Evidence gaps

Help fill the evidence gaps by undertaking first aid and education research and evaluation.

Looking forward – 2025 guidelines

Evidence gaps

Evidence-based first aid education is reliant on evidence from higher-certainty, well-designed studies, such as randomised controlled trials. The volume of research available to draw upon has increased in recent years, however, many first aid and education topics need further exploration and generalisable outcomes. There remain significant evidence gaps across most of the first aid and education topics.

Criteria of studies to be included in the Guidelines

  • Available in English language (though for the 2025 publication we would like to explore expanding this to include other languages).
  • Published in a peer reviewed journal. Note that some types of research provide better evidence (in terms of the strength or certainty of the conclusions) than others because they are more robust and less prone to bias. See the evidence pyramid for more on the hierarchy of evidence.
  • Human study (not animals), based on lay first aid providers (not professional providers) on a topic relevant to first aid or first aid education. 

Case studies, evaluations, surveys and other reports published informally (on this website for example) cannot be used to formulate guidelines. However, they may be drawn upon to help inform non-systematic reviews or education considerations.

Ways you can get involved

  • Do research projects and publish your findings. Below is a list of evidence gaps which may help guide your ideas. Contact the International Journal of First Aid Education for support with structuring a research project and publishing it. Visit http://firstaid-revolution.org.

  • Partner with a university to do research. Universities tend to have expertise, resources and sometimes funding to carry out research. It may be rewarding to approach universities in your region to advocate they publish research that addresses the evidence gaps below.

  • Partner with another National Society to test whether a particular learning approach works as well in both countries or settings. Having two teams from different national organisations working together can be motivating and allows comparison between different environments.

  • Evaluate your programmes and publish your results. See the Outcomes measurement toolkit for ideas on how to do this. You could get in touch with the Reference Centre about sharing your results  on their online platform. Or the International Journal of First Aid Education may be able to support you with structuring your evaluation and publishing it more formally. 

Evidence gaps

Explore the noted gaps in evidence for first aid and first aid education topics below. Are we missing any important evidence gaps from the list? Let us know.

Jump to the sections you’re interested in…

Education essentials

Education modalities

Contexts

General approach

Breathing difficulties

Medical conditions

Trauma 

Environmental

Unresponsiveness

Mental distress

Education essentials

Closed
Effective education strategies based on relevance to learners' life experiences
  • How does adapting education (courses & materials) to address the specific illnesses or injuries that a population is most at risk of, affect outcomes? 
  • Is it more effective to only learn about the very few topics that are most likely to affect those close to a learner, or many topics that may affect anyone?
  • How does lack of resources or limited access to healthcare affect outcomes for first aid in [remote communities, conflict zones, places with an increasing elderly population but no increase in healthcare provision, disaster contexts]?
  • How do learner groups’ expectations and requirements differ (e.g., parents, designated first aiders in workplaces, carers, etc.)?  
  • Is different advice needed for those who might self-care or provide home care?
  • What are the emerging first aid topics that should grow the scope of the Guidelines and what evidence is there for their need? (E.g., sepsis, pain relief, injury and transmission prevention, people with multiple health conditions, mental health, drug dependency, antimicrobial resistance.)
Effective education strategies for learner needs and attributes
  • How does the length, cost or accessibility of course or learning opportunity affect uptake by different populations (e.g., caregivers, parents, older people, refugees, people with a disability).
  • How does the place of learning affect the outcomes? (E.g., Out in the community compared to in a school or the jungle under a tree compared to a lecture theatre.)
  • How do limitations in training materials or equipment affect learning outcomes?
  • What adaptations can be made to first aid content or approaches for specific learner needs (disability, age, etc.) that leads to improved [learning outcomes] compared to different content or approaches?
  • Is first aid education reaching people with low incomes and the more vulnerable adequately, or are we focusing on those who can pay to learn?
  • How often does a learner need to learn to maintain learning outcomes [e.g., skills, knowledge, attitude)? Does this vary by learner population or first aid intervention?
  • What impact do things like [a uniformed compared to a non-uniformed facilitator, a medical compared to non-medical professional, etc.] have on learning outcomes?  How does this vary between cultures or age groups?
Effectiveness of different modalities and tools
  • What modalities and tools help us reach [a specific audience] who otherwise couldn’t learn?
  • What outcomes are affected by using different types of tools such as free resources, short courses, long courses, or just-in-time information?
  • Do facilitators align their education practice to existing digital tools (such as a first aid app)? What is the effect on outcomes if they do or do not?
  • What strategies are effective in helping facilitators feel confident with using changing methodologies? 
  • Can we use big data or artificial intelligence to personalise or refine digital learning?
  • How does the use of simple training tools (e.g., improvised manikins, a heart you can compress, etc.) compared to the use of purpose-built, manufactured training equipment (e.g., manikins) affect outcomes? 
  • How does training that uses [simulation, practical scenario-based methods] compare with didactic lectures in terms of effectiveness but also in terms of efficiency? Cost-benefit analysis.
Measuring effectiveness of education

