Pilot Implementation of a Culturally Adapted Prehospital Trauma Program for Community Health Responders in Rural Nepal

Introduction: Trauma-related deaths are rising in low- and middle-income countries (LMICs) like Nepal, where pre-hospital care systems are limited. Community health responders (CHRs) could reduce the time to post-injury care in rural settings. This pilot study evaluates the feasibility and impact of a CHR-based trauma program in rural Nepal. Methods: A quasi-experimental study first adapted a trauma curriculum for CHRs in Achham, Nepal, using global guidelines from the World Health Organization and the American College of Surgeons, using a modified Delphi process. The final program included three components: a two-day skills training, a pictorial guidebook for reference, and a one day refresher after three months. Two municipalities in Achham were assigned to intervention or control, with only the intervention group’ CHRs receiving the training. Outcomes measured included CHRs’ knowledge and confidence assessed over six months, and patient-based pre-hospital care process indicators. Care process indicators were assessed at the hospital emergency department. Changes in knowledge over time were analyzed using repeated measures ANOVA. Bivariate analysis was performed to assess differences in pre-hospital trauma care indicators by study group. Results: The intervention group showed a significant increase in knowledge and confidence immediately post-course and sustained over six months. There was no significant difference in mean patient age (26.5 years versus 22.1) and trauma mechanism (p = 0.14) across the two groups. The most common mechanism was falls (n=165, 77.5%). Intervention municipalities had higher rates of pre-hospital care provision, including fracture immobilization (51.4% versus 17.1%, p < .001) and cervical collar use, compared to controls. Conclusion: This study adapted and implemented a contextual trauma training program for CHRs in rural Nepal. Results show early feasibility and appropriateness in this context. The program leverages existing community networks and offers a potential approach in LMICs to bridge the existing critical gaps in rural pre-hospital trauma care that require further investigation.