Farmers, Forestry and First Aid (F3A) and farmers’ preparation for traumatic injury in the field

Abstract

Background

Agriculture is a high-risk industry in the United Kingdom, with disproportionate rates of fatal and serious traumatic injury. Farm workers face hazards from machinery, livestock, chemicals, and transport incidents, often in remote settings where emergency care is delayed. Existing first aid training is usually generic and does not reflect the specific risks of agriculture.

Objective

To describe the development of Farmers, Forestry and First Aid (F3A), a trauma-focused first aid training programme for agricultural workers, and to evaluate participant reactions to the course.

Methods

F3A was developed by clinicians and farming professionals using experiential learning principles and scenario-based training. The course covers basic life support, cardiopulmonary resuscitation, automated external defibrillator use, and immediate management of severe trauma. Anonymous post-course feedback was collected from participants across 32 courses using a training evaluation form with Likert-scale and free-text responses.

Results

Feedback was received from 344 participants. Overall satisfaction was very high, with median scores at the top of the scale for all Likert items and 97% of respondents recommending the course. Free-text comments indicated that participants found the course practical, relevant to farm work, and effective in increasing confidence in responding to traumatic emergencies.

Conclusions

F3A aims to address an important gap in rural trauma preparedness by providing agricultural workers with context-specific first aid training. Participant reactions were strongly positive, supporting wider delivery of the course and further longitudinal evaluation to assess skill retention and real-world impact.

Introduction

Despite some progress in reducing absolute numbers of fatalities over the past four decades, the average fatal injury rate in agriculture remains disproportionately high compared to the all-industry average [1]. According to the Health and Safety Executive, 27 individuals lost their lives in agriculture-related incidents in Great Britain in the 2022/23 reporting year [1]. Predominant causes of fatal injuries included animal-related incidents, transport accidents, falls from height, contact with machinery, being struck by objects, and electrocution. These findings underscore the inherent risks present across a diverse range of farm tasks and environments. Notably, a significant proportion of fatalities involve older workers, with individuals aged 65 and over, accounting for approximately one-third of all deaths. This demographic pattern suggests heightened vulnerability among ageing farming populations. These persistent risks highlight the urgent need for industry-specific safety and emergency response strategies tailored to the realities of modern farming.

First aid provision is a critical component of occupational safety, particularly in remote and resource-limited settings such as farms, where immediate professional medical assistance is often unavailable. However, existing first aid training programs are typically designed for generic workplace environments and may not address the specific hazards, response scenarios, or contextual challenges encountered in agriculture and forestry work.

This paper examines the necessity, development, and impact of a specialised first aid training course designed for the agricultural sector. By aligning course content with farm-specific risks and operational realities, the ‘Farmers, Forestry and First Aid’ (F3A) program seeks to improve the preparedness and response capabilities of farm workers. Currently this course has been run exclusively for farmers, with plans to run forestry-tailored courses in the future. This paper aims to present the need for the F3A course and how it teaches participants to deliver effective life-saving interventions, thereby aiming to support better health outcomes and reduce fatal injury rates within the industry.

Literature review

Farming and forestry are the most dangerous professions in the UK, with the worst rate of worker fatal injury of all the main industry sectors (per 100,000 workers) [1]. The annual average injury rate over the last five years is approximately 21 times higher than the all-industry rate, with a 5-year average of 31 people killed per annum as a result of agriculture-related activities [1]. This represents an average of 8.6 fatal injuries per 100,000 workers in agriculture, compared to the next worst sector, which is construction, with an average of 1.72 fatal injuries per 100,000 workers [1]. The global agriculture occupational fatality rate reflects a similar trend with the worst figures coming from Columbia (265.2 deaths per 100,000 workers in 2014) and Lithuania (75.0 in 2015) [2]. In the UK, being struck by a moving vehicle was the most common cause of death from 2018 to 2023 [1]. Other causes of death include being injured by an animal (cattle), falling from height, being struck by an object, and contact with machinery (for example, amputation from contact with a power take-off shaft) [1].