Measuring effectiveness for example in terms of learning outcomes (knowledge, skills, attitude, retention, etc.). Effectiveness may also be measured in terms of actual behaviour (helping others, using health services appropriately, etc.).

  • What outcomes should we measure to evaluate the effectiveness of first aid education (such changes as behaviour, attitude, ability to think critically, knowledge, skills etc.)?
  • What outcomes should we measure to increase external recognition (such as benefits to the health system, cost-effectiveness, reduction in hospital attendance, greater self-sufficiency, improved health outcomes)? And how should we measure them?
  • What outcomes are the learners looking for from first aid education (such as satisfaction, feeling better equipped to help, a certificate, more confidence)?
  • What resources are necessary to help us measure outcomes and impact (including how to collect, process, analyse and publish data)?
  • How can we improve the efficiency of our education offer, while maintaining effectiveness? 
  • Which domains of first aid (prevent, recognise, first aid, access help, self-recovery) contribute to ill or injured people’s health outcomes?
What is the impact of first aid education?

Impact for example in terms of reductions in incidence or severity of illness, injury, death, suffering, pain, or changes in the use of health services.

  • What is the impact of first aid education applied to large populations (such as taught in schools or as part of the driving test)? 
  • How does more people learning first aid [knowledge, skills, attitude] affect medical services (e.g., increased or decreased usage)?
  • Which education strategies have the greatest impact on [individual, community, population] behaviour change or resilience? 
  • What indicators can we use to position first aid as part of the public health agenda? 
  • Where should we focus our work to have the greatest impact (e.g., on those most in need, on those we can easiest reach, etc.)?
  • What impact does training compared to no training have on patient outcomes, public health outcomes particularly concerning cost-analysis?
  • Do people who have learned first aid to get their driver’s licence experience fewer road accidents?
Effectiveness of learning within other initiatives
  • What new ways are there to reach people such as first aid education through media (e.g., television), first aid at life moments (e.g., pregnancy, retirement) public health (e.g., social prescribing), repositioning first aid as self-care, etc.?
  • Who may be in a position to provide first aid care or education in their role (such as refugee workers, home-from-hospital volunteers, school nurses, key workers)?
  • Who do we need to collaborate with to embed first aid education in other initiatives (e.g., the Government, the WHO, local healthcare providers, or policymakers)?
  • How can we more effectively adapt first aid education to relevant emergencies such as flooding, fire, pandemics, earthquakes, or crises?
Learning theories
  • What theories should support our first aid education?  And how are these changing as people learn differently?
  • Is there evidence for [X existing theory] including how the theory translates into practice or how to make it more relevant or tangible to practice? 
  • Are emerging educational tools (e.g., digital) aligned or supported by educational theories and models?
  • Which approach to developing ‘helping behaviour’ through first aid education is effective? Consider that different situations, cultures and laws influence behaviour and attitudes to helping, and where there are studies, they are currently incomparable in terms of outcome measures and variables.
Inclusivity and diversity
  • Who is not being served by current first aid education and why? 
  • How can we increase the inclusion of those populations who are underserved or underrepresented?
  • Which specific education methods, adaptations or programmes can demonstrate they have improved outcomes for learners with a specific disability? 
  • What types of unconscious bias may already be part of existing first aid education activities, or impact the help people in society may or may not receive? And what can be done to overcome them?
  • How can we adapt first aid training to cultural, religious or societal realities?

