Taxi driver training in Madagascar: The first step in developing a functioning prehospital emergency care system

Background: Prehospital care in developing countries is severely lacking. Few countries can afford the relatively expensive formalised Western model of a prehospital emergency medical system. The WHO has highlighted the development of layperson first responder programmes as the most basic step in the development of a functioning prehospital system. Aim: To describe the first training programme of its kind, run in Mahajanga, Madagascar. The faculty was invited by Mahajanga Medical School. Methods and Results: Local input was taken into account in developing the curriculum. 26 taxi drivers were invited to attend in cooperation with the local municipality. The faculty consisted of five instructors from the Division of Emergency Medicine and EMSSA, plus local doctors from University Hospital Mahajanga. The 1-day course included workshops on prehospital scene management, bleeding and broken bones, immobilisation and patient movement, and labour and delivery. The workshops made use of commonly available items only including packets, string and towels; French and Malagasy translators were available throughout. Conclusions: Both faculty and candidates deemed the course a success and plans for formal evaluation of knowledge and skill retention are underway. Future plans are to continue the training using local instructors and in rural districts.