Farms are high hazard, high risk environments. Hazards in an agricultural setting include the use of pesticides, slurry pits, machinery, and livestock. Approximately 44% of farmers worldwide experience unintentional pesticide poisoning annually - most commonly related to improper handling, storage, or application of the substances, even after a single or short-term exposure, due to their high level of toxicity [3]. Slurry pits are hazardous due to the release of toxic gases (for example: hydrogen sulphide, methane, ammonia) that can lead to serious health problems or even death if inhaled [4]. At high levels, hydrogen sulphide can inactivate the sense of smell, making it difficult to detect [5]. This leads to cases such as the farming tragedy in Northern Ireland 2012, where two sons and a father all died in a fatal accident involving a slurry tank, as each of them tried to save the next, not realising there were toxic fumes present [4].

A third of agriculture sector deaths are people aged 65 and over, and the number of deaths in this age bracket is likely to increase as the population ages [1]. With urbanisation and higher industry costs leading to a lack of succession in the farming industry, many older farmers are being forced to retire later, or not at all [6]. Silver trauma patients (a term used to describe those aged 65 years and older) have higher mortality as they often have multiple comorbidities, can have greater injuries from low-energy trauma, and can present atypically [7]. Without a specialised geriatric approach to emergency care, these factors compound to this cohort being under-triaged, having delayed investigations, and ultimately being under-treated [7].

Furthermore, geographical health inequalities are at play in the agricultural setting. The long distances to tertiary medical centres, transportation challenges, plus the limited access to phone service in rural areas all exacerbate health disparities [8]. These logistical challenges associated with farmland, plus the time constraints associated with a reduced workforce, and financial pressures, mean many agricultural workers delay or avoid seeking healthcare [9]. This results in an ageing population who work in the highest risk profession that are less likely to ask for help when they need it, being very vulnerable to near-fatal or fatal accidents [10].

The farming industry faces significant mental health challenges that are linked to the stress of the natural unpredictability of farming, the isolation and loneliness of the job, and the uncertain financial future of the sector [9]. There were 102 registered suicides by individuals working in agricultural-related trades in England and Wales in 2019 [9]. This is compared to 92 corporate manager and director suicides, 83 health professional suicides, and 33 secretarial and related occupation suicides in the same year across England and Wales [11]. Farmers often sacrifice both their mental and physical health by working long hours, living at work, getting an inadequate amount of sleep, whilst also having to deal with price fluctuations, policy changes, epidemics, and climate change [9]. Unfortunately, there is still stigma within some of the farming communities that can make it difficult for individuals to seek help due to the patriarchal culture [12]. These unique factors intrinsic to the agricultural workforce, plus the ability to access firearms and pesticides, with the opportunity to be alone, are linked to the higher rates of suicide in farming compared to the general population [13].

In the UK, the National Farmers Union (NFU) recognises the dangerous nature of farming and offers courses to help mitigate the risk. These focus on risk assessment and first aid, and are developed from the Health and Safety at the Workplace framework [14]. The NFU have also founded the Farm Safety Foundation, a charity aimed at offering farm safety advice and support through education and events [15]. They aim to educate people about the risks of farming to physical and mental health and offer advice on ways to minimise risks where possible [16]. Whilst it is important to mitigate risk, the work is inherently dangerous. As such, it is important to also look at ways to improve outcomes from farming accidents. Prior to establishing the F3A course, there were no courses focusing on trauma management in the agricultural setting in the UK [17].

The current Health and Safety Executive guidance is that farms are required to have an appointed first aid person, to look after equipment, facilities, and be available at all times to call the emergency services; however, this person does not require any formal training [18]. There is no legal requirement for a farm to have a trained first aider or how many a farm should have [18, 19]. The equipment required is again guided by their own assessment of risk, with minimum requirements being sterile dressings and bandages, safety pins, and sterile gloves [18]. Self-assessing risk, having a non-trained first aider, and such a limited equipment requirement arguably renders this guidance to be just a tick box exercise that does not improve farming safety.

There are often increased times to definitive medical care due to the remote nature of farms, lone working, and the severity of injuries affecting the ability to call for help [20]. There is no legal requirement for farms to supply automated external defibrillators (AEDs), but they are being recommended by the NFU if it would take over 10 min for an ambulance to reach the location [21, 22]. In out-of-hospital cardiac arrest, survival decreases by approximately 10% for each minute without cardiopulmonary resuscitation and defibrillation [23].