Education modalities

Closed
Online learning
  • What online learning methods are most effective for first aid education? 
  • Is learning online an adequate alternative to face-to-face learning for recertification?
  • Does digital learning increase community resilience in the same way face-to-face courses might?
  • Does access to first aid education via technology make learners think they don’t need to attend a course? 
  • Can technology be learner-centred? 
  • Can technology ignite interest in first aid?
Blended learning
  • What are the best ways to integrate digital and face-to-face learning?

  • Which learner groups would benefit most from blended learning?

  • What elements contribute to the effective design of blended learning?

Virtual or augmented reality learning
  • Can alternative reality experiences improve education effectiveness?
  • Which aspects of the virtual learning experience are key to successful learning? Which aspects detract from the learning experience?
Peer learning
  • What is the impact of peer learning within interventions that result in certification compared to how it affects interventions with no certification?
  • What is the impact of peer learning on learners other than youth or students (e.g., groups affected by opioid poisoning or using reciprocal learning with older adults or within families)?
Video learning
  • What is the impact of using video as a standalone educational tool? 
  • What is the optimal length, structure or content of a video for educational purposes?  
  • Does the use of video have a positive impact on helping learners recognise conditions such as heart attack, stroke, diabetic emergency, etc.? 
  • Does the use of [X video] improve learner’s confidence or willingness to act in [X context]? 
  • Do videos improve learners competence in first aid for [bleeding, burns, fracture, snakebite, etc.]?
Refresh and retrain
  • What are the most effective and appealing ways to refresh and retrain for different learner groups? 
  • What is the optimum time frame for refresh and retrain activities for different population groups? How long after learning, how often, how long for, etc.?
  • How does the frequency of using one’s first aid skills impact upon their need to refresh and retrain? Do they need to retrain less often?
  • Is an online refresh (after initial face-to-face training) a suitable approach compared to traditional refresh courses, particularly for those people who are very remote, distanced, cannot freely travel or cannot afford the cost of travel and accommodation.
  • Is micro-learning a suitable approach compared to traditional refresh courses for those people who have no time to dedicate to training?
Feedback devices
  • Are feedback devices associated with improved [learning,  patient] outcomes?
  • What different types of feedback (auditory, visual, or physical) are effective at improving outcomes? 
  • How may feedback devices be applied to first aid skills other than CPR (e.g., splinting or bleeding control)?
  • What impact does the notion of the “necessity” of specialist equipment such as feedback devices have on helping behaviours? 

Contexts

Closed
Conflict context
  • What types of exposure to conflict and skills practise are most beneficial to learners ultimately providing first aid care? How can we provide that exposure and practise safely? These may include consideration of realistic scenarios, virtual reality, serious games, real-life exposure, etc. 
  • How can we prepare individuals or communities for providing first aid in conflicts?
  • How do motivation and attitude (the willingness to help) influence the response in comparison to curricular, topics trained, or duration of course, etc.?
  • What impact does the use of real-case-scenarios during training have on the willingness to help in conflict settings?
  • What influence does the absence of EMS and sometimes even lack of access to professional emergency care (hospitals, clinics, first aid posts etc.) have on first aid providers (when they are effectively at the end of the care chain)?
Disaster context
  • How do people respond in the moments, hours, days, weeks, months or years following the disaster? How do human factors affect the response, particularly for medical response teams?
  • Which methods (strategies, modalities or tools) are effective in encouraging the general public to prepare for a disaster (including grab bags, disaster kits, family preparedness plans, etc.)?
  • What is the best way to develop effective community resilience to disaster? 
  • Is there evidence of the types of first aid adaptations that may be necessary for a disaster context, including what improvised interventions are effective or not?
  • What are the most effective ways to develop learners’ ability to adapt to the circumstances of relevant disaster types, particularly considering the relevant limitations that will be in place?
Water context
  • How can we effectively address risk factors and change people’s behaviour?
  • What types of messages and mode of delivery are effective in changing behaviour related to water competencies and safe rescue?
  • How does a multiple intervention approach to water safety education affect outcomes (e.g., campaign + direct education + self-directed learning + caregiver and child education interventions, etc.)?
Remote context
  • How should educational messaging differ between residents of and visitors to remote contexts? This may include the types of first aid topics that can be most beneficial to the different groups and communities. 
  • What specific changes in [attitude, knowledge or skills] should be included in first aid education for remote contexts based on the prolonged access times for EMS?
  • Which types of education modalities or programmes will reach people in remote communities and have the greatest impact?
  • Does inequality in access to digital technology result in inequality in access to first aid training?

