Designing and implementing a practical prehospital emergency trauma care curriculum for lay first responders in Guatemala

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Figure 1
Map of Chimaltenango, Escuintla, and Sacatepequez Departments of Guatemala.
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Figure 2
Distribution of pretraining and post-training assessment scores. Legend: Title—“Time,” Red Label—“Post,” and Blue Label—“Pre.” The depicted curves represent the densities of the distributions of the preassessment and postassessment scores and have been overlaid with the corresponding histogram. The Shapiro-Wilks test for normality yielded p values of p<0.001 and p=0.014 for the fit of the predistribution and postdistribution, respectively. Thus, the null hypothesis that both distributions are normally distributed may be rejected, implying that nonparametric testing methods must be used in data analysis.

Table 1

Participant demographics

Table 2

Participant performance by topic category

Curriculum topic categories	Preproportion correct (%)	Postproportion correct (%)	Percentage point difference (post–pre score)	P value*
Scene safety	44.1	86.1	42.0	<0.0001
Hemorrhage control	31.8	67.9	36.1	<0.0001
Transport	48.2	76.4	28.2	<0.0001
Fracture management	44.7	70.0	25.3	<0.0001
Triage	45.6	69.9	24.3	<0.0001
Resuscitation	39.8	60.5	20.7	<0.0001
Airway and breathing	50.3	68.5	18.2	<0.0001

*P value determined using McNemar’s χ² test.
†Test Questions by Category: Scene Safety—2 (1), 6 (3), 16(4), 17(5); Hemorrhage Control—1 (14), 9 (16), 14(17), 26(13); Transport—4 (25), 5 (26), 13(15); Fracture Management—10(21), 11(22), 12(23), 21(24); Triage—7 (6), 15(7), 18(2), 23(8); Resuscitation—20(18), 24(19), 25(20); Airway and Breathing—3 (9), 8 (11), 19(12), 22(10).

Table 3

Interquartile mean of participant test scores and differences

Occupation	Prescore % (IQR)	Postscore % (IQR)	Percentage point difference (post–pre score)	Within group p value*	Between group p value†
Civilian	40.4 (33.7–48.1)	80.8 (71.5–86.2)	40.4	<0.001	0.007
Law enforcement	38.4 (25.9–43.3)	69.2 (59.6–78.8)	30.8	<0.001	<0.001
Firefighter	50.0 (40.4–59.6)	73.1 (61.5–84.6)	23.1	<0.001	<0.001

*Wilcoxon signed-rank test used for preassessment and postassessment scores.
†Mann-Whitney test used for distributions of improvements between groups, referenced against two other groupings.