Farmers must adhere to RIDDOR (Reporting of injuries, Diseases and Dangerous Occurrences Regulations) by reporting accidents at work. These include death, with the exception of suicide, specified reportable injuries, and injuries that result in the worker being incapacitated for over 7 days. Injuries to non-work persons should also be reported in certain circumstances. There are also occupational diseases that require reporting, including those sustained from biological agents [24].

In summary, an ageing workforce in a high-risk working environment with lax health and safety requirements all underpin the necessity for a trauma-focused first aid training programme customised for the agricultural sector.

Methodology

The development of the farm-specific first aid course originated from the collaborative efforts of three professionals: a veterinary surgeon, a pre-hospital emergency medical consultant affiliated with the Air Ambulance service, and a former intensive care nurse who transitioned into full-time dairy farming. Each had encountered recurrent injury patterns and preventable fatalities within their respective fields. Drawing upon their collective clinical expertise and first-hand agricultural experience, they identified a critical gap in the provision of context-specific first aid training tailored to the agricultural and forestry sectors. In response, they established a charitable initiative, “Farmers, Forestry and First Aid (F3A)” aimed at equipping rural workers with essential life-saving skills.

Initial outreach and course promotion involved targeted engagement with farming communities through social media, agricultural shows, and a dedicated website. These channels played a crucial role in generating early interest and facilitating participant recruitment. There are no exclusion criteria, and the course is open to any persons working in the farming industry. There is a cost involved in the course, to cover equipment and basic running costs (currently £99 + VAT per attendee as of March 2026).

To ensure clinical credibility and educational rigour, the course was accredited by the Faculty of Pre-Hospital Medicine (UK), meaning the educational material has been assessed and meets strict evidence-based standards of training. Collaboration with volunteer physicians from the Northumbria Specialist Emergency Care Hospital facilitated the rapid development of an e-learning platform. This platform was structured around defined learning outcomes to standardise trainer recruitment and course delivery. As participant numbers increased, further standardisation was implemented through the creation of a formal teaching protocol outlining the recommended structure and content delivery of each course iteration to ensure continuity. Trainers are all voluntary medical professionals with a background in emergency medicine, including doctors, nurses and paramedics, who often have ties to the farming industry (for example covering rural catchments or previously living on farms).

Course content was tailored to accommodate the learning preferences and logistical constraints of full-time agricultural workers, achieved by creating a course lasting 5 h (10 am to 3 pm) to minimise disruption to essential farm operations. Emphasis was placed on practical, hands-on instruction with minimal classroom learning as there was no minimal educational requirement to attend the course. National injury datasets informed the design of four high-fidelity simulation scenarios representing common traumatic injuries in farming. These were limb amputation, crush injury, impalement, and falls from height. These scenario-based learning methods reflect established practices in clinical life support education, facilitating the translation of knowledge into actionable, retained skills.

Courses are hosted by a farmer, often in buildings located on a farm. Each session commences with a brief formal presentation, contextualising the course with industry-specific injury statistics and the rationale behind its inception. Given the growing proportion of older individuals in the farming workforce and the associated increased risk of cardiac arrest - compounded by long emergency response times in rural areas - the course begins with basic life support (BLS), cardiopulmonary resuscitation (CPR) and the recovery position. Participants are first demonstrated the skill before being assessed on their competence performing them. The second half focuses on the four simulated trauma scenarios.

The scenarios start by learners observing a trainer demonstrating an ideal use of the trauma skill in a simulated scenario, followed by an explanation of the theory and principles behind the teaching. For each scenario there is a specific trauma skill covered, to ensure reproducibility among courses. Where possible, skills are taught to be self-administered in the case of a lone farmer having an accident (for example applying tourniquet to own arm). They then have an opportunity to ask questions about the scenario, before splitting into smaller groups and trying out the techniques for themselves in a simulated setting. They then discuss their performance with the trainer and reflect on what was done well and what could have been done differently. They may have the chance to practice the simulation multiple times and are assessed by a trainer to ensure they meet the minimum requirements to pass the course. To pass, the student needs to show engagement in all sessions and demonstrate high quality BLS.

