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Item Influence of bystander activation on pre-hospital emergency care response time: systematic review(Emergency Care Journal, 2023-07) Musyoka, Felistus Ndanu; Tenambergen, Wanja; Mapesa, Job; Ndolo, Abdushakur; Agot, George; China, Joy; Koyio, Lucina; Ngunu, Carol; Mulonzi, Martin; Njeri, VeronicaThis article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emer- gency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We fol- lowed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emer- gency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analy- sis included forty-six relevant studies meeting the inclusion crite- ria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the timely provision of these services is paramount. Bystanders play a central role in activating emergency medical services (EMS) and providing cardiopul- monary resuscitation. Prompt calls to EMS by bystanders resulted in reduced PEC response times, improved survival chances, and better neurological outcomes, particularly among out-of-hospital cardiac arrest patients. There is substantial evidence that prompt bystander activation of EMS significantly reduces PEC response times, thereby saving lives and strengthening existing PEC sys- tems. However, further research is necessary to accurately assess the impact of different interventions aimed at enhancing bystander activation of EMS and reducing PEC response times.Item Effectiveness of Bystander Knowledge through Community-Based Training on Responsiveness of Prehospital Emergency Care in Nairobi County, Kenya(Journal of Health, Medicine and Nursing, 2025-07) Musyoka, Felistus Ndanu; Tenambergen, Wanja; Mapesa, JobPurpose: Most of the emergencies occur outside heath care setting and prehospital emergency care is vital in reducing preventable deaths and disabilities. In Nairobi, emergency response remains fragmented, and bystander involvement is limited due to low knowledge and training. To assess the effect of bystander Knowledge through community-based training on responsiveness of pre-hospital emergency care. Methodology: This quasi-experimental pre-post intervention in Mama Lucy Kibaki Hospital's catchment area trained 128 Community Health Promoters (CHPs) to educate 64,000 households on emergency notification and response. Baseline and end-line data collected via questionnaires were analyzed using SPSS v26.0. Findings: Training bystanders dramatically improved their emergency response knowledge and efficiency. Knowledge scores significantly increased (p=0.001), with notable gains in knowing the emergency number (55% to 83%), saving the tollfree number (16% to 73%), and recognizing 1508 (4% to 48%)— all p<0.0001. The percentage of individuals knowing what to do in an emergency rose from 85% to 94% (p<0.001), and the mean knowledge score increased from 6.39 to 7.30 (p<0.001). Improvements were observed across all demographic groups. Post-secondary educated respondents showed the strongest gains (+13.7 percentage points to 96.5%, p<0.001). Males experienced greater improvement (+14.4 points to 93.7%) than females (+9 points to 82.2%). The training was most effective for interior residents (achieving 100% knowledge) and those near major roads (+21.3 points to 78.9%, p<0.001). Casual labourers demonstrated the largest gains (+40.9 points to 90.9%). Workingage participants, specifically those aged ≤30 and 31-40 years, also showed significant knowledge increases (+11.4 and +10.9 points, respectively). These knowledge gains led to faster emergency responses, with 87% of reports occurring within 0-5 minutes postintervention, compared to 0% at baseline. Delays exceeding 15 minutes plummeted from 80.4% to 4.1% (p<0.001). The strongest predictors of knowledge were post-secondary education (OR=5.64, p<0.001) and interior residence (OR=7.32, p<0.001). Casual labourers showed reduced odds of knowledge (OR=0.24, p=0.017), while respondents aged 31-40 years had 74% higher odds (OR=1.74, p=0.039). Gender, most employment statuses, and age >50 years did not significantly affect knowledge Unique Contribution to Theory, Practice and Policy: Community-based training significantly improves bystander knowledge and emergency response times, offering a vital solution for strengthening pre-hospital emergency systems in Low- and Middle-Income Countries (LMICs). This highlights the critical need for diverse bystander training strategies. The study recommends; developing a specialized pre-hospital emergency care training model for the elderly. Conducting further research on how marital status influences knowledge acquisition from training. Revising the WHO Emergency Care System Framework (ECSF) to explicitly incorporate bystander training.