Task shifting – A model of pre-hospital trauma training for lay persons

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Community based medical service: a simple yet radical response to the world’s most dangerous roads?

According to the World Health Organisation, globally 1.24 million people die on the world’s roads every year. Africa, although the least motorised region of the six world regions ranks the highest in road traffic fatalities with forty of the 50 countries with the highest road-death rates being an African country.  In many African countries death by road accidents has surpassed death by malaria.

Pre-hospital care has a critical impact on the mortality of those injured in emergencies especially during roadway casualties. Unfortunately, in many countries emergency medical services that provided pre-hospital care are almost nonexistent. In this absence, the Emergency First Aid Responder (EFAR) System developed a passive and a coordinated process to deal with emergencies in low-resource areas.  The EFAR system seeks to task shift pre-hospital care to properly trained community members.

EFAR model – first aid as part of the wider health care response strategy

  • The EFAR system started in South Africa as a way to establish pre-hospital emergency care in local regions. In South Africa, the concept is being led by the Western Cape emergency medical service and the Academic Division of Emergency Medicine of Cape Town in partnership with local communities, but the African Federation for Emergency Medicine advises implementation in countries outside of South Africa.​
  • A Governing Body is responsible for oversight of the entire system, in terms of financing, quality of training and managing research. In the initial stages, the African Federation for Emergency Medicine provides implementation support free of charge. The Governing Body can be any entity that can assume the above esponsibilities usually existing medical services, health departments, hospitals or universities.
  • The Governing Body recruits Community Advisers for each target community. The idea is that the EFAR training curriculum can be modified and adapted to each local area based on its needs and resources. The appointed Community Advisors must assess the emergencies specific to clinics and hospitals in their area and the infrastructure and resources available to ensure EFARs are trained in emergencies that are prevalent in the community.
  • After the EFAR training curriculum has been localised – lay community members are trained to provide frontline emergency care in local regions based on the capabilities, infrastructure, and resources available in their area.
  • During an emergency, residents can call upon their nearest EFAR from his or her residence or sending an SMS.
  • Each community will have at least one Head EFAR to help manage dispatch and operations.
  • The EFAR system is designed to be integrated with existing healthcare structures, and can be used to support existing emergency medical services.


Task Shifting: A Solution for strengthening pre-hospital care in low-resource settings?


The management of trauma patients varies across the globe. In health systems where formal pre-hospital arrangements do not exist, tasking shifting allows appropriately trained lay people to take on the first tier of care. By reorganising the workforce in this way a community with limited resources will be able to utilise their greatest asset – the local population – to expand the pool of human resources for health.


Lessons to be learnt:

  • The EFAR model provides human resource support during general pre-hospital emergencies – although not exclusively designed for road side accidents – training curriculum is developed from a needs assessment, therefore regions with high road traffic accidents can build first aid training for road causalities into their training curriculum.
  • Many sites have developed innovative ways to fund their own EFAR systems, and the African Federation for Emergency Medicine is able share the techniques that are appropriate to each region



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Author Information

Kathryn Schulz joined The New Yorker as a staff writer in 2015. In 2016, she won the Pulitzer Prize for Feature Writing and a National Magazine Award for “The Really Big One,” her story on the seismic risk in the Pacific Northwest.

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