To reinforce training outcomes each participant is issued a bespoke trauma kit, including a “tourni-key” bleeding control device, a blast bandage, a triangular bandage, and vet wrap. This kit is actively incorporated into the scenario-based exercises, and farmers are then able to keep the kits and are advised to keep them in their tractor cabs. They are also taught how to improvise tourniquets and basic first aid in a rural setting. This approach aims to familiarise learners with equipment critical to the immediate management of trauma while awaiting professional medical assistance. Upon course completion, participants receive a certificate of attendance in addition to the trauma kit. No formal written assessments are included; a deliberate decision to reduce barriers to participation among the target demographic as farmers anecdotally find this an off-putting experience.

Feedback and outcomes

Data collection

Feedback was collected anonymously from participants at the end of the course. Feedback forms were distributed to all trainees. All feedback forms received were included in the analysis. Trainees could choose not to fill in the form if they wished. Participants were asked to rate eight statements on a 4-point Likert scale with the option of free-text for any additional feedback, using the Training Evaluation Form (Appendix 1). Data were collected from a total of 32 courses, conducted over 3 years, with a total of 364 participants. 344 responses were received (94.5% response rate).

Participants were asked to rate the following statements:

1. The training delivered met my expectations.

2. The training had a good mix of theory and practical.

3. The information was presented clearly and in logical sequence.

4. The trainer was knowledgeable about their subject matter.

5. The training facilities were comfortable and the equipment in good order.

6. The training and assessment process was delivered with equal opportunity.

7. I now feel more confident and competent with my skills.

They were then asked to answer yes/no to the following question:

• 8.Would you recommend F3A as a Training Provider?

Results

The results of the survey from 344 respondents are summarised numerically in Table 1 and displayed as a Likert scale in Fig. 1. We used the free text entries to provide more granularity on the answers to each statement.

Table 1.

Numerical results of 344 completed F3A feedback surveys

Question number	1	2	3	4	5	6	7
n = strongly disagree [SD]	2	2	2	2	2	2	2
n = disagree [D]	0	0	0	0	0	0	0
n = agree [A]	46	32	35	17	60	38	82
n = strongly agree [SA]	291	310	307	325	282	303	260
n = no response [NR]	5	0	0	0	0	1	0
Total responses	339	344	344	344	344	343	344
Median	SA	SA	SA	SA	SA	SA	SA
QR1a	SA	SA	SA	SA	SA	SA	SA
QR3a	SA	SA	SA	SA	SA	SA	SA
IQRa	0	0	0	0	0	0	0

^aAbbreviations: QR1, first quartile range; QR3, third quartile range; IQR, interquartile range

Fig. 1.

Likert scale visualisation of F3A survey results

Quantitative data

The majority of participants strongly agreed with the statement for every section. For each of the seven Likert items, the median score was at the top of the scale (i.e., “strongly agree”), and the interquartile range was zero, indicating a high level of consensus among respondents. 0.6% of respondents (n = 2) strongly disagreed with each statement. Some respondents did not leave a response for some statements (marked in purple in Fig. 1). In response to Question 8, relating to whether they would recommend F3A, 100% of responses were “yes”, with 335 responses (97%) and 9 forms with no response (3%).

Qualitative data – key themes

Of the 344 participants surveyed, 192 (55%) provided written feedback in the free text box. All other participants left this box blank. One comment was illegible.

Overall course quality

The vast majority of participants gave very positive feedback. Words like informative, useful, clear, well delivered, and well-presented were consistently used. Participants felt the course was practical, relevant, and directly applicable to their work in an agricultural context.

Trainers and delivery

The trainers received only positive remarks: they were described as knowledgeable, friendly, approachable, expert, and engaging. The delivery was described as being clear, simple, interactive, and easy to understand. Many commented on the relaxed, friendly, and low-pressure atmosphere, which helped participants feel comfortable asking questions.

Practical elements

Practical scenarios and hands-on training were highlighted as particularly valuable. Many participants appreciated the realistic, farm-based simulations being sprung on them, which made the training relevant and memorable.

