Advanced responder training priorities in Kenya: A Delphi study with implications for low- and middle- income countries.

Introduction: Low- and middle- income countries account for 90 % of global trauma-related mortality. Organized prehospital emergency medical services and formal first responder systems are often lacking, contributing to this disproportionate injury burden. Lay first responder training programs have demonstrated effectiveness in addressing gaps in prehospital care. However, the curriculum, skills, and resources required to implement a context-appropriate advanced responder program remains unclear. Methods: A three-round modified Delphi consensus was generated at the Masinde Muliro University of Science and Technology (MMUST) in Western Kenya, including paramedics and paramedic lecturers. The 85-item survey consisted of six demographic items, 30 knowledge items, 30 skills items, and 19 resource items. A total of 79 items were included for consensus evaluation. Results: A total of 26 participants were included in the Delphi process, with 100 % retention across three rounds. Participants were primarily male (53.8 %) and practicing paramedics (61.5 %), with a median of seven years of experience (IQR: 4.0, 9.0). 33 of 79 items met consensus, defined as greater than 70 % agreement. This included 11 items in knowledge category, 14 items in skills category, and eight items in resources category. Participants prioritized content related to multi-system integration, respiratory and cardiovascular emergencies, and the female reproductive system. Particular emphasis was placed on airway and dehydration management, hemorrhage control, and emergency labor. Medication overdose and gastrointestinal complications were assigned lower priority. Participants identified the need for additional equipment and trained instructors to effectively implement advanced responder training. Conclusion: This three-round, modified Delphi study in Western Kenya establishes a list of context-appropriate essential knowledge, skills, and resources required for advanced responder training. Consensus was achieved on 33 of 79 items. Similar Delphi-based approaches may help guide the development of advanced responder programs in other resource-limited settings.