Taniya S Nagpal, Nicole Pearce, Khushmol Dhaliwal, Joseph Roshan Abraham
Implementing evidence-based obesity management guidelines requires development of medical competencies: A commentary outlining future directions in obesity education in Canada
Obesity pillars
2019 world health assembly declared emergency care essential achieve 2030 sustainable development goals subsaharan african ssa countries developed robust approaches sustainably deliver emergency medical services ems scale highincome country models financially impractical innovative reassessment ems delivery resourcelimited settings necessary timely emergency care access substantially reduce mortality developed lay first responder lfr program training 1291 preexisting motorcycle taxi drivers predominant form shortdistance transport subsaharan africa provide trauma care transport road traffic injuries three pilot programs launched staggered fashion 2016 2019 west central east africa 55 h curriculum iteratively developed train first responders longitudinal data patient impact patient demographics injury characteristics treatment rendered emergency care knowledge acquisitionretention socialfinancial effects lfr training collected pooled across three sites collective analysis novel costeffectiveness ratios calculated based prospective cost data site previously projected aggregate disabilityadjusted life years dalys addressable lfrs used inform costeffectiveness ratiosusd cost per daly averted costeffectiveness ratios compared african per capita gross domestic product gdp following whochoice guidelines state ratios less gdp per capita costeffective 2171 total patient encounters across three pilot sites lfrs frequently provided hemorrhage control 61 patient encounters patient transport motorcycle 985 median preposttest scores improved 341 percentage points 395 vs736 p 00001 significant knowledge retention six months 75 initial participants remain voluntarily involved 3 years postcourse reporting increased local stature customer acquisitionincome 320 greater nontrained counterparts locally sourced firstaid materials cost 654usdparticipant costeffectiveness analysis demonstrated cost per daly averted5165usd lfr training highly costeffective according whochoice guidelines expands emergency care access lfr program may alternative approach formal ambulancereliant ems costprohibitive resourcelimited subsaharan african settings novel socialfinancial mechanism appears incentivize longterm voluntary lfr involvement may sustain programs resourcelimited settings