Confidence and usefulness

A key outcome was an increase in participant confidence to respond to emergencies, including farm-related accidents. Several noted that the course gave them practical skills and knowledge that they believed will be useful immediately and in the future.

Relevance to industry

The course was seen as highly relevant to agriculture, forestry, and rural sectors. It was noted as better than traditional classroom courses, being more engaging and tailored to the specific risks in the farming environment.

Suggestions for improvement

Individual candidates requested more content on children’s first aid given that many farms are family-run and more coverage on heat and chemical burns.

Analysis

Overall, participant responses for course evaluation were strongly positive for both qualitative and quantitative data.

Two responses represented notable outliers, showing “strongly disagree” ratings despite also stating that they would recommend the course. These responses may reflect a misunderstanding of the scale. For this reason, medians and interquartile ranges were reported instead of means, as they better reflect the distribution of ordinal responses.

Thematic analysis of participant responses revealed a high degree of satisfaction with the course, particularly in the areas of trainer competence, practical application, and course relevance. A recurrent theme was increased confidence in handling first aid and emergency scenarios, with multiple participants noting that they felt better prepared for real-life incidents. This was beneficial as participants mentioned fear of legal action and worsening the situation as potential barriers to issuing help. Practical, scenario-based training was particularly appreciated, especially those that mimicked on-farm situations.

Discussion

Limitations of data

A major limitation is the absence of pre-training data, which restricts our ability to measure learning gains or attitude shifts. The reliance on self-reported post-training perceptions may also be influenced by social desirability or recency bias, meaning that the perception of confidence may not translate into practical gains in real-life scenarios. The data provide evidence of reaction (Kirkpatrick level 1) but require further study to provide robust metrics of learning or behavioural change. Additionally, the small number of anomalous responses points to the importance of data validation in self-administered surveys.

A further limitation is the lack of discriminative power within the questionnaire. The fact that each area has a median of the highest satisfaction score suggests a ceiling effect, and a scoring system with more options at each end of the scale (e.g. a four- or eight-point Likert scale) may have helped to reduce this effect.

While the free-text responses enriched the quantitative dataset by providing context and depth, they were offered by just over half of the participants. This introduces potential response bias, as individuals with strong opinions - usually positive - are more likely to provide written feedback. Less satisfied or more neutral participants may have opted out, skewing the qualitative data.

Despite these limitations, the qualitative data support and elaborate on the quantitative findings, confirming high levels of satisfaction and pointing to specific strengths in content relevance, trainer quality, and practical delivery. These insights also offer actionable suggestions for continuous improvement, to ensure the course is achieving its aims.

Educational delivery

Updated Resuscitation Council UK guidelines have outlined the benefit of tailoring first aid and CPR training to specific populations and their learning needs in the community [25]. Traditionally, farmers have tended to learn new skills through demonstrated teaching by peers and family members; often learning farming practices via these methods from childhood [26]. They learn best through observation and hands-on methods, compared to visual or auditory modes [27]. For this reason, the F3A course was designed to integrate large amounts of practical demonstration and hands-on learning, with the goal of increasing recall during real-life emergencies in the future.

To maximise learning for the participants, the F3A teaching follows a modified structure of Kolb’s experiential learning cycle (Fig. 2). This is a practical educational model which can be applied to adult learners, to provide a structure that encourages retention of information. In this structure, learners first have a “concrete experience” of practicing the technique (in the F3A course, this initially involves observing a trainer demonstrating the gold standard of the simulation, as we are starting with completely untrained participants), before engaging in “reflective observation” (asking questions to the trainers), then “abstract conceptualisation” (explanation of the theory and principles behind the teaching), before taking part in “active experimentation” (trying out the techniques for themselves in a simulated setting). Often the learners have the chance to practice the simulation multiple times on the course, thus the cycle restarts and is repeated to solidify learning.

Fig. 2.

Summary of Kolb’s experiential learning cycle

To further ensure that all learners benefit from the structure of Kolb’s model, trainers could ensure that each learner practices the simulation and has a chance for feedback and reflection on their performance at least twice. Barriers to this could include the time constraint of the course, and the size of the breakout groups (which is why the F3A is tailored to a maximum of 3 break-out group participants per trainer), and time given during lunch and after the course for any feedback or questions from the farmers if not achieved during the teaching.

