ArticleBMJ public health2026
Knowledge gains and retention following the rural emergency trauma system strengthening (RETSS) programme: a longitudinal observational study in rural Nepal.
Article in BMJ public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Following the 2015 Nepal earthquake, the Nepal Red Cross Society, Canadian Red Cross, Centre for Global Surgery at McGill University Health Centre, and local leaders launched the Rural Emergency Trauma System Strengthening (RETSS) programme to strengthen first-responder capacity in trauma care, cardiac arrest management and disaster preparedness during the early phase of emergencies. RETSS employed a district-level train-the-trainer (ToT) model to establish a sustainable local training network. Methods: We conducted a retrospective analysis of RETSS programme data (2017-2020), including participant demographics, geographic distribution and knowledge outcomes. Pre- and post-training scores were compared using Wilcoxon signed-rank tests. Per cent improvement and retention decline were calculated using standardised formulas. Knowledge retention was assessed among repeat basic life support (BLS) participants using time-stratified analyses. Results: In 2017, 24 healthcare providers (HCPs) (70.8% male; mean age 35.6 years) attended ToT sessions. Between 2017 and 2020, a total of 1170 HCPs were trained across 158 government facilities in Sindhupalchok (59.7%) and Kavrepalanchok (40.3%). Most trainees were female (61.4%) and aged 18-29 (52.5%). BLS scores improved from a median of 9.0 (IQR 6 to 12) to 22.0 (IQR 20 to 23) (+122.2%, p<0.0001), and Primary Trauma Care scores from 11.0 (IQR 7.2 to 14.0) to 18.5 (IQR 16 to 20) (+55.6%, p<0.0001). Knowledge declined between sessions, with retention at first repeat of 59.1% overall. Retention was highest among participants repeating within ≤6 months (75.5%) and varied across longer intervals (7-12 months: 57.1%; 13-18 months: 61.8%; >18 months: 72.2%, n=4). Conclusions: RETSS demonstrates the feasibility of a scalable, locally led training model to strengthen emergency and trauma care in rural, disaster-prone regions and was associated with substantial short-term gains in provider knowledge. Substantial knowledge decay over time supports the implementation of structured refresher training at approximately 6-month intervals.
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