Examples of remote contexts include wilderness environments, isolated communities or rural areas with limited resources. Medical care may be limited or take a long time to access in this context. Additionally, individuals and communities may experience longer wait times for medical help and have to consider extra factors – such as environmental hazards – compared to those living in urban areas.
Guidelines
Good practice points
- First aid programmes should reflect the difference between visiting and living in a remote location.
- Local government or community organisational support should be secured before developing the first aid programme.
- Where possible, learners should be involved in the development of educational content.
- Local organisations should manage the selection process of community-based first responders if they are expected to fulfil a defined role in the community after their training.
- Education should be aimed at those most likely to encounter ill or injured individuals.
- If learners plan to visit a remote place, they should be advised to plan their route, as well as inform family and friends of where they are going and when they expect to return.
Education considerations
Context considerations
- Base educational content for remote contexts on the risks posed in those specific environments. For example, where medical assistance is limited or requires longer travel times, learners need to know how to prioritise and provide care for life-threatening injuries.
- Draw attention to context-specific illnesses such as Hypothermia, Hyperthermia or Altitude sickness. Provide general advice such as avoiding alcohol, drinking plenty of water and developing ways to protect against the weather (e.g., by building a shelter or starting a fire) to help learners prepare for such conditions.
Learner considerations
- Include information specific to the remote location, such as how to signal for help, who can provide help, and what level of care is available for learners who are unfamiliar with the remote context.
- Adapt first aid education to the needs of the learners. For example:
> Drivers who encounter a road traffic collision where a person has a Spinal injury may not be able to immobilise the spine properly while transporting the person in a moving vehicle. Therefore, education should focus on simple ways to protect the neck and back, including gentle handling and restricting movement.
> If someone has a Burn and water or other liquids are in short supply, they could put a bowl under the burn and pour the liquid over the burn into the bowl so that the water can be used again. This is more effective than putting the burn into the bowl of water as the body part will warm the water. Pouring it keeps the temperature of the water lower.
Facilitation tips and tools
- Emphasise the role of first aid providers in situations where medical care takes a long time to access and how they may have to prioritise care for an ill or injured person.
- Empower learners to make informed decisions, bringing awareness to the stress they may experience in these situations.
- Use scenario-based role-play to help learners critically assess what actions they should take. Follow up with a debrief to allow learners to discuss any feelings of uncertainty, fear or anxiety. Provide reassurance.
- Encourage learners to improvise when they do not have appropriate first aid equipment. Help them to understand the purpose of the equipment, rather than the need for something specific. For example, if they are in a cold environment and do not have a blanket, encourage them to think about building a shelter or a fire instead.
Scientific foundation
Non-systematic review
Based on the evidence, we identified the key actions to take when developing first aid programmes for a remote context.
Differentiate the first aid education
Differentiate first aid education according to the learners’ context (i.e., the programme for those living in a remote community should differ from one aimed at people visiting a remote area). This point is particularly relevant to how a bystander might respond to an ill or injured person. In remote communities, people are more likely to know one another and know where and how to get help. In contrast, individuals on short trips to these locations need to find out in advance how to access help for themselves and others (Born et al., 2012; Orkin et al., 2012). Additionally, communities with limited access to medical care need customised education that takes their geographical setting, infrastructure and access to resources into account and tailors public health and emergency response messaging accordingly (Orkin et al., 2012).
Prioritise the first aid interventions
People in a remote setting will likely have to wait a significant length of time to receive medical care. Therefore, first aid providers should understand which actions to prioritise. It is also essential to ensure learners understand why some first aid actions are a priority over others (Born et al., 2012; Tiska et al., 2004).
Secure local cooperation and agreement.
Local government, community or voluntary organisations can be active sponsors and organisers of first aid education, such as community-based first responder programmes. Understanding a community and being present within it establishes the foundation for a programme to be successful in the long-term (Orkin et al., 2012). Local government organisations can help with the administrative aspects of a programme by organising Refresh and retrain sessions (Kay & Myrick, 1982). In some rural contexts, local community groups or networks have created sustainable first aid programmes that do not rely on outside assistance (Ratner & Katona, 2016).
Use peer selection to identify capable first responders
Some evidence has shown that the best way to identify people who will perform effectively as first responders is to have local organisations manage the selection process. This is another example of why it is important to secure local support for any first aid programme before it begins (Jayaraman et al., 2009; Kay & Myrick, 1982; Raj Pant et al., 2015).
Target education
In remote communities, there may be a group of people who are more likely to encounter and transport ill or injured individuals. One example is commercial drivers who transport people to medical facilities in areas where it would take too long or be too difficult for an ambulance to arrive. Programme designers should capitalise on the opportunity these individuals have to provide first aid and offer the appropriate training. Other examples of groups to target include farmers or park rangers. It is important to work with these particular groups and create the programme’s content together. This collaboration is an effective way to ensure the content and approaches meet the needs of the specific audience (Born et al., 2012; Jayaraman et al., 2009; Orkin et al., 2012; Pant et al., 2015; Tiska et al., 2004).
References
Born, K., Orkin, A., VanderBurgh, D., & Beardy, J. (2012). Teaching wilderness first aid in a remote First Nations community: The story of the Sachigo Lake wilderness emergency response education initiative. International Journal of Circumpolar Health, 71(1).
https://www.tandfonline.com/doi/pdf/10.3402/ijch.v71i0.19002
Jayaraman, S., Mabweijano J. R., Lipnick M. S., Caldwell, N., Miyamoto, J., Wangoda, C. M., Hsia, R., Dicker, R., & Ozgediz, D. (2009) First things first: Effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda. PLoS ONE, 4(9), 6955.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0006955
Kay, B. J., & Myrick, J., A. (1982). An evaluation of program implementation strategies for a rural firstresponder system. Journal of Community Health, 8(2), 57–68.
https://link.springer.com/article/10.1007/BF01326551
Kay, B. J. (1984). ‘Barefoot doctors’ in rural Georgia: The effect of peer selection on the performance of trained volunteers. Social Science & Medicine, 19(8), 873–878.
https://doi.org/10.1016/0277-9536(84)90405-2
Orkin, A., VanderBurgh, D., Born, K., Webster, M., Strickland, S., & Beardy, J. (2012). Where there is no paramedic: The Sachigo Lake wilderness emergency response education initiative. PLoS Medicine, 9(10).
https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001322
Pant, P. R., Budhathoki, B., Ellis, M., Manandhar, D., Deave, T., & Mytton, J. (2015). The feasibility of community mobilisation for child injury prevention in rural Nepal: A programme for female community health volunteers, BMC Public Health, 15, 430.
https://link.springer.com/article/10.1186/s12889-015-1783-5
Ratner, K. G., & Katona, L. B. (2016). The peacebuilding potential of healthcare training programs. Conflict and Health, 10(1).
https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-016-0096-3
Tiska, M. A., Adu-Ampofo, M., Boakye, G., Tuuli, L., Mock, C. N. (2004). A model of prehospital trauma training for lay persons devised in Africa. Emergency Medicine Journal, 21, 237–239.
https://emj.bmj.com/content/emermed/21/2/237.full.pdf
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Explore the guidelines
Published: 15 February 2021
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
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
Here you can find out about the process for developing these Guidelines, and access some tools to help you implement them locally.