Further research and longitudinal evaluation of course outcomes

Examples from literature show how other high-risk industries have developed tailored first-aid courses with positive outcomes. For example, a “wilderness medicine” first-aid course for commercial fishermen (focused on the Dungeness [UK] crab fleet) produced significant gains in participants’ knowledge, skills, and confidence, and was described as “effective and well received” by participants. The authors suggested that providing first aid training specific to the remote, hazardous fishing environment could markedly reduce the long-term morbidity and disability from injuries that occur far from definitive care [28]. Likewise, an Oregon State University Extension program (USA) offering farm-focused first-aid workshops covering similar injuries to those covered in the F3A course found strong improvements in farmers’ self-rated preparedness: participants’ understanding of farm injury response jumped by two points on a 5-point scale, and most felt the training would lead to fewer injuries on their farms [29].

These findings support the view that context-specific first-aid training is both valued by participants and could lead to better responder action in emergencies. Recently updated Resuscitation Council UK educational guidelines advise the tailoring of first aid education to specific populations for more successful outcomes, thus supporting the methods set out by F3A [25]. There is considerable literature suggesting that courses like F3A – which are practical, hands-on, and tailored to workplace risks – can boost confidence and willingness, which by extension, can improve health outcomes in real-life emergencies [30, 31]. However, there are a lack of data on transferrable outcomes of improvement in morbidity and mortality in sectors following these courses, so the true impact of this type of course on cannot be determined and would need further longitudinal studies to assess this in the future.

For further analysis of the true impact of F3A, further studies will be required. These could include follow-up of course participants (for example, at one and/or five years following the course) to evaluate whether they feel that they have utilised any of the skills learned during the F3A course, and whether they have needed to use any of the pieces of kit provided in their trauma first aid packages. Further possibilities include giving some participants an MCQ (multiple choice questions) test covering trauma skills pre- and post-test, with a follow-up test one year later, to examine whether information and skills were retained. One barrier to this would be that many farmers are not familiar with/ fond of the idea of a test, and this may be a barrier for people to take part in the course.

As vehicle/machinery accidents are the leading cause of death in farming, data could also be gathered from national or regional databases which record traumatic injuries, for example in the UK, TARN (Trauma Audit and Research Network) or National Major Trauma Registry [32]. Whilst anecdotally farmers are educated on the dangers of their equipment, it is understood that often machinery is necessary to agricultural work. Cases could be examined for whether bystanders performed any advanced interventions or used advanced equipment (like tourniquets, blast bandages) from these accidents. Regions that have been largely covered by F3A (e.g., Cumbria) could be compared against regions that have had no F3A input, to determine whether there was any statistical difference in these measures in topics covered by F3A. This research would be challenging as the number of cases is likely to be low, but the impact of each lifesaving intervention on the individual and community is high, so even a small improvement in bystander intervention would be a positive result. Improving health and safety measures in vehicle design also provides a vital role in reducing these traumatic injuries.

Non-educational research point

A recent study in the Journal of Dairy Science concluded that animal behavioural traits are moderately heritable and, with modern sensor-based monitoring systems, can be measured objectively and continuously on a farm [33]. This enables early identification of animals that are highly reactive or aggressive, which are known to increase the likelihood of handler injury. By incorporating behavioural traits into breeding programmes, farmers can gradually select for calmer and more predictable livestock, thereby reducing risks associated with routine management. This is a non-educational research point, which could contribute to safer working environments on UK farms alongside providing regular courses like F3A. It could provide a plethora of data which could then be targeted towards providing location-specific courses in ‘problem areas’ with higher numbers of reactive animals, in conjunction with TARN data.

Barriers to change

Despite overwhelmingly positive written feedback, several barriers to effective course implementation were identified. Farmers generally demonstrate reluctance to participate in exams, tests, or written assessments, preferring practical learning methods due to their familiarity with hands-on work. Consequently, the course design prioritized practical components and minimized written or reading-based instruction. As a result, formal competency assessments at the course’s conclusion were replaced by ongoing evaluation during demonstrations to ensure skill acquisition. This approach complicated the standardization of competency levels compared to written tests. Additionally, there is limited awareness of health and safety hazards on farms and a prevailing belief that incidents are unlikely to occur, which has contributed to the historical neglect of trauma care knowledge in this community. The introductory PowerPoint presentation on the course addresses these cultural factors and emphasizes the need for change to reduce harm.

