Research design/methodology

TYPE: Randomized controlled trial

VALIDITY: This study has an appropriate design. However, the paper did not report the exact distribution and status of the subjects’ prior first aid training. It is possible that some of the subjects had never received first aid training. The presence of such people in the study may produce biased results.

ENVIRONMENT: A community-based study performed at associations and sports clubs. The study attempts to simulate two common pre-hospital emergency scenarios.

Research question

Can a PDA-based expert system enable lay people to provide better quality emergency care in pre-hospital settings, compared to the care provided from memory of prior training?

The outcome measures included the ability to perform various steps of first aid treatment for two common medical emergency conditions simulated for the study. An Objective Structured Clinical Examination (OSCE) was employed to evaluate the subjects’ performance according to pre-defined criteria.

Patient/Problem/Population definition

PATIENT: Standardized patients of two common emergencies: an unconscious trauma victim with severe bleeding and a patient suffering cardiac arrest

PROBLEM: Common first aid training courses for the public are not conducive to long term retention of memory and practical skills. Therefore, lay people generally provide unsatisfactory quality of first aid treatment in emergencies.

POPULATION: Lay people from associations and sports clubs

TYPE: Health services research

Intervention

PDA as a device for providing expert advice to lay people performing first aid in common medical emergencies.

Comparison

The provision of PDA-assisted emergency first aid treatment by lay people versus those who rely on their memory of skills and knowledge gained during past trainings.

Outcome

There was significant improvement in the first aid performance of the PDA-assisted group particularly in applying skilled treatment such as pressure dressing, placing the patient in recovery position, airway management and quality of CPR. Out of a maximum total score of 24 for the perfect treatment, the control group achieved a mean score of 14.8 with standard deviation of + 3.5. The PDA-assisted group scored 21.9 + 2.7 with performance significantly better than the control group (p <0.01). Both groups performed comparably while carrying out simple steps such as checking for responsiveness, calling for an ambulance and dialing the correct emergency phone number. The control group identified ‘lack of skills’ or ‘fear of being alone’ as some of the stressors in the exercise and remarked that ‘appropriate guidance’ was needed.

Application of results to patient care

PDA-based expert advice is potentially a reproducible and readily available approach for providing relevant knowledge to lay people performing first aid. This study suggests that PDAs may significantly improve lay people’s first aid performance. It also found that a majority of the people using PDAs did not feel the need for additional professional expertise.

Further areas for research

Objective information about the subjects’ experience and familiarity with PDAs may help illustrate whether these factors could have biased the results. Further efforts to control for prior first aid training and prior experience with PDAs may help to give a better picture of the effect of PDA-based treatment advice on lay people’s performance.