First aid training for laypeople

The global burden of death and disability is significantly influenced by illness and injury, which can occur at any time and anywhere. When these conditions are acute or life-threatening, immediate care outside the hospital becomes crucial. In these situations, first aid provided by laypeople (i.e. individuals without formal healthcare education) is a vital component of the prehospital care system, playing an important role in preserving life, alleviating suffering, preventing further harm, and promoting recovery. Therefore, training laypeople in first aid is widely assumed to increase first aid-related competencies and, hence, may improve the health outcomes of suddenly ill or injured individuals.

The main objective is to assess the effects of first aid training for laypeople compared with another type of training or no training on the health outcomes of people receiving first aid, the quality of the first aid provided, and the helping behaviour of people providing first aid. Secondary objectives are to assess the effects of first aid training for laypeople compared with another type of training or no training on first aid-related educational outcomes, including knowledge, skills, self-efficacy, and willingness to help, and adverse effects.

We searched CENTRAL, MEDLINE, Embase, four other databases and two trials registries, together with reference and citation checking. We handsearched the websites of organisations, journals, and conference proceedings. The latest search date was 16 December 2024.

We included randomised controlled trials (RCTs) and cluster-RCTs in laypeople comparing physical health first aid training with no first aid training (i.e. another type of training or no training).

Our critical outcomes are the health outcomes of people receiving first aid, the quality of the first aid provided, and the helping behaviour of people providing first aid. Our important outcomes are first aid-related knowledge, first aid-related skills, self-reported first aid-related self-efficacy, and self-reported first aid-related willingness to help.

We used the Cochrane Risk of Bias 2 tool (RoB 2) to assess bias in RCTs and its extension in cluster-RCTs.

When possible, we synthesised results for each outcome using meta-analysis of risk ratios (RR) and ratio of means (RoM) with 95% confidence intervals (CI) for dichotomous and continuous outcomes, respectively. When meta-analysis was not feasible due to the nature of the data, we followed the synthesis without meta-analysis (SWiM) principles and summarised results using vote counting based on the direction of effect. We applied GRADE to assess the certainty of the evidence for each outcome.

We included 36 RCTs (21 individual and 15 cluster-RCTs) with a total of 15,657 participants. Thirty-four studies (94%) were conducted in high- or upper-middle-income countries, and only two in low- or lower-middle-income countries. Seventeen studies evaluated adult populations (≥ 18 years; 4542 participants), whereas 19 studies included child or adolescent populations (< 18 years; 11,115 participants). First aid training components, such as content, didactic approach, mode of delivery, duration, frequency, and instructor, varied substantially across studies. Similarly, studies measured outcomes using different tools and scales at various time points.

Critical outcomes None of the included studies reported on the health outcomes of people receiving first aid or the quality of first aid provided. The evidence is very uncertain about the effect of first aid training on helping behaviour (1 study, 3070 participants; very low-certainty evidence), due to very serious risk of bias and serious imprecision. Important outcomes First aid training compared to no first aid training probably increases acquisition of first aid-related knowledge (RoM 1.58, 95% CI 1.37 to 1.82; I² = 93%; 8 studies, 3515 participants; moderate-certainty evidence), skills (RR 2.53, 95% CI 1.81 to 3.55; I² = 92%; 12 studies, 3063 participants; moderate-certainty evidence), and self-efficacy (RR 1.91, 95% CI 1.23 to 2.97; I² = 50%; 2 studies, 285 participants; moderate-certainty evidence), measured within one month after the end of the training (i.e. in the short term). The evidence is very uncertain about the effect of first aid training on willingness to help in the short term (RoM 1.02, 95% CI 0.97 to 1.07; I² = 85%; 2 studies, 1083 participants; very low-certainty evidence). We judged the overall risk of bias for the 36 included studies to be either high or of some concern, except for one study, which was at low risk of bias. Lack of blinding of the outcome assessors and a large amount of missing outcome data were the most common methodological issues. The serious or very serious risk of bias was the primary reason for downgrading the certainty of the evidence in this review.

Our review found no studies that compared the effects of first aid training to no first aid training on the health outcomes of people receiving first aid or the quality of first aid provided. There were insufficient data to draw conclusions about the impact on helping behaviour. Nevertheless, in the short term, first aid training probably increases the acquisition of knowledge, skills, and self-efficacy. But the evidence regarding its effect on willingness to help in the short term remains very uncertain.

This Cochrane review had no dedicated funding but was supported by internal sources from the Foundation for Scientific Research of the Belgian Red Cross-Flanders.

Protocol available via doi.org/10.1002/14651858.CD015538.