#Ambulance! Partnering with ICRC’s Health Care in Danger to scale peer learning for frontline pre-hospital emergency care staff and volunteers

On Wednesday, 17 May 2017, the International Committee of the Red Cross (ICRC) convened its Health Care in Danger Annual Meeting at the ICRC Headquarters in Geneva. During the afternoon session regarding training and education initiatives related to the Health Care in Danger (HCiD) project, Reda Sadki presented the outcomes of the #Ambulance! initiative. Sadki is the founder of the Geneva Learning Foundation.

The #Ambulance! project launched a call to action in 2016 for ambulance and pre-hospital emergency workers to document situations of violence. This initiative involved a four-week digital course designed to help workers share experiences and learn how to solve problems with peers from around the world. The following article is an edited version of Sadki’s remarks regarding the achievements of the 2016 pilot and the strategy for 2017.

Download Reda Sadki’s slides

I am going to walk you through what we achieved with the Ambulance Initiative in 2016 and explain why we are so excited about what we are preparing in 2017. The Ambulance Initiative is led by the Norwegian Red Cross, with the International Federation of Red Cross and Red Crescent Societies, and the ICRC’s Health Care in Danger Project. The Scholar approach underpins this initiative. This pedagogical model was developed through a partnership between the University of Illinois College of Education, Learning Strategies International, and the Geneva Learning Foundation.

From equipment chatter to risk awareness

In the context of protection for healthcare workers, especially pre-hospital emergency workers, we need a specific shift in mindset. One learner described how she went from listing medical and technical issues or equipment issues to actually adding possible risks around security to her preparedness. She successfully added mindfulness and risk awareness to her routine.

This is an individual outcome. What if we could scale this? How would we do it? Imagine if we had 700 ambulance staff and volunteers from 70 different countries. To help develop that mindfulness, each of them was willing to dedicate 30 minutes a day. They were never online at the same time because of time zones, and no one was allowed to travel. How would you organize a system to develop that kind of outcome under these constraints?

The old-fashioned way would be to conduct workshops and trainings. You would need at least 28 events with 25 people each. Imagine the financial cost and the expenditure required to move bodies and materials to get people together. You must also consider the opportunity cost. If you are at a workshop, you are time away from work and not providing assistance to people in need. It is an open question what kind of outcome would be achieved with this massive financial and resource expenditure.

In fact, we discovered that our fully-remote model could result in outcomes such as improved mindfulness, at scale. That means peer learning resulted in tangible improvements in the daily work of practitioners. This was an emergent outcome, something we did not plan for, but that turned out to be significant.

First, however, we need to revisit the problem we set out to solve.

Solving four challenges

With the #Ambulance! Initiative, the problem we wanted to solve was how to mobilize a global community to document security risks. There is a lack of evidence and tangible case studies from the community level regarding what challenges around security and violence look like. The proposed solution was to leverage the Scholar approach using a four-week course format. This format uses participatory peer-review-based approaches in which people are not just ingesting knowledge but are developing it and putting it to use.

We faced specific challenges in developing an entirely digital initiative that was open and scalable.

1. The first challenge is scale. We found that there is no upper limit to the number of participants. This is one of the takeaways from massive open online courses. Peer review is an important part of what makes scalability possible. It provides a way to give formative assessment feedback as people work. This helps them progress because they get feedback from peers rather than tutors. Consequently, you do not need to add more tutors as you add more learners.
2. The second challenge is access. By August 2016, we had nearly 300 people from the Americas, almost 150 from African countries, and almost 100 from the Asia-Pacific region. Many of them came from warm or hot zones and fragile contexts. We were able to tell them that they were all welcome to join. We did not need to select by any characteristics other than the fact that they were frontline ambulance staff or volunteers with experience in response.
3. The third challenge is expertise. We minimized the demand on subject matter expert time. We used a rubric, which is a checklist or set of criteria that very precisely defines the standards. This is where expertise is injected. In the course, we had amazing experts from the Red Cross, Red Crescent, government, and private ambulance providers . However, the point was not to acquire their content. Their interventions were a heuristic intended to stir thinking for the participants to look at their own dilemmas.
4. The fourth challenge is complexity. An aircraft carrier is so complex that there is no operating manual, yet it operates as a high reliability organization. This is achieved by leveraging the collaborative intelligence between people working in the system. In the context of the ambulance course, the project was both project-based and problem-based learning. Participants were tasked with developing a case study describing an incident. They then had to analyze the incident by asking “why” over and over again until they squeezed as much as possible out of the specific situation.

