First Aid Training for Laypeople: Bridging Evidence and Practice (A Cochrane Corner Response Review)

Cochrane Review: Objectives, Methods, and Key Findings

Objectives: Kendall et al. (2025) investigated whether first-aid training for laypersons improves outcomes compared with no training or alternative training.

Methods: The review included 36 randomized and cluster-RCT studies (15,657 participants) up to December 2024. Most participants were school-aged children or adolescents, primarily located in high-income countries. There was very limited representation from low-income settings. Interventions varied in length and content, focusing on topics like CPR and wound care. Outcomes were measured through written or practical tests immediately after training and at short-term follow-ups (typically 1–3 months). Overall, the risk of bias was mixed, with common issues such as unclear randomization and limited blinding.

Key findings: First aid training produces clear improvements in knowledge, practical skills, and confidence within the first month, supported by large effect sizes and moderate-certainty evidence. Similar positive results are seen in Sub-Saharan Africa, including Kenya, where brief, low-cost training enhances emergency recognition and readiness.

These benefits begin to decline after one to three months, and low-certainty evidence regarding any skills is retained beyond three months. Importantly, studies did not assess actual patient outcomes, focusing instead on test performance and self-reported measures. Most studies come from high-income settings, limiting relevance to East Africa. This is a critical need for better-designed studies in low-resource settings and a structured approach to regular refresher training to sustain skills.

Effectiveness, Retention, and Outcomes in East Africa

Recent peer-reviewed studies in East Africa reinforce Kendall’s conclusions and provide new insights, especially on the real-life use of first aid. Pine et al. (2025) trained 225 Ugandan boda-boda drivers, resulting in substantial improvement in first-aid knowledge. Participants’ knowledge scores jumped from 33.4% to 62.6% after a 5.5-hour course. Similarly, Delaney et al. (2024) trained 1,291 drivers across three countries saw median knowledge score increased by 34.1 points. Similarly, studies in lower- and middle-income countries (LMICs) such as a study by Kyarikunda et al. (2025) in Uganda demonstrated a remarkable increase in mean post-training knowledge and skills scores regarding prehospital care among police officers. Observations at facilities like Moi Teaching and Referral Hospital from training support staff and drivers show significantly higher post-training assessment scores. These large gains confirm the Cochrane review finding of improved learning with training.

Knowledge and skills tend to decay over time without regular practice or review. Pine et al. (2025) reported a 16.3-point drop in scores approximately six months after initial training. Delaney et al. (2024) reported significant retention at six months but emphasized the need for refresher training to maintain skills. These findings align with our observations: after training security personnel, skill retention is high for the first three months but declines after about a year. This mirrors the Cochrane review which notes that long-term retention is uncertain and likely declines.

First aid trainees actively use their skills in emergencies, addressing a gap identified in earlier controlled trials. In one study, nearly 20% of trained drivers reported a total of 91 emergency interventions, mainly at road traffic accidents, including fracture splinting and victim extrication (Pine et al., 2025). Another study documented over 2,000 patient encounters across three countries, in which responders frequently provided hemorrhage control (Delany et al., 2024). Similar patterns have been observed at Moi Teaching and Referral Hospital, where trained support staff have successfully recognized cardiac arrests early in waiting areas. Together, these findings demonstrate that lay training translates into practical, life-saving actions in real-world settings.

Community lay first responder (LFR) programs in East Africa are exceptionally cost-effective, costing between $12.84 and $30 USD per trainee and just $51.65 per DALY averted, well below the regional GDP per capita. Formal advanced certifications from organizations like the Red Cross (Kenya Redcross society, n.d.) or AMREF can cost between $60 and $230 USD (Idriss-Wheeler et al., 2024; Pine et al., 2025). Tertiary hospitals minimize systemic expenses by offering on-the-job training and community outreach at no cost to participants. These public health initiatives demonstrate high durability, with roughly 75% of trained individuals remaining active as first responders three years after their initial training.

In summary, these LMIC studies align with Kendall’s Cochrane review finding that training yields strong initial gains. The results, however, depend on follow-up training; both the Cochrane review and regional data stress that “frequent refresher training” is needed to maintain skills.

Challenges in LMICs

Implementing lay first-aid programs in Kenya/East Africa faces multiple hurdles, including access and equity, resource constraints, cultural and linguistic factors, legal issues, emergency response infrastructure, and retention needs (Stassen et al., 2025; Ndile et al., 2020).

Training is often concentrated in cities, leaving rural and disadvantaged communities underserved. Access is strongly influenced by income and education levels. To address this gap, programs are using mobile units, school partnerships, and online platforms.

There is significantly limited equipment and a shortage of certified instructors. Success often depends on partnerships with local NGOs or hospitals and volunteers. Keeping training low-cost is essential, but scaling these efforts typically requires additional donor or government support.

Effective training should use local languages, culturally relevant examples, and pictorial guides to address varying literacy levels (Stassen et al., 2025). Beliefs regarding fatalism and religious views of death can discourage bystanders from intervening. Engaging community leaders and using familiar local analogies can improve acceptance in responding to emergencies.

Kenya lacks a comprehensive Good Samaritan law, leading to bystanders fearing being treated as suspects or facing legal repercussions. While campaigns like the “Msamaria Mwema” (the Swahili translation for ‘good Samaritan’), an initiative by the Automobile Association of Kenya to train public transport drivers in first aid exist, there is a pressing need for legal protections and public education on existing immunities (Federation Internationale de l’Automobile, 2024).

WHO notes that about 10% of Kenyans have access to formal ambulance services (WHO 2023). Matatu (public transit) drivers can reach accidents in ~3 minutes versus 9+ minutes for ambulances. Training must include safe transport methods and structured communication to link these ‘de facto’ responders with the hospital system.

First aid skills diminish quickly without regular practice. Frequent boosters such as SMS reminders or community practice days are essential to maintain readiness.

Conclusion

As first aid trainers, we believe strengthening emergency response in Kenya and East Africa requires community-centered, accessible, and legally protected training systems. First aid programs should be integrated into public administrative gatherings, schools, and community forums to expand reach, while Community Health Promoters should be empowered as Trainers of Trainers (ToTs) to sustain grassroots education using local languages and culturally relevant approaches. Governments should establish comprehensive Good Samaritan protections to prevent victimization of first responders and build public confidence in assisting during emergencies. Mandatory first aid training for all drivers, especially public transport operators, alongside toll-free emergency response centers and stronger coordination with hospitals, would significantly improve prehospital care. Continuous refresher programs are also essential to maintain skills and create a well-prepared citizenry capable of responding effectively to emergencies.

Acknowledgements

Translations of this article have been kindly provided by the authors and by Bassinte Ossama.

Competing Interests

The authors have no competing interests to declare.