Evidence for international first aid guidelines predominantly comes from studies conducted in western contexts during peacetime and/or healthcare settings. Yet, internationally the burden of trauma falls on low- and middle-income countries where lay responders might have to act in fragile contexts, where first aid and healthcare resources are limited or not available.

This study focuses on the principles and practices that govern first aid education (FAE), versus clinical evidence of first aid interventions. Accepting that application of first aid may vary according to context, we sought to understand educational principles according to contextual resources of fragile and non-fragile environments.

We interviewed educators, from six countries where conflict, geography or resources deemed them to be fragile, to explore which educational approaches were used and found effective in educating potential lay responders.

Through qualitative analysis, we identified educational approaches and themes including:

  • The need to take a basic (de-medicalized) approach;
  • Context adaptation;
  • Consideration of the types of injuries and emergencies that learners were likely to face;
  • Engaging learners through active learning approaches; and
  • A focus on critical thinking.

We connected a similar set of educational approaches in non-fragile contexts, as reflected in the International First Aid and Resuscitation Guidelines 2016. Recognizing common educational approaches provides educators with a common base on which to develop their educational approach and build future recommendations with global applicability. This also allows for mutual research and application between FAE in fragile and non-fragile environments.

DPLA Rights


Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.





To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.