The Scholar approach

The pedagogical model underpinning this is called the Scholar approach, which I first implemented while working at the International Federation of Red Cross and Red Crescent Societies (IFRC), and which The Geneva Learning Foundation (TGLF) has been developing since 2016 with the World Health Organization (WHO) and other partners.

This approach builds on the groundbreaking and visionary “New Learning” pedagogy of Bill Cope and Mary Kalantzis.

It relies on a simple three-step process. Step one is to write. Step two is to review. Step three is to revise. Each participant described and analyzed a security or violence risk they faced and submitted a draft. They then peer reviewed the drafts of three peers using the quality standard rubric. They were not just giving their opinion. They were evaluating against the rubric.

This process creates a condensed espresso of intense thinking, writing, and knowledge development in relation to one’s own experience. By the time you finish giving feedback and receiving feedback, you have to interpret it and make your own decisions on how to revise your work. You produce an artifact of your actual capabilities.

Tangible outputs and emergent outcomes

In 2016, in the course of four weeks, this group produced 72 case studies. These were detailed, specific descriptions of contexts and dilemmas that had never been described before in such a way. This was done in just 30 minutes a day without requiring people to stop work.

For the learners themselves, those who successfully completed the requirements received a certificate from the International Federation. Some ambulance organizations have already begun to recognize and grant continuing professional development credits for completion of this course.

The reactive feedback from participants was amazing. One participant from Canada noted that connecting with people working in zones of conflict was an eye-opener. It helped people gauge where they were relative to their own context and helped those in difficult places feel a sense of shared solidarity. Participants gained new colleagues from around the world. Jean-Marie, a bush doctor in Burundi whose ambulance is an airplane, connected with Romeo, a Filipino nurse in Baghdad.

The path forward in 2017

We asked participants if they would be willing to support their colleagues if we ran another experience like this. Almost all of them said they would be willing to help. Complete strangers from different contexts were inspired to commit to each other.

Based on this, we are proposing to run two learning journeys in 2017. One starts in early June and the other will take place after the summer. We are replicating what worked well in the first course. We have three language cohorts in Spanish, English, and Arabic. We are also hosting webinars around problem solving.

We have established several priorities for 2017.

1. The first is to grow the volunteer team leadership. We call them the A-Team. These volunteers were selected only from people who successfully completed the 2016 course. They are an exceptional set of people.
2. The second priority is organizational engagement. We are reaching out to organizations to see how this initiative can be useful to their priorities. For example, the Philippines Red Cross has decided to use the #Ambulance! Initiative to connect ambulance teams from different islands.
3. The third priority is adopting a curriculum approach. This ensures there are two courses that people can take sequentially.
4. The fourth priority is putting the tangible knowledge outputs to use to help other frontline responders.
5. The fifth priority is the credential of value. We are working to demonstrate that this training makes a tangible difference.

From an organizational perspective, this initiative enables organizations to offer a certified global training opportunity for staff and volunteers. Organizations can receive and contribute to the case studies and best practices produced. We also strongly support organizations that wish to monitor and supervise their own participants. Finally, we are looking at setting up cohorts in various languages because people think best in their own language.

What did we learn?

The #Ambulance! initiative catalyzed a transformation that began with individual risk awareness, moving participants beyond standard medical protocols. As one learner described the shift: “Whereas the main thought process before each call was essentially medical revision of the task at hand, I now also think of the possible risks and best practices in each situation”.

This internal shift was reinforced by the act of documenting their reality, which another participant found “very helpful to me personally to put into writing what happens to us,” adding their hope that “it can be helpful for other people”.

As these personal accounts were shared, they fostered deep empathy across the global network. A participant from a safer context admitted, “I am humbled. I cannot imagine facing a fraction of the violence… Makes me feel wimpy if I ever felt the need to use it, relative to some of the incredibly challenging and harrowing stories I have read”.

This exchange did more than just build solidarity – it expanded professional horizons. “First of all, I gained new colleagues from around the world,” one responder noted, adding that “we exchanged our experience”.

Through this, another learner realized “that we need to be connected with the population we are helping, with respect of diversity and having their feedback regarding what we are doing”.

Ultimately, these connections translated into practical application, where even case studies regarding “normal” operations became valuable educational assets.

As one participant concluded: “I want to take these case studies and share them with my colleagues – we have continued training program and we want to share these experiences”.

What’s next?

The first course for 2017 will launch its pre-course briefing on 29 May and run throughout June. You can find out more about the activities in English, Arabic, and Spanish at the Geneva Learning Foundation website. We look forward to seeing this initiative grow and inspire other communities of action.