June 3, 2024

Student non-profit garners USAID grant to bolster pre-hospital trauma care in LMICs

University support helped set the stage for the award, and the U-M Center for Global Surgery is a partner in the project.

LFR team in Nigeria
LFR co-founder Zach Eisner (center) with team members in Nigeria. At the right is fellow UMMS student Ashwin Kulkarni, who also works with LFR.

A student-led organization has garnered a federal grant to expand its first responder education programs in limited-resource settings.

LFR International, which teaches essential trauma-response to motorcycle taxi drivers, has been awarded a $200,000 Development Innovation Ventures grant from the United States Agency for International Development (USAID). The award, intended to help LFR pilot and scale its nascent digital education offerings for first responder education (LFR stands for Lay First Responder), represents a significant milestone for the organization and the two University of Michigan medical students who founded it.

“On a personal level, it isn’t lost on me that I’m a PI on this federal grant while I am also still a medical student. I’m so grateful—and I am trying not to have imposter syndrome,” said Zach Eisner, a third-year medical student and the Executive Director of LFR. “I keep reminding myself that the people at USAID recognized the potential in our organization. They believe in it, which feels amazing.”

He and a classmate, Peter Delaney, started LFR International in 2016 as undergraduate students as Washington University, in St. Louis. Both went on to medical school at UMMS and, with support from the University, continued to build their organization while in Ann Arbor. Global REACH awarded seed funding in 2018 to help LFR to expand collaborations and relationships in sub-Saharan Africa, where much of the work is focused.  The Michigan Center for Global Surgery has supported research to help the team iterate, improve, and validate its programs. During the COVID-19 pandemic, LFR received funding and resources from the U-M Duderstadt Center to produce videos and online modules so that training could continue despite international travel restrictions.

To date, the organization has trained 7,000-plus transportation providers as lay first responders from Guatemala to Kenya. The new USAID funding, a stage 1 grant with the opportunity to apply for more substantial awards in the future, will help further scale those efforts. A primary aim is to conduct a randomized controlled trial with 800 participants in Sierra Leone, comparing in-person training to the newly developed digital programs.

A further goal of the two-year project is to evaluate knowledge and skill retention and psychosocial impact of the training on program participants, as well as how often they are called upon to apply their new skills. Eisner, an M3, and Delaney, who graduated in 2023 and is currently completing an orthopedic surgery residency in Cleveland, will lead the project with in-country partners at the University of Makeni. The U-M Center for Global Surgery is also a partner.

“Zach and Peter have done a remarkable job with LFR. They’ve taken a powerful idea—training the right people to respond to roadside emergencies—and have been able to put it into practice in a way that has a tangible impact,” said Center for Global Surgery Director Krishnan Raghavendran, MD. “We are extremely proud of them and happy to support their work.”

Road traffic accidents are the largest contributor to the global burden of injuries. Most of them—as much as 90%, according to some studies—occur in LMICs, even though these settings account for only about 60% of the world’s motor vehicles. Death rates due to road traffic accidents in LMICs are three times higher than in high-income countries. There are many contributing factors, including underdeveloped pre-hospital services. Delaney, who worked as an EMT while in undergraduate school, saw this firsthand during a global health experience in Uganda. He happened to witness a road accident.

“This huge crowd gathered and I expected any minute to hear sirens in the distance, but I never did,” he recalled. “It was a big mentality shift. Back in St. Louis, I responded this sort of emergency all the time and I just realized there is no 9-1-1 here. No ambulance was on the way.”

The incident sparked the idea for LFR: with no outside help to rely on, could those already onsite be trained to assist? Today, Uganda is one of the eight countries where LFR is active, training taxi drivers basic trauma response skills like how apply a tourniquet, make a splint, or safely immobilize a person who may have a back or neck injury. To date, the drivers who have been through the program have provided emergency medical services to an estimated 15,000 individuals.

“The primary objective of LFR International is to save lives,” said Eisner, LFR International’s Executive Director. “We’re proud to have demonstrated that our program works in-person over the past eight years. Now, we are excited to have received support from USAID to determine the efficacy of our digital intervention package. Doing so will allow us to increase the scalability of our training, while engaging many more communities to develop contextually-informed, sustainable, and rapidly scalable emergency trauma care solutions.”

LFR co-founders Zach Eisner (right) and Peter Delaney (center right) talk with WHO Director-General Tedros Ghebreyesus during a campus event in 2023.