Improving initial care of road traffic injured people in Tanzania : Evaluation of a traffic police first aid education programme

Sammanfattning: Background: An overwhelming proportion of road traffic deaths and injuries in low- and middle-income countries occurs in prehospital environments. Lay responders such as traffic police officers play an important role in providing initial assistance to victims of road crashes, either alone or in collaboration with others. However, published and unpublished reports indicate that traffic police officers lack appropriate first aid education and therefore competencies to care for road crash victims.Aim: The overall aim of this thesis was to evaluate the impact of a post-crash educational programme on traffic police officers’ first aid competencies and application at the workplace.Methods: Four interrelated studies were conducted in Dar es Salaam, Tanzania. In Study I, questionnaires (n = 340) assessing the current knowledge, attitudes, and practice regarding initial post-crash care among traffic police officers were analyzed using descriptive statistics. In Study II, individual interviews with leaders of traffic police unit and drivers’ associations (n = 12) exploring factors potentially influencing the implementation of a post-crash first aid (PFA) educational programme were analyzed using qualitative thematic analysis. In Study III, before–after questionnaires (n = 135) evaluating the impact of a PFA educational programme on knowledge, perceived skills confidence, and skills utilization among traffic police officers were analyzed using descriptive and inferential statistics. In Study IV, focus group discussions with traffic police officers (n = 34) exploring factors influencing the use of first aid skills at the workplace were analyzed inductively using qualitative content analysis.Results: Although nearly all traffic police officers believed that it was part of their responsibilities to provide first aid to crash victims, their knowledge and practice of critical first aid procedures such as airway management and victim positioning were generally very poor (Study I). Study II showed that, among other things, methods of delivering training and the availability of incentives among participants could affect implementation of a PFA educational programme. Study III showed that following implementation of a post-crash educational programme, the mean knowledge score for first aid increased from about 45% before training to about 73% six months after training (p < .001, n = 102). The mean perceived skills confidence scores for providing first aid (measured on a five-point Likert scale), when rounded, increased from low (i.e., two points) before training to high (i.e., four points) six months after training (p < .001, n = 102). However, of traffic police officers who witnessed a serious crash event (n = 92), fewer than half reported having used their trained first aid skills. Study IV showed that contextual issues related to physical, social, resource, and work situations influenced the opportunity of police officers to apply their trained first aid skills at the workplace.Conclusion: A PFA educational programme has been shown to improve traffic police officers’ knowledge and perceived skills confidence regarding provision of first aid when adult learning principles are incorporated into the implementation of training. However, the increase in knowledge and perceived skills confidence did not translate into increased use of trained first aid skills in caring for crash victims. To enhance the use of skills, there is a need to improve the working conditions of traffic police officers, including equipping them with essential resources for the provision of post-crash care.