Background: Timely pre-hospital care is critical in rural Nepal where formal Emergency Medical Services are scarce. In 2018, a three-day Community First Responder (CFR) program was delivered to more than 200 community volunteers in Geruwa Rural Municipality, Bardiya, Nepal; however, long-term effectiveness and degree of skill decay remained unknown. Purpose: To quantify first-aid knowledge retention and on-scene application among CFRs five years after their initial training. Method: A mixed-methods follow-up study was conducted in 2024. Quantitatively, 25-item validated MCQ administered to all reachable CFRs (n = 112). Qualitatively, in-depth interviews with two active CFRs and one elected ward chairperson. Knowledge scores were categorized into quartiles (low, moderate, significant, higher retention). Self-reported emergency responses since training were enumerated and thematic analysis of barriers performed. Results: The response rate was 100 %. Median post-course score was23/25; at five years 59 % of participants retained moderate knowledge, 36 % significant, 4 % higher and 2 % low. CFRs documented 510 real cases (trauma 35 %, burns 15 %, obstetrics 7 %, wildlife attacks 8 %). Complex skills showed the steepest decay: adult CPR ratio 4 % correct, snake-bite immobilization 5 %. Qualitative themes included language and literacy mismatches (Tharu vs. Nepali), transport delays, time-conflict with farming, demand for local refresher trainers. No serious adverse events were reported. Conclusion: Community-based CFR training yields measurable but partially decayed knowledge at five years, sustained by periodic field practice. Embedding language-appropriate refreshers, local trainers and transport solutions is essential to preserving life-saving competence in low-resource settings.