Acceptability, Feasibility, and Appropriateness of Police-Based Basic Life Support Training and Public-Space Automated External Defibrillator Integration in Nepal: A Mixed-Methods Implementation Evaluation

Out-of-hospital cardiac arrest (OHCA) represents a critical public health challenge in Nepal, where limited prehospital emergency services result in police officers frequently serving as first responders. Despite this frontline role, police lack routine Basic Life Support (BLS) training. Since 2023, our team has piloted a police-based BLS training program across Nepal. This study evaluates the acceptability and appropriateness of the program and assesses the potential for national adoption of police-based BLS training and the integration of automated external defibrillators (AEDs).

We conducted a mixed-methods implementation evaluation guided by Proctor’s Implementation Outcomes Framework, with a focus on acceptability, feasibility, and appropriateness. Quantitative data were collected via cross-sectional surveys of trained police officers (n=40). Qualitative data included four focus group discussions with frontline officers (n=21) and five in-depth interviews with key stakeholders representing police leadership, municipal government, and the health ministry. Data were analyzed using descriptive statistics and thematic analysis.

Survey respondents demonstrated strong program support: 87.5% reported confidence in performing CPR and believed training was important for Nepal's general public; 84.4% believed community members could master BLS skills; 78.1% indicated an increased likelihood of personally responding to an emergency; and 98.3% recognized the utility of AEDs in Nepal. Qualitative findings revealed that police officers, healthcare professionals, and municipal leaders viewed police-based BLS training as both appropriate and acceptable, with robust support for AED integration. Notably, a trained officer in a focus group successfully applied choking-management skills to save a child's life. However, implementation barriers varied by stakeholder role and included requirements for policy integration, budget allocation, infrastructure development, and sustained community engagement.

Equipping Nepal's police as BLS-trained first responders is feasible, acceptable, and appropriate across stakeholder groups. This mixed-methods evaluation provides actionable insights for program scale-up and AED integration, offering a replicable model for strengthening early OHCA response in resource-limited settings.