General approach

Closed
General approach
  • What tools or education methods increase learners’ ability to competently assess a scene and ill and/or injured person?
  • Is [X approach] effective in improving learners’ ability to identify the appropriate help they need to access (e.g., ambulance, transport to a hospital, internet search, etc.)?
  • What strategies may be effective to overcome certain population’s resistance to accessing EMS?
  •  How does [X population] respond to a multiple casualty incident, and can we effectively prepare them for this type of incident?
  • What is the effect of clear communication, and/or offers of reassurance and comfort on the outcomes of the ill or injured person?
  • In a seriously injured or unresponsive person, is the [“safety, stimulate, shout”, AVPU, ABC approach] effective for primary assessment compared to another approach?
  • Does a unique emergency number facilitate access to help and memorization of the alert message?
Hand hygiene
  • In places without access to soap and water, does using [X substance] for handwashing provide effective hand hygiene?
  • In the case of penetrating injuries, does wearing [gloves, plastic bags] influence the rate of infection?
Psychological first aid
  • How effective is psychological first aid in different kinds of emergencies and disasters? 
  • How effective are psychological first aid courses and training for different groups of first aid providers (learning outcomes)? 
  • What impact does psychological first aid support have on beneficiaries?
  • Does learning psychological first aid also impact one’s own psychosocial well-being and coping skills in emergencies or crises?

Breathing difficulties

Closed
Choking
  • What strategies are effective in increasing preventive behaviours for choking in caregivers of babies and young children? 
  • Is [X education approach] effective for skills development of back blows, abdominal thrusts, and chest thrusts compared to [Y education approach]? 
  • What are the factors that affect caregivers’ (of children) ability to recognise or treat choking, and what are effective education approaches to support these?
Breathing difficulties
  • What are the contexts and profiles of the types of people who care for someone with chronic breathing difficulties (or do self-care)? And how can first aid education be adapted to their needs? 
  • How subjective are breathing difficulties? What factors influence whether a first aid provider recognises and accurately triages episodes of breathing difficulties?
  • Does [calmly breathing, fresh/humid/cold air, reassurance] aid recovery?
  • Does administration of oxygen improve survival in people with shortness of breath or hypoxemia? 
  • Are there other effects on the person with shortness of breath resulting from the provision of oxygen to them (e.g., delay in EMS access)? 
  • Does [blowing on the face, removing from the situation] help stop breath holding?
Asthma attack
  • What is the effect of [fresh air, loosening clothing, moving away from triggers] on the outcomes of the person experiencing an asthma attack?
  • What are the most effective ways to help a person experiencing an asthma attack if an inhaler is not available? 
  • What factors contribute to or education strategies are effective in helping [specific population] more accurately recognise and triage the severity of an asthma attack in [specific population]? (E.g., teachers in children.)
  • What is the optimal bronchodilator for administration? What is the optimal dose of bronchodilator? How should this bronchodilator be administered? 
  • Is there evidence that prehospital use of bronchodilators for asthmatics with acute shortness of breath reduces mortality?
Croup
  • Does [drinking warm drinks, humidified or fresh air/steam, positioning, providing comfort] affect the person’s outcome? 
  • What education strategies are effective in helping caregivers recognise and confidently provide first aid for croup?

