EFAR System Model: Difference between revisions

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{{short description|Emergency First Aid Responder System Model}}

The '''Emergency First Aid Responder System Model''', or '''EFAR System Model''', was first published by Jared H. Sun and [[Lee A. Wallis]] in ''[[Emergency Medicine Journal]]'' in 2012, describing a system utilizing community members as first responders in low-resource settings to provide immediate basic care during medical emergencies until certified medical personnel arrive.<ref name=":0">{{Cite journal|last=Wallis|first=Lee A.|last2=Sun|first2=Jared H.|date=2012-08-01|title=The emergency first aid responder system model: using community members to assist life-threatening emergencies in violent, developing areas of need|url=https://emj.bmj.com/content/29/8/673|journal=Emergency Medicine Journal|language=en|volume=29|issue=8|pages=673–678|doi=10.1136/emermed-2011-200271|issn=1472-0205|pmid=22011973}}</ref> Since its creation, it has been deployed across twenty-three municipalities in [[South Africa]] and has been adapted for use in [[Zambia]].<ref>{{Cite journal|last=Wallis|first=Lee A.|last2=Twomey|first2=Michele|last3=Shing|first3=Rachel|last4=Sun|first4=Jared H.|date=2014-01-01|title=A strategy to implement and support pre-hospital emergency medical systems in developing, resource-constrained areas of South Africa|url=https://www.injuryjournal.com/article/S0020-1383(12)00311-7/abstract|journal=Injury|language=English|volume=45|issue=1|pages=31–38|doi=10.1016/j.injury.2012.08.015|issn=0020-1383|pmid=22917929}}</ref><ref name=":1">{{Cite journal|last=Wallis|first=Lee A.|last2=Kafwamfwa|first2=Muhumpu|last3=Cunningham|first3=Charmaine|last4=Pigoga|first4=Jennifer L.|date=2017-12-01|title=Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting|url=https://bmjopen.bmj.com/content/7/12/e018389|journal=BMJ Open|language=en|volume=7|issue=12|pages=e018389|doi=10.1136/bmjopen-2017-018389|issn=2044-6055|pmid=29229657|pmc=5778307}}</ref>

== History ==

In low- and middle-income countries, trauma-related deaths disproportionately occur in the prehospital setting and are exacerbated by poorly resourced, poorly trained, or underdeveloped emergency medical services.<ref>{{Cite journal|date=2000-04-01|title=The global burden of injuries|url=https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.90.4.523|journal=American Journal of Public Health|volume=90|issue=4|pages=523–526|doi=10.2105/AJPH.90.4.523|pmid=10754963|pmc=1446200|issn=0090-0036|last1=Krug|first1=E. G.|last2=Sharma|first2=G. K.|last3=Lozano|first3=R.}}</ref> With increasing [[globalization]] and subsequent [[Industrialisation|industrialization]], the global burden of injury affecting low-income countries had been projected to continue increasing disproportionately in developing countries.<ref>{{Cite web|url=https://www.who.int/bulletin/volumes/87/4/08-052290/en/|title=WHO {{!}} Injuries: the neglected burden in developing countries|website=WHO|access-date=2019-08-14}}</ref> As many countries attempted to imitate high-income country emergency medical services infrastructure, these efforts were found to be financially unsustainable.<ref>{{Cite journal|last=Clem|first=Kathleen J.|last2=Thomas|first2=Tamara L.|last3=VanRooyen|first3=Michael J.|date=1999-07-01|title=International emergency medical services: assessment of developing prehospital systems abroad 1|url=https://www.jem-journal.com/article/S0736-4679(99)00065-7/abstract|journal=Journal of Emergency Medicine|language=English|volume=17|issue=4|pages=691–696|doi=10.1016/S0736-4679(99)00065-7|issn=0736-4679|pmid=10431962}}</ref> Thus, a new strategy was needed to establish emergency medical systems in developing countries, and support their development into mature systems.

In 2009, Sun and Wallis began training community members as emergency first aid responders in [[Manenberg]], South Africa to treat the high levels of violence-related trauma present there,<ref name=":2">{{Cite web|url=https://www.stanford.edu/group/sjph/cgi-bin/sjphsite/no-time-to-waste-community-emergency-responder-programs-in-south-africa/|title=No Time to Waste: Community Emergency Responder Programs in South Africa|last=Holtzman|first=Jessie|date=2012-02-09|website=Stanford Journal of Public Health|language=en-US|access-date=2019-08-14}}</ref> as first responders had previously been suggested by the WHO as a possible alternative.<ref>{{Cite journal|last=Sasser|first=SV|last2=Kellerman|first2=A|date=2005|title=Prehospital Trauma Care Systems|url=http://who.int|journal=The World Health Organization|volume=|pages=|via=World Health Organization}}</ref> They found community members were dispersed and able to arrive on scene sooner than professional emergency medical providers.<ref name=":0" /> Experiencing success, they realized that using community members who want to assist was a possibility worth exploring.<ref>{{Cite web|url=https://harriscpd.co.uk/wordpress/archives/5949|title=Podcast#21(Part2): “Africa’s"Africa's Best Practice?”" « HarrisCPD|language=en-US|access-date=2019-08-14}}</ref> The EFAR system model was then designed to integrate into pre-existing or support the development of formal emergency care systems, or even serve as the foundation upon which a new emergency care system could be built.<ref name=":0" /> However, the EFAR system model has primarily served to alleviate the inconsistent and unreliable response times of ambulances and other emergency services in the Cape Town area.<ref name=":2" />

EFAR systems were implemented in two rural regions of Zambia in 2015, though no refinements were made to the course for the new setting.<ref name=":1" />