1
|
Draper A, Rose B, Knickerbocker C, Tannenbaum SL, Lozada J, Berne J. Open-source code maps traumas for targeting interventions: Applying the model to compare penetrating traumas with "Stop the Bleed" training locations. Am J Surg 2024; 237:115789. [PMID: 38879354 DOI: 10.1016/j.amjsurg.2024.115789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND To improve equitable access to geospatial analysis, a free open-source R package, called Rosymap, was created to map trauma incident locations. METHODS To demonstrate the R package, penetrating trauma events for all patients who received care at a level one trauma center, and the locations of all "Stop the Bleed" training locations between 2019 and 2022 were geospatially analyzed. RESULTS The level one trauma center treated 1531 patients for penetrating traumas between 2019 and 2022. Using Rosymap, a map was produced showing the poor overlap in distribution between penetrating traumas and "Stop the Bleed" training locations. CONCLUSION Rosymap, a free open-source GIS R package, visualized that the majority of "Stop the Bleed" training locations were not performed within clusters of penetrating traumas serviced by our level one trauma center. These results suggest that trauma providers and public health advocates should consider geospatial analysis when planning interventions and when attempting to choose locations equitably and accurately. To facilitate and promote the implementation of geospatial analysis, Rosymap is available as open-source code.
Collapse
Affiliation(s)
| | | | | | | | - Jose Lozada
- Broward Health Medical Center, Trauma Surgery, USA
| | - John Berne
- Broward Health Medical Center, Trauma Surgery, USA
| |
Collapse
|
2
|
McLauchlan NR, Frasier LL, Fisher L, Carroll J, Christian CW, Delaney A, Cave KJ, Gallagher JJ, Rose S, Morris JB, Kaufman E, Cannon JW. High-Fidelity Bleeding Control Simulation Scenario During Medical Student Orientation Improves Students' Self-Reported Ability to Identify and Treat Life-Threatening Bleeding with 3-year Follow-up. JOURNAL OF SURGICAL EDUCATION 2024; 81:1484-1490. [PMID: 39138072 DOI: 10.1016/j.jsurg.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/14/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE Increasingly, medical schools integrate clinical skills into early didactic coursework. The Stop the Bleed® Campaign emphasizes prehospital hemorrhage control to reduce preventable deaths; however, this course overlooks team interactions. We assessed the impact of high-fidelity simulation during medical student orientation on identification and treatment of life-threatening hemorrhage in a team setting. DESIGN In this mixed method, prospective pre-, post-, and follow-up survey analysis assessing student knowledge and attitudes, student teams encountered a standardized patient in a prehospital environment with pulsatile bleeding from an extremity wound. Individual students completed surveys assessing previous experience, willingness and ability to assist bleeding person(s), and knowledge and attitudes about tourniquets. Postscenario, faculty preceptors made qualitative observations on teamwork. SETTING Medical student orientation at a tertiary care academic medical center with long-term follow-up. PARTICIPANTS Medical students (N = 150). RESULTS Ninety students (60%) completed both pre- and postsimulation questionnaires. Sixteen (17%) students had previous tourniquet training experience although none had applied a tourniquet outside of training. Postsimulation, students reported increased likelihood of providing treatment until additional help arrived (p = 0.035), improved ability to identify life-threatening hemorrhage (p < 0.001), and more favorable opinions about tourniquet use (p < 0.001) and potential for limb-salvage (p = 0.018). Long-term follow-up respondents (n = 34, 23%) reported increased ability to identify life-threatening hemorrhage (p = 0.010) and universal willingness to intervene until additional help arrived. Follow-up survey responses elicited themes in hemorrhage control including recognition of the importance of continuous pressure, appropriate use of tourniquets, a desire for repeated team training, and the recognition of clerkship rotations as an optimal setting for skill reinforcement. Preceptors noted variable team responses but uniformly endorsed the exercise. CONCLUSIONS High-fidelity bleeding simulation during medical student orientation improved students' knowledge and attitudes about treating life-threatening hemorrhage and served as an introduction to team-based emergency care. Future studies should further explore team training and hemorrhage control education.
Collapse
Affiliation(s)
- Nathaniel R McLauchlan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Lane L Frasier
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Lydia Fisher
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Jennifer Carroll
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Cindy W Christian
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104; Department of Pediatric Hospital Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104
| | - Anna Delaney
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Kelli J Cave
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - John J Gallagher
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Suzanne Rose
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Jon B Morris
- Division of Surgery Education, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Jeremy W Cannon
- Division of Traumatology, Surgical Critical Care & Emergency Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104.
