Cochrane Corner: Is first aid training for laypeople effective?

Background

Illness and injury can occur at any time and anywhere, and if the condition is acute or life-threatening, timely care outside the hospital becomes crucial. Within the prehospital care system, bystanders and community members can play a vital role by providing immediate assistance to an ill or injured person until professional help arrives, particularly when prehospital emergency medical services (EMS) are not readily available. This is considered first aid, in which the interventions aim to preserve life, alleviate suffering, prevent deterioration, and promote recovery.

Laypeople, defined in this review as community members without formal healthcare education, can be trained to recognise, assess, and prioritise the need for first aid. First aid training should be understood as a learning activity with defined learning goals to develop the knowledge, skills, and attitudes pertaining to the appropriate provision of basic first aid. It covers first aid procedures and techniques, and can vary in content, instructor, teaching methods, modalities, duration, and frequency, depending on the target audience and setting.

Although first aid training is assumed to enhance knowledge, skills, and attitudes and hence improve the quality of first aid provided by laypeople and the health outcomes of the recipients of first aid, a current and comprehensive systematic review was lacking. In a 2022 prioritization exercise by Cochrane First Aid, the effectiveness of first aid training was ranked among the five most urgent review topics by lay first aid providers and first aid guideline developers.

Research Question

What is the effect of first aid training for laypeople on health(care) outcomes and learning outcomes?

Literature Search

We searched for (cluster-)randomised controlled trials (RCTs) comparing physical health first aid training for laypeople with any other type of training (e.g., mental health first aid, HIV prevention, trauma management) or no training (e.g., waiting list control). Other types of experimental or observational research were excluded.

We included studies recruiting participants without formal healthcare education, therefore excluding trainees, graduates, and professionals in healthcare, emergency services, military, and related professions. Studies with first-year medical students were included as they were considered untrained in first aid. We did not impose any population restrictions regarding sociodemographic or socio-economic factors.

First aid training was defined as a formal, structured learning activity with intentional learning goals, focused on basic first aid interventions. Not of interest to this review were training in advanced life support (as this includes invasive interventions and medication administration), training focusing solely on preventive measures, and training where first aid actions were only a small part of a broader training program. Also excluded were informal, unstructured learning activities without intentional learning goals (e.g., having participants look at a pamphlet or poster, mass media awareness campaigns).

Studies were included if they assessed the effect of first aid training on at least one of the following critical or important outcomes. Critical outcomes were health(care)-related: (1) health outcomes of people receiving first aid, (2) quality of first aid provided, and (3) helping behaviour of people providing first aid. Important outcomes were: (1) first aid training-related learning outcomes (including knowledge, skills, self-efficacy (a person’s belief in their own ability to provide first aid), and willingness to help), (2) costs or cost-effectiveness, and (3) adverse effects of training (e.g., over- or underestimation of one’s competencies).

We searched for studies published up to 16 December 2024 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Epistemonikos, ERIC, and Web of Science. We also searched clinical trial registries, grey literature, the reference lists and similar articles of included studies, and contacted relevant content experts.

Results

We identified 21 RCTs and 15 cluster-RCTs with a total of 15,657 participants. Fifty percent of the studies were conducted in North America, 25% in Europe, 11% in Asia, 5.5% in Oceania, 5.5% in Africa, and 3% in South America. Nineteen studies were conducted in children and adolescents, accounting for 70% of all participants.

We included a total of 56 first aid training interventions that varied in content, didactic approach, mode of delivery, duration, frequency, and type of instructor. Of these, 32 exclusively covered resuscitative first aid, 13 focused on non-resuscitative first aid, and 11 encompassed both. Didactic approaches were either self-directed (n = 29), lecture-based (n = 17), mixed (n = 7), or unclear (n = 3). Most trainings (n = 27) were delivered in an electronic asynchronous manner, i.e., using video, computer games, and websites without real-time interactions with an instructor. Other trainings were delivered face to face (n = 22), using a blended format (n = 5), while two relied on a coaching manual (either with or without videotape) and one was unclear. Regarding duration, 26 trainings were shorter than one hour, nine took between one hour and one day, and 13 took at least one day; eight could not be classified. Just one training was repeated multiple times.

Conclusion

First aid training for laypeople likely improves short-term first aid-related knowledge, skills, and self-efficacy, but evidence from RCTs on willingness to help and real-life health(care) outcomes is lacking.

Implications for first aid practice and research

The currently available RCTs support short-term improvements in knowledge, skills, and self-efficacy in laypeople following first aid training, regardless of the wide variation in training components (i.e., content, instructor, didactic approach, mode of delivery, duration, frequency, audience, and setting). Due to the limited number and uneven distribution of available RCTs, subgroup analysis for each component was not feasible, making it impossible to draw meaningful conclusions about the most effective training features. Further high-quality RCTs are needed to clarify this.

The RCTs included in this review predominantly took place in high-income countries and primarily assessed learning outcomes using a wide variety of measurement methods (i.e., tools and scales) and timings. Future research is needed to determine a standardised core set of outcomes with reliable and validated time frames, measuring tools, and competency thresholds, to facilitate consistent and objective evaluation of the effectiveness of first aid training.

Furthermore, research should move beyond evaluating the effect on learning outcomes and focus more on how first aid training translates into health(care) outcomes during real-life emergency situations. In addition, studies should investigate the long-term effects of first aid training, as well as costs and any potential unwanted effects.

Finally, to expand the evidence base and applicability of first aid training, future research should include more low- and middle-income countries, where available resources and access to prehospital EMS might differ compared to high-income countries.

Visual Abstract

Acknowledgements

We gratefully acknowledge the Cochrane First Aid volunteers volunteers who provided the Kiswahili translation of the visual abstract, Kheri Issa (Tanzania Red Cross Society), and Jamlick Karumbi (Cochrane Africa).

Competing Interests

One of the activities of the Belgian Red Cross-Flanders is providing first aid training to laypeople.

Author Information

Irvin Kendall is a PhD student at the Centre for Evidence-Based Practice of Belgian Red Cross-Flanders, and is first author of the Cochrane systematic review. Jorien Laermans and Vere Borra are the Coordinators of Cochrane First Aid, whereas Emmy De Buck is the Director of Cochrane First Aid; all three of them co-authored the Cochrane systematic review.