Adoption in resource constrained settings
There is clear evidence of a need for formalized training in hemorrhage control in Guatemala. Our training schema is predicated on delivering a low-cost, easy to assemble physical model with an accompanying downloadable phone or computer based application that does not rely on a constant internet connection. Crucially, the low cost of supplies, ease of assembly, and lack of reliance on steady or constant internet all contribute to the broad accessibility of the program. Furthermore, we intend to continue the training we have initiated at the Bombero Municipal School, where basic EMT training is conducted. This training site gives wide exposure to the course, allowing for recruitment of many volunteer firefighters. Our team also has connections with many different medical departments throughout Guatemala, expanding the reach of the training module across the country. Finally, we plan to allocate a portion of this grant to outreach and training.
The country of Guatemala, like many LMIC countries, lacks an organized EMS system and there is very little established infrastructure for prehospital care. All prehospital care is provided by three independent firefighting companies, largely utilizing volunteer services. Transport vehicles and other medical equipment are rarely available, and often firefighters buy the necessary equipment at their own expense. Given the lack of formalized prehospital infrastructure, there is also a gap in medical training and education of these prehospital staff. Anyone with a 6th grade education is eligible to become a firefighter in Guatemala, and must subsequently complete a 2 week, 160 hour course endorsed by USAID. One of the firefighter training programs offers an optional 2.5 year EMT course, but very few actually complete this. Due to the lack of training and volunteer status of most of the firefighters who provide prehospital care, the majority of prehospital care consists of a "scoop and run" approach rather than taking vital signs, doing ultrasounds, or providing significant stabilization prior to transport to definitive care. Ultimately, 8,500 firefighters with basic first aid training and little to no equipment attend to the emergency needs of 18 million Guatemalans. These volunteers would greatly benefit from formalized training in hemorrhage control techniques.
All of the content for this surgical training module was created within the regulations of the GSTC Discovery Award. We have been exceedingly mindful to use only open access platforms that are free of charge, available on multiple platforms (the app is available on both Android and Apple products), and there are no licenses or paywalls to access any of the materials. The ability to develop and use two different versions of the physical model removes the barrier of possible electrical or technical difficulties with the sensor-based model. We intend to translate the content and instructional manuals into more languages aside from just Spanish and English as well, to increase reachability and accessibility.