| |
Collapse
|
3
|
Anderson M, Williams R. Bleeding control methods for kids: A pediatric approach to the national education campaign-a pilot program. J Trauma Acute Care Surg 2024:01586154-990000000-00803. [PMID: 39269280 DOI: 10.1097/ta.0000000000004454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
BACKGROUND The project purpose was to design and test an age-appropriate curriculum to train children aged 5 through 13 years on bleeding control methods based on the national Stop the Bleed initiative. Studies have shown that children as young as 5 years are able to perform first aid and cardiopulmonary resuscitation. The project aimed to demonstrate that children as young as 5 years can be taught bleeding control methods. Our hypothesis was that there would be a 60% retention rate on retesting of the children within 1 year across all age groups. METHODS The study design was an observational cohort study from February 2018 to January 2020. Participants (aged 5 through 13 years) were trained on bleeding control methods but using an age-based curriculum. The initial training included 500 children. The participants were taught tourniquet applications, wound packing, and direct pressure skills. The curriculum consisted of a 30-minute didactic portion with participant involvement and engagement followed by 30 minutes of hands-on skill training and demonstration. In addition, participants were required to be able to recite the "5 Rules" to helping hurt people. Descriptive statistics were performed. RESULTS Participants were retested approximately 1 year after the initial training. The retest group only consisted of 227 participants because of a multitude of reasons for the decrease in children. Children were tested in comprehension and application of each skill. Results indicated a greater than 70% retention for all skills across all participants for the retesting after 1 year. CONCLUSION The findings indicated that children as young as 5 years can be taught to perform bleeding control methods of tourniquet application, wound packing, and direct pressure. While the results indicate that the older the child, the better the retention, if children were provided multiple trainings over a 1-year period, the retention could be higher. LEVEL OF EVIDENCE Observational Cohort Study; Level VIII.
Collapse
Affiliation(s)
- Melissa Anderson
- From the Denver Health (M.A., R.W.), Denver; and Division of Trauma and Emergency Surgery (R.W.), University of Colorado School of Medicine, Aurora, Colorado
| | | |
Collapse
|
4
|
Johnston KC, Deal B, Estrada S, Elizabeth C, Barnes G, Swanberg A. The response readiness tool: An instrument to measure knowledge, skills, and attitude after taking a stop the Bleed® course. Public Health Nurs 2024; 41:1165-1177. [PMID: 38766686 DOI: 10.1111/phn.13335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024]
Abstract
Stop the Bleed® is an emergency response course that offers a certificate of completion but no ending assessment. The purpose of this educational study was to develop and test the Response Readiness Tool (RRT) that measures learning of participants after taking Stop the Bleed®. The study used a pre-/post-test design to measure knowledge and attitudes, and a post-test only for skills. Participants were recruited from existing Stop the Bleed® courses. Knowledge was measured with a 10-item questionnaire, attitude was measured with five Likert-style questions, and skills were measured by observing simulated tourniquet placement. Ninety-five participants were recruited over two semesters. There was a significant difference in the knowledge and attitude scores indicating participants' improvement in learning and attitude toward responding. Internal consistency reliability of scores showed moderate reliability with Cronbach's Alpha of 0.73 and McDonald's Omega of 0.75. A positive correlation was found between expected proficiency and pre-test indicating the tool had construct validity. RRT provides Stop the Bleed® instructors with an instrument to measure knowledge, skills, and attitude of participants after taking Stop the Bleed®. Statistics show moderate reliability and validity; however, larger samples are needed for full psychometric testing. This publication presents the revised tool after the completion of this study.
Collapse
Affiliation(s)
| | - Belinda Deal
- The University of Texas at Tyler, College of Nursing, Tyler, Texas, USA
| | | | | | - Glenn Barnes
- The University of Texas at Tyler, College of Nursing, Tyler, Texas, USA
| | - Amanda Swanberg
- The University of Texas at Tyler, College of Nursing, Tyler, Texas, USA
| |
Collapse
|
5
|
Do Thi N, Thi GH, Lee Y, Minh KP, Thanh HN, Shin JS, Luong Xuan T. First-aid training for primary Healthcare providers on a remote Island: a mixed-methods study. BMC MEDICAL EDUCATION 2024; 24:790. [PMID: 39044192 PMCID: PMC11267758 DOI: 10.1186/s12909-024-05768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Ensuring ongoing first-aid training for primary healthcare providers (PHPs) is one of the critical strategies for providing quality health services and contributing to achieving universal health coverage. However, PHPs have received insufficient attention in terms of training and capacity building, especially in the remote areas of low-to-middle-income countries. This study evaluated the effectiveness of a first-aid training program for PHPs on a Vietnamese island and explored their perspectives and experiences regarding first-aid implementation. METHODS A mixed-methods study was conducted among 39 PHPs working in community healthcare centers. The quantitative method utilized a quasi-experimental design to evaluate participants' first-aid knowledge at three time points: pre-training, immediately post-training, and three months post-training. Sixteen of the PHPs participated in subsequent semi-structured focus group interviews using the qualitative method. Quantitative data were analyzed using repeated measures analysis of variance (ANOVA), while qualitative