Medical conditions

Closed
Chest pain
  • Does [X education approach] improve early recognition or reduce the time taken to access EMS for a person experiencing a heart attack?
  • Does administration of aspirin by first aid providers delay EMS involvement? 
  • Is aspirin safe if given by a first aid provider to a person with chest pain who is not having a heart attack? 
  • What are the clinical results of aspirin administration compared to no aspirin administration by first aid providers on people with subsequently proven coronary events?
  • Can first aid providers recognise the contraindications of aspirin? What are the most effective ways to train first aid providers to recognise contraindications?
Stroke
  • Does [X education approach] improve early recognition or reduce the time taken to access EMS for a person experiencing a stroke?
  • How much training is needed and what type of training should be used to enable first aid providers to correctly apply [a stroke assessment system]?
  • What is the accuracy of the use of stroke assessment systems by first aid providers (compared to the accuracy of the use of stroke assessment systems by healthcare providers) and what impact does the accuracy of assessment have on patient outcomes?
  • What are the effects on patient outcomes of having direct transport to a specified stroke centre when a stroke assessment system measurement is positive?
Allergic reaction and anaphylaxis
  • Which education interventions are effective at improving preventive actions by people at risk of allergic reactions? 
  • Does [X education approach] improve early recognition of a person experiencing a severe allergic reaction?
  • What factors increase the likelihood that a person who has been prescribed an auto-injector, carries it with them and/or will use it when needed? 
  • How can a first aid provider determine that a witnessed allergic reaction needs epinephrine? 
  • Should an initial injection be administered in the early stages of anaphylaxis, before the onset of severe symptoms? 
  • What is the most effective preparation and training for first aid providers to improve their efficiency in administering an auto-injector?
  • Are there education interventions that can be aimed specifically at improving the outcomes of adolescents at risk of anaphylaxis?
  • How can a first aid provider determine that a person needs additional epinephrine? 
  • What should the optimal time interval be between doses of epinephrine?
Shock
  • What is an effective education design for teaching the different types and causes of shock?  Which education approach is most effective in building [skills, confidence, knowledge, retention]? 
  • Does [raising a person’s legs, other positional change] affect clinical outcomes?
  • Does keeping the person warm have a positive impact on clinical outcomes?
  • Is there potential harm of passive leg elevation in people with pelvic, abdominal or chest, and head trauma?
Diabetic emergency
  • Does [X education approach] improve [early recognition, first aid, or accessing help] in the case of a person experiencing a diabetic emergency?
  • Does a focus on hypoglycemia (rather than hyperglycemia) in first aid education, affect [educational, clinical, societal] outcomes?
  • What complications are associated with various oral hypoglycemia treatment options? 
  • What dietary forms of readily available sugars affect patient outcomes (e.g., glucose, gels, pastes and spray or dietary sugary snacks containing gelatin, honey, sweetened condensed milk, etc.)?
Seizure
  • In [X population] does [X education approach] improve [early recognition or appropriate first aid] for a person [unknown or known to them] who is experiencing a seizure?
  • Does [X education approach] decrease stigmatising behaviours and increase helping behaviours toward those who experience seizures? 
  • Does the use of a specific body position immediately after a seizure compared to another position decrease the risk of worsening the clinical condition for a person experiencing a seizure?

