Arguably, one of the weak links in the Chain of Survival is the instigation of bystander CPR. The experience of King County with high rates of bystander CPR is associated with impressively high survival rates (AHAN, 2015). This contrasts with a less encouraging provision of first aid in other places and correspondingly lower rates of survival from out-of-hospital cardiac arrest (Leong BSH, 2011). This is both a matter of concern and interest. One of the most important contributions made by the International Liaison Committee on Resuscitation (ILCOR) report in 2015 was to provide the long overdue official recommendation and endorsement for first aid education (Singletary et al, 2015). In so doing, it also provided the mandate necessary to gain funds and support for training in first aid. It is obvious however, that only a mandate and support are not sufficient.
Education and training have to be provided on the ground, by any and all means possible. The availability of learning resources in the languages of mass communication within some of the countries that need it most has not been sufficiently addressed. English is a popular language internationally in which first aid training may be provided, as are several others.
However, there are many countries where the local language of mass communication is not the one in which up-to-date training resources are readily available. Consequently, the exercise of upskilling the population is potentially more daunting and a challenge too far (Gautam et al, 2016). Governance, benchmark and update issues are further matters of interest. Together, the variables add to the risk of adverse clinical outcomes for individuals, poor uptake by the society at large, and may contribute to the global health inequality in general. As an example, the public health concerns about first aid education may be compared and contrasted with the situation regarding several specific illnesses including HIV/AIDS, for which updated WHO training resources are available in the local languages of many countries. Until the ILCOR 2015 recommendations, perhaps, the discrepancy could be traced mainly to the lack of a recommendation by a reputable international group.
Now this gap has been addressed by the ILCOR, new challenges are emerging, and are worth noting. Currently, the ‘ownership’ and the responsibility to contextualise and deliver first aid training falls at many doors. Over the years, the author has had substantial experience of implementing first aid training in several countries including India. The burden of illness and injury in India is well documented. The author was recently responsible for the development and implementation of an up-to-date multi-language first aid training resource and programme, which presented numerous challenges.
ILCOR's conclusion that, in effect, first aid education delivered by any means is better than no education, is encouraging and well founded. An independent audit of the multi-language training for the commercial drivers in India demonstrated high satisfaction levels with remarkable anecdotes of success. The feedback provided valuable evidence of the quality of the translation. Audit and regular follow-ups with updates may, therefore, represent one of the important tools to ensure that translated theory results in translated practice.
In India, the greatest challenge in providing multi-language first aid training was to ensure the accuracy of translation and communication, which required not only accurate translations, but also monitoring that the cultural context and cues were accurate for each local language. Finding healthcare professionals and publishers willing to help with translation may not be too difficult but the technical standardisation, cultural accuracy and quality control deserve bespoke services and expertise. Until it becomes available, those responsible for first aid education will need to depend, among other things, on double translation to ensure accuracy, high fidelity and governance (from English to local languages and back).
There are several large and important segments such as schools, industry, transport and residential areas that require first aid training in local languages. One of the better ways to reach these is by providing appropriate customised resources, and incentives. In the case of the project with which the Author was concerned, the major contact and access point of the training recipients was the testing and training centre for the commercial drivers.
It is clear that the ILCOR report is more than likely to add to the momentum for the demand of focused and contextual first aid training. Commercial opportunities and altruistic attention both deserve to be addressed. Decision makers should be more amenable to being persuaded and guided in the direction of enhanced first aid training. Media and public demand for ‘proper’ first aid should be expected to grow. It is desirable if not unavoidable that those who seek to ride the next wave and meet the public health challenges, as well as the opportunities, should give multi-language first aid resources their serious consideration.