physical environment is hostile. We wanted to create guidelines that worked for them as well.

Education What’s the point? Wanting to create guidelines that worked for everyone was not our only motivation. For a long time we had been trying to include an education section into the guidelines alongside the clinical info. Why? Tell Nancy story. This is a journey we’d been on in our domestic FAE, moving from measuring numbers attending a course, to changes in learners’ confidence and willingness to act after a course. We had also redesigned our FAE, creating an ‘everyday’ approach. The previous 14 point instruction for the recovery position was distilled into three simple to follow instructions. Our education became learner centred, making it easy to remember, relevant and fun to learn.

“Train people how to think, not how to do.” Field Educator Insight A basic approach Context adaptation Audience adaptation Active learning Critical thinking “Train people how to think, not how to do.” “It’s about how creative you are with what you know, not just about first aid skills.” “It’s not just bandages; teach that the point is to stop bleeding with whatever you have.” Conducted research into FAE in fragile contexts, we wanted to know from the experts in the field what educational approaches they used and the impact they had seen those approaches have. These were the five themes that we identified through these interviews. Basic – no resources, using what you have, tied in with our Everyday approach Context – understanding social norms, local contexts, it’s about being credible in that context Audience – asking them what skills they want to learn, what injuries do they come across, incorporating their prior experiences into the education Active – lots of role play, peer-learning, the person at the front as a facilitator rather than a lecturer. A key point was allowing learners to reach solutions for themselves, being empowered to solve a problem not relying on the educator. Critical – lots of different scenarios, teaching them to apply their skills/knowledge critically. See quotes. *Expand on point re. being a facilitator not an expert teacher.

What factors enable intervention in a first aid situation? Survey with first aid learners in countries including: Bangladesh, Myanmar, Egypt, South Sudan, Lebanon amongst others. Wanted to understand what factors enabled people to give FA and what factors inhibited them from giving FA. This is to ensure our education would be targeting the most salient factors in keeping with the theme of audience adaptation identified by the educator interviews.

You are walking in a rural area You are walking in a rural area. Your friend sustains a deep cut from barbed wire. They are bleeding heavily. You do not have any first aid equipment. Example – scenarios. Learners are given scenarios and work in groups to come up with their response. These responses are then role-played to the rest of the group and feedback is given. Can see in this scenario themes from previous slide (basic, they haven’t got any equipment, critical, they are in a rural area, help isn’t on hand, no taps etc). *Global applicability – that scenario could be experienced in any part of the world.

Building Community and Individual Resilience Part of the development of the next iteration of IGFA we created the Chain of Survival behaviour. This opens up the scope of first aid from merely an intervention, to a series of behaviours which incorporate being prepared for an emergency, being able to recognise the need for urgent care, having the critical thinking skills to make and take the best course of action, and the role of the responder in the recovery process. Our education needs to cover all the aspects of this chain in order for it to be truly effect behaviour change. Prevent and prepare – resilience Self recovery – resilience In fragile contexts, resilience in this arena might go someway towards mitigating against the impact of a lack of healthcare provision. FAE is also about empowerment, empowering people to respond to crises as they arise. Using FAE as a vehicle for peace building – study in Sudan showed that by bringing communities into the same physical space to learn skills with buy-in from community leaders can begin to bridge social divides. Hands-on training exercises allow for positive interactions between trainees from different groups, which in turn can challenge stereotypes and facilitate cross-group friendships. These features map onto social psychological principles that have been shown to improve intergroup relations and are consistent with lessons learned from peace through health initiatives in public health and medicine. Gave them a common identity (first aid learners) where previously there had been no shared identity at all. For us in the RCRC Movement, this is supported by our Fundamental Principles which underpin everything we do, including neutrality, impartiality (thus taking no side in a conflict).