Trauma

Closed
Bleeding severely
  • Does [X education approach] improve early recognition and appropriate first aid for life-threatening bleeding?
  • What is the most effective technique for applying direct manual pressure to a bleeding wound by an [adult or child]?
  • In what circumstance or at what age/stage, can an injured person effectively apply pressure to their own severely bleeding wound?
  • To what extent do [plastic bags, clothing, hand, etc.] provide adequate protection from cross-infection when providing first aid to a bleeding person? 
  • What is the most effective way to prepare first aid providers to deploy tourniquets in multiple casualty scenarios?
  • What are the responses of bystanders and first aid providers at a multiple casualty incident?  And what can be done to increase their helping behaviours for bleeding casualties? 
  • Is [X tourniquet design] more or less effective than [Y tourniquet design or no tourniquet] on babies and young children?
  • In delayed-help environments, can tourniquets be loosened to reassess or stop bleeding with direct pressure when conditions warrant (e.g., scene safety improves, access to wounds improves, or additional resources are available)?
  • What is the maximum time that a tourniquet can be left in place before the benefit/risk ratio reverses? 
  • Is the use of a hemostatic dressing feasible and effective for control of severe bleeding?
  • Is cold therapy effective for minor nosebleeds to supplement pressure application to stop nosebleeds?
Chest and abdomen injuries
  • Does [a certain position] benefit a person with an open chest wound or an abdominal wound? 
  • How does a non-occlusive dressing impact the outcomes of a person with an open chest wound? 
  • For a population at high risk of chest and abdominal injuries does [X education intervention] increase appropriate preventative behaviours?
  • Does [X education appraoch] improve learning outcomes?
  • How does [pushing back in, firm pressure on, applying a moist dressing to] bulging organs affect patient outcomes? 
  • Does light pressure on a painful spot of a suspected fractured rib improve healing etc.?
Amputated body part
  • Is it beneficial to patient outcomes to keep an amputated body part on ice? And for how long?
  • Does [X education approach] improve [preventative behaviours, first aid, or accessing help] for a person with an amputated body part?
  • For [X population at high risk of an amputated body part] does [X improvised or prepared equipment] impact appropriate first aid actions?
Wound care
  • Does [X education approach] improve [attitude, knowledge, skills] to [prevent, recognise, treat, or access appropriate help] for a simple skin wound? 
  • For those without access to [clean water or appropriate dressings,] is [X alternative treatment] beneficial to outcomes?
  • What are the best topical agents and dressings that a first aid provider may have access to treat a wound? 
  • When should a first aid provider seek additional care for superficial wounds? And what are the signs to recognise this?
  • Does [disinfectant solution, sterile compress, timing of sterile dressing, removing a foreign object, immobilising it] affect patient outcomes?
Burns
  • Is [X duration of cooling for burns] beneficial to outcomes? And is cooling a burn until the pain is relieved adequate? And does this method work equally well on different ages, populations and areas of the body?
  • What is the optimal temperature of cold application for cooling burns? 
  • Does running water compared to water immersion affect outcomes for cooling burns? Or repouring the same water?
  • In a remote or low resource area, does immediately cooling the burn with [alternative substance to water] affect outcomes? 
  • In a remote or low resource area, does applying [alternative ointment or dressing] to the burn affect outcomes? 
  • Does applying plastic cling film to a burn improve outcomes? 
  • Is [X method] of identifying the severity of a burn effective?
  • Does [X education approach] improve [learning outcome] to [prevent, recognise, treat, or access appropriate help] for a [thermal, chemical or sun]  burn? 
  • When is a burn sufficiently large that cold application creates a risk of hypothermia?
  • With respiratory tract burn, does drinking ice water help healing?
Fractures, sprains and strains

Does [X education approach] improve [attitude, knowledge, skills] to [prevent, recognise, treat, or access appropriate help] for an extremity injury? 

Is the application of cold or ice packs beneficial for acute extremity injuries?

What is the optimal frequency, duration and initial timing of ice or cooling treatments after an acute injury?

Does immobilisation or elevation of an extremity injury using a splint or sling affect outcomes? 

In humans with strains and sprains, is elevation effective to improve health outcomes?

Is there any benefit in terms of pain reduction or healing if first aid providers stabilise a suspected fracture? 

Does distance from a definitive healthcare facility make a difference in the effectiveness of stabilisation?

Does realigning an angulated fracture [before/instead of/after] splinting affect outcomes?

Does travel time to a definitive healthcare facility affect the risks or benefits of realigning an angulated fracture? 

Does the use of a compression wrap for joint injuries affect outcomes?

