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Experience of the Belgian Red-Cross Flanders

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Evidence-based First Aid: Experience of the Belgian Red-Cross Flanders Prof. Philippe Vandekerckhove, MD, PhD Belgian Red Cross-Flanders Overview . Evidence-Based Practice in Belgian Red Cross- Flanders . Evidence-based first aid guidelines . Evidence-Based Practice: from first aid to blood supply . Conclusions History . About 10 years ago: a volunteer who followed first aid training in the Belgian Red Cross-Flanders volunteered in our neighbouring country… . Surprising conclusion: – no harmonisation in first aid training throughout Europe – Disagreement on the best technique to be used in certain situations History . 2006: Development of European first aid guidelines and European First Aid Manual (EFAM) . Objective: − To determine the most effective, safe, and feasible first aid techniques and procedures − To formulate recommendations for training − To develop European training materials . This was done using evidence-based methodology to identify effective interventions and interventions that were dated, ineffective or even harmful. Centre for Evidence-Based Practice Working principles Centre for BRCF service Evidence-Based Practice Panel of external experts Methodology . 3 types of evidence-based products for different purposes − Scoping reviews: Exploratory • Method: limited consultation of databases, may be less than a full review of the evidence • Endproduct: internal use, serves to inform the steering committee − Systematic reviews: Profoundly • Method: 1 research question, extensive search for all available evidence (following methodology of the Cochrane collaboration) • Endproduct: peer-reviewed publication, knowledge synthesis, serves to inform policy-makers − Evidence-Based Practice guidelines: User-friendly • Method: systematic literature search combined with guideline panel meeting. Complete coverage of a health/social topic, development according to AGREEII criteria • Endproduct: Set of recommendations + didactical materials, serves to offer high-quality assistance Overview . Evidence-Based Practice in Belgian Red Cross- Flanders . Evidence-based first aid guidelines . Evidence-Based Practice: from first aid to blood supply . Conclusions EFAM 2006 First Aid Guideline European development first aid Guidelines First Aid Manual (Europe) Goal: uniform First Aid instructions in Europe First Aid Manuals Different First Aid Manuals in different European languages, (European countries) depending on the context (e.g. countries with rather hot or rather cold climate), … 32 organisations, 28 countries EFAM 2011- update First Aid Guideline development IFRC (2011) International First Aid and Resuscitation Guidelines First Aid Manual (Europe) Goal: uniform First Aid instructions in Europe First Aid Manuals Different First Aid Manuals in different European languages, (European countries) depending on the context (e.g. countries with rather hot or rather cold climate), … AFAM (2009-2011) . Aim: − To develop guidelines on layperson first aid training programmes in Sub-Saharan Africa. − To offer a flexible resource pack to support the development of first aid training materials. − Provision of adapted first aid training materials. AFAM - Project justification . African Red Cross Societies requested first aid materials adapted to African context . First aid training: a low-cost opportunity to decrease the burden of disease & injury in Sub-Saharan Africa (World Bank) . Elements in Africa that call for specific first aid guidelines − a distinct burden of disease and injury − varying access to formal healthcare − a strong embedment of traditional/folk remedies . First aid recommendations are often linked to prevention advice: Preventive measures can reduce both fatal and non- fatal injuries and diseases AFAM - Methodology . Based on: − EFAM 2005 and 2011 − IFRC International first aid &resuscitation guidelines 2011 − Resuscitation Guidelines 2010 (American Red Cross and American Heart Association) . Methodology > Selection of topics based on global burden of disease statistics with relevance for Sub-Saharan Africa » approximately 40% of all deaths and morbidity burden can potentially be addressed by emergency care > Evidence review of literature by 2 experienced reviewers > Validation by expert panel: 11 African experts (specialists and Red Cross experts), chair: Prof. Dr. Jimmy Volmink > Consultation round: 7 additional external experts > Pilot implementation (Uganda, Swaziland) AFAM - Methodology Centre for International affairs Evidence-Based Practice Search strategy expanded with African databases (Afrolib and Target group = African population African Index Medicus) + focus on studies? performed in ? Africa Multidisciplinary expert panel of Panel of external experts 11 African experts? AFAM – results: study selection Potentially relevant studies with relevance to first aid n = 23998 Studies excluded from titles and abstracts n = 23113 Studies selected for full text evaluation n = 885 Studies excluded from full text n = 742 Unavailable studies n = 6 Other language n = 22 Study design criteria n = 197 Population criteria n = 39 Intervention criteria n = 125 Outcome criteria n = 12 Evidence covered in other included studies n = 341 Included studies n = 143 AFAM - results: African context . Specific search for African studies or studies performed in low and middle income countries. AFAM integrates succesful African remedies that make the best of limited resources. Examples: − ash for hand washing − homemade oral rehydration solutions for diarrhoea based on maize flour − boiled and cooled water for wound cleansing − application of honey or Aloe Vera and dressings from banana leaf for burns AFAM - results: pilot study . Example: Use of oral rehydration solution for diarrhoea Pilot study •The maize box was not recognized, because maize is packaged as maize flour in big bags •The salt tub was not recognized, because it is not used in African countries Expert Panel and AFAM team AFAM - Implementation . Current AFAM users: Uganda Red Cross Uganda Red Cross Uganda Red Cross Society (URCS) Society (URCS) Society (URCS) Baphalali Swaziland Baphalali Swaziland Baphalali Swaziland Red Cross Society Red Cross Society Red Cross Society (BSRCS) (BSRCS) (BSRCS) Kenya Red Cross Kenya Red Cross Kenya Red Cross Society (KRCS) Society (KRCS) Society (KRCS) Croix-Rouge Croix-Rouge Croix-Rouge Camerounaise (CRC) Camerounaise (CRC) Camerounaise (CRC) Namibia Red Cross Namibia Red Cross Namibia Red Cross Society (NRCS) Society (NRCS) Society (NRCS) South African Red South African Red South African Red Cross Society Cross Society Cross Society (SARCS) (SARCS) (SARCS) Sierra Leone Red Sierra Leone Red Sierra Leone Red Cross Society Cross Society Cross Society Overview . Evidence-Based Practice in Belgian Red Cross- Flanders . Evidence-based first aid guidelines . Evidence-Based Practice: from first aid to blood supply . Conclusions Projects for every department . First Aid Service: − Help! (First aid guidelines for Flanders) − Sports injuries prevention and first aid (for Flemish government) . Social Assistance Service: − Which interventions are effective to tackle loneliness in elderly people? − Which interventions are effective to increase competences in at risk pre-schoolers? . Red Cross Youth: − Learning guidelines for first aid, e.g. From what age on children can perform CPR? Projects for every department . Interventions Service: − Does risk/crisis communication via internet results in increased knowledge, risk perception, preparedness, resilience, self-reliance and in a decrease in fear? . Blood Service: − Are platelets treated with pathogen reduction technology effective in reducing bacterial contamination and/or sepsis in patients requiring platelet transfusions? − Is blood of uncomplicated hemochromatosis patients safe and effective for blood transfusion? Example of study selection: hemochromatosis Overview . Evidence-Based Practice in Belgian Red Cross- Flanders . Evidence-based first aid guidelines . Evidence-Based Practice: from first aid to blood supply . Conclusions Conclusions . The Belgian Red Cross-Flanders wants to achieve its goals in a quality-oriented manner by using Evidence-Based Practice: − First aid guidelines: Important to develop guidelines and didactical materials adapted to the target group and the context − The Blood Service . The principle of Evidence-Based Practice can be applied to humanitarian aid, public health, social sciences, ….
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