In some cases, healthcare professionals struggled to express themselves in lay terms and resorted to using medical terminology to answer questions. In general, farmers did not respond well to this, so trainers were helped and encouraged to avoid any medical terminology in favour of lay terms.

Some feedback, including from other first aid providers, was that F3A is not a ‘first aid’ educational charity, and the skills taught are too advanced to be given this label. This is valid feedback, as the content discussed goes beyond the scope of standard first aid courses, and it should likely be referred to as an ‘Agricultural Trauma Specific First Aid Course’, given that the course focuses more on the trauma chain of survival and agriculture-specific injuries, alongside standard BLS skills which are provided in more standard ‘first aid’ courses [34]. A ‘middle ground’ needs to be achieved where it is labelled as something more advanced than basic first aid, but it is also not misleadingly suggesting a highly medicalised course for professionals.

Delivering high-quality e-learning for trainers presented significant challenges. The team developed a system combining publicly available resources, such as St John’s Ambulance videos, with in-house skills videos. Volunteer trainers managed the administration of the e-learning platform. While the system effectively delivered course content and assessments, many users, including both trainees and volunteer administrators, found it unintuitive and difficult to use. This usability issue hindered the recruitment of additional trainers. Implementing a higher-budget platform or employing a trained administrator would likely have streamlined the process of training and assessing course trainers.

Conclusion

The F3A course aims to equip farmers and forestry workers with first aid skills tailored to the specific risks of their hazardous work environments. Participant feedback indicates strong approval of the course’s relevance, practical focus, and delivery, supporting its effectiveness in enhancing perceived preparedness for traumatic injury response in rural contexts. Nevertheless, significant challenges persist. The agricultural workforce is ageing, frequently geographically isolated, and subject to substantial physical and mental demands. A lack of nationwide tailored course provision and the absence of formal legal requirements for first aid training further discourage farmers from pursuing trauma first aid education.

Future work must prioritise expanding access to the F3A course across a larger geographical area of the UK and hard-to-reach farming populations, including younger farmers and migrant workers. Longitudinal studies are needed to evaluate skill retention and ultimately, real-world impacts on injury outcomes and survival rates. Exploring integration with existing health and safety frameworks and potential policy advocacy for mandated training could further strengthen agricultural safety culture.

Given the culture of this industry and the nature of remote agricultural accidents, there is a high probability of significant under-reporting of injuries in the UK national statistics. This potential confounder needs to be considered when designing future outcome studies attempting to quantify reduction in morbidity and mortality from F3A-type training.

In summary, while the F3A course lays important groundwork, sustained effort, research, and collaboration are required to overcome systemic barriers and safeguard the health and lives of those who sustain the nation’s agriculture and forestry industries.

Appendix 1

Author contributions

F.W. contributed to all sections, final editing, review process and submission I.S., S.B., and I.A. contributed to all sections W.P. supervised project. All authors reviewed manuscript before submission.

Funding

This study received no funding for its design, data collection, analysis, or interpretation. No authors or any trainers for this course have been paid to deliver the courses. Support was offered by Northumbria Healthcare NHS Trust Research and Development and The Bright Charity to cover the article processing/publication fee only.

Data availability

Anonymised aggregate data and the Training Evaluation Form are available from the authors upon reasonable request.

Declarations

Ethical approval

This project was conducted as a service evaluation. No identifiable data were collected. Ethical review was not required under NHS HRA guidance for service evaluation.

Consent to participate

Participation was voluntary. Completion of the anonymous post-course feedback questionnaire was taken as implied consent to participate in this study.

Consent for publication

All data were collected anonymously. No identifiable personal information is included in this manuscript. Consent to publish is not applicable.

Course program

A complete course program are available from the authors upon reasonable request.

Competing interests

The authors declare no competing interests.