Spinal injury
  • Does manual stabilisation of a cervical spinal injury affect patient outcomes? 
  • Is manual stabilisation of the head with the hands effective to change recovery?
  • Does [X education intervention] improve learner’s [attitude to, understanding of] spinal injury? 
  • Does [X education approach] increase learners [knowledge, skills] to [recognise, treat, or access help] for a suspected spine injury?
Head injury
  • What signs of concussion can be used to support assessment by a first aid provider? 
  • Which assessment tool is most effective for use by first aid providers to determine whether a head injury may be serious? 
  • Does [X education approach] increase learners [knowledge, skills, attitude] to [prevent, recognise, treat, or access help for] a head injury?
  • What education methods are effective for [X population] to prevent or recognise a serious head injury?
Mammal bites
  • What is the most effective treatment for [monkey, bat, etc.] bites? 
  • Does wound irrigation improve outcomes for [a mammal] bite?
  • What education methods are effective for [X population] to prevent or treat [a mammal] bite?
Insect bites and stings
  • What are the preventative measures for getting bitten or stung? 
  • What are the effective education methods for [X population] to prevent, recognise or treat an insect bite or sting?
  • What is the fastest and most effective way to remove a [honeybee stinger or a tick]? 
  • Does cooling the sting site with ice change recovery?
  • In humans with a swollen throat due to an insect bite, is sucking on ice or cooling the mouth with cold water effective to reduce swelling?
  • Does the application of [vinegar etc.] to the site of a sting change recovery?
  • In humans with itch due to bite or a sting is the use of itch-soothing crème or lotion effective to reduce itching?
  • Does the application of topical antihistamine change recovery?
Aquatic animal injury
  • What is the most effective treatment for [X aquatic animal] injury? 
  • Is removing the tentacles effective as a first aid treatment?
  • Does rinsing with vinegar or another intervention increase survival, tissue healing, etc.?
  • Does [X education approach] increase learners [knowledge, skills, attitude] to [prevent, recognise, treat, or access appropriate help] for  [X aquatic animal injury]?
Snakebite
  • Does keeping the injury and the injured person still and resting, reduce the spread of venom or affect other outcomes? 
  • Does pressure immobilisation in addition to [rest, splinting, padding, etc.] improve outcomes?
  • What education methods are effective to improve appropriate [prevention, recognition, treatment, and access of help] for snakebite?
  • Is irrigation of the venom effective and feasible for first aid providers as first aid treatment?
Poisoning
  • Is [dilution] treatment effective for ingestion of an oral, inhaled, cutaneous or ocular caustic substance?
  • Which education methods are effective for [X population] to improve appropriate [prevention, recognition, treatment, and access of help] for poisoning?
  • In people experiencing a “bad trip”, is being in a cool environment compared to no cool environment effective to change recovery?

Environmental

Closed
Hyperthermia
  • What is the most effective way to teach the range of severities of hyperthermia (heat exhaustion, exertional hyperthermia and heat stroke)?  
  • Which education methods are effective in improving appropriate [prevention, recognition, treatment, and access of help] for degrees of hyperthermia?
  • Is [X treatment] an effective and practical alternative for active cooling in places without access to water?
Dehydration
  • What is the most effective way to improve the prevention and recognition of dehydration in [X population]? 
  • Is [X] homemade oral rehydration solution effective?
  • How can a first aid provider determine the amount of liquid required for rehydration?
Hypothermia
  • What is a practical and effective rewarming treatment for [moderate or severe] hypothermia? 
  • Which education methods are effective to improve appropriate [prevention, recognition, treatment, and access of help] for hypothermia?
Frostbite
  • What are effective first aid interventions [NSAIDs, rewarming methods, etc.] to improve outcomes from frostbite?
  • In humans with frozen feet, is continuing to walk a risk factor for recovery?
Drowning
  • What is the most effective way to teach laypeople how to recognise drowning? Particularly the early stages of the drowning process.
  • Can people learn and apply rescue techniques? 
  • What are the most effective training techniques for [any of the domains of the Drowning chain of survival]? How often does education need to be repeated? 
  • Does giving 2-5 initial rescue breaths impact outcomes? 

More evidence gaps and research ideas for drowning can be found on the website of the International researchers Drowning Alliance.

