Development of an evidence-based guideline when evidence is scarce: the importance of a balanced guideline panel

Presentation video:




Oral session: Knowledge translation and communicating evidence (1)


Tuesday 22 October 2019 - 11:00 to 12:30


All authors in correct order:

Avau B1, Laermans J2, Van Remoortel H2, Vanhove A1, Vandekerckhove P3, De Buck E4
1 Centre for Evidence-Based Practice, Belgian Red Cross, Cochrane Belgium, Cochrane First Aid, Belgium
2 Centre for Evidence-Based Practice, Belgian Red Cross, Belgium
3 Belgian Red Cross, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Belgium
4 Centre for Evidence-Based Practice, Belgian Red Cross, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Cochrane First Aid, Belgium
Presenting author and contact person

Presenting author:

Emmy De Buck

Contact person:

Abstract text
Background: the Belgian Red Cross is a worldwide pioneer in the development of evidence-based first aid guidelines. These guidelines target the consumer as provider of healthcare interventions, and are tailored to the local context for which they are developed. In 2011, we developed a basic first aid manual for laypeople for Sub-Saharan Africa, which was updated in 2016.

Objectives: the objective of the current project is to develop an evidence-based guideline and training manual for first responders in Sub-Saharan Africa. These people are trained in advanced first aid techniques by our African Red Cross sister societies and represent the first line of help within their community when disaster strikes.

Methods: we composed a panel of 13 African experts, from seven different countries, to steer the contents of the draft manual. This panel consisted of seven academic experts in first aid and emergency medicine and six field practitioners, including four first aid instructors. Evidence summaries were prepared by the Centre for Evidence-Based Practice for 87 PICO (patient, intervention, comparison, outcome) questions on topics raised by the expert panel. Content writers wrote a draft manual with practical recommendations, based on the identified evidence, which was discussed in March 2019 during a two-day meeting in Johannesburg (South Africa).

Results: 33 PICOs were covered by the guidelines of the International Liaison Committee On Resuscitation (ILCOR). For 88 PICO questions not covered by ILCOR, we screened 35,936 records, resulting in 268 relevant papers, of which 13 were Cochrane Reviews. The expert panel considered the identified evidence and contextualized the recommendations to the Sub-Saharan African context, with respect to values, acceptability and feasibility of interventions, according to the principles of the GRADE Evidence-to-Decision framework. Evidence was lacking in 40% of evidence summaries, in which cases the panel formulated good practice points, based on practical experience, taking into account the manual’s target audience. The balanced composition of our panel was vital for successfully completing this task. The manual is currently going through a second round of expert feedback and will be pilot tested during advanced first aid training courses in Malawi in the autumn of 2019 and launched in three countries in 2020.

Conclusions: advanced first aid is a topic for which the evidence base is scarce. A training manual was developed according to the principles of evidence-based practice, but relied heavily on the practical experience of content experts with various backgrounds.

Patient or healthcare consumer involvement: several members of the guideline panel are experienced first aid instructors from our regional sister societies. These instructors added field expertise and knowledge on the local context to the discussions, but are also the future users of the manual. By including them, we made sure our manual is as relevant as possible to our target audience, first responders and their trainers.