Unresponsiveness

Closed
Unresponsive and breathing normally
  • Where a decreased level of responsiveness is the result of an overdose, is lying the person in a semi-raised position preferable to a side-lying position?
  • For a person with a diminished level of responsiveness who is breathing and not in need of CPR, does positioning in a lateral/side-lying recovery position result in [unrecognised cardiac or respiratory arrest; decreased need for hospitalisation; decreased risk for aspiration]? 
  • What education strategies are effective in helping [specific population] more accurately recognise and provide first aid for an unresponsive person who is breathing normally in a [specific population]? (E.g., unknown person to the helper, adolescents, etc.)
  • What is the best recovery position?
  • What are the risks of any position for an unresponsive person who is breathing?
Unresponsive and abnormal breathing
  • What is the optimal [sequence, ventilation/compression rate] for CPR for [children, babies]?
  • What treatment recommendations are effective for cardiac arrest in settings that have low resources such as limited access to health care, ambulances, transport or defibrillators?
  • In circumstances where a call cannot be initiated immediately using a speakerphone, does doing [X length time] of CPR before calling EMS compared to calling EMS and then doing CPR, affect outcomes?
  • Does transport with CPR in progress affect patient outcomes? What is the risk of harm to the person performing CPR during transport?
  • What is the impact on patient outcomes of doing CPR on a padded surface such as a car seat or bed? 
  • Does the use of an app to locate and alert the nearest first responders to the cardiac arrest increase the person’s chance of survival?
Opioid overdose
  • What is the efficacy of naloxone programmes in countries other than the USA, Canada or the UK?
  • What is the efficacy of naloxone use with different opioid user groups?
  • What is the risk compared to the benefit of bystander-administered naloxone?
  • What effect does bystander-administered naloxone (intramuscular or intranasal) plus conventional CPR compared to conventional CPR only have on outcomes?
  • In people with a needle in place does removing the needle by a first aid provider influence tissue healing, etc.?
  • In users with a tourniquet in place does removing the tourniquet change survival, recovery, etc.?

Mental distress

Closed
Traumatic event
  • Does psychological first aid affect the outcomes of those people experiencing a traumatic event?
  • What strategies or techniques are effective to safely and immediately support someone after a traumatic event without re-traumatisation?
  • What is the risk level of the first aid provider experiencing secondary trauma in the responding process and what are effective strategies to prevent or cope with this trauma?
Acute grief
  • Does psychological first aid affect the outcomes of people experiencing acute grief?
  • When is the best time to offer psychosocial support in an acute grief situation and for how long? 
  • What are the effective support and care to be offered to those who are facing ambiguous losses or missing loved ones?
Suicidal ideation
  • Does psychological first aid affect the outcomes of people experiencing suicidal ideation?
  • What are the effective strategies and tools in helping to distinguish self-harm and active suicidal risk, thus helping to guide more effective and appropriate care and management to the person at risk?

Useful links

Training on the evidence-based practice Five modules from the Centre for Evidence-Based Practice that you can do online. 

Presentation on using first aid evidence Overview from Cochrane First Aid of how to consult, interpret and use first aid research evidence.

Resources about study design and research methods Tutorials from Students 4 Best Evidence (supported by Cochrane) on a range of topics.

Understanding evidence Resources from Ask for Evidence on some factors affecting the reliability of evidence.

Types of study design An article from Vox which describes the types of study designs.

Get advice on your research design or publish your research International Journal of First Aid Education 

Get in touch to submit evidence gaps or tell us about your research

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Explore the guidelines

Published: 15 February 2021

First aid

First aid

Explore the first aid recommendations for more than 50 common illnesses and injuries. You’ll also find techniques for first aid providers and educators on topics such as assessing the scene and good hand hygiene.

First aid education

First aid education

Choose from a selection of some common first aid education contexts and modalities. There are also some education strategy essentials to provide the theory behind our education approach.

About the guidelines

About the guidelines

Here you can find out about the process for developing these Guidelines, and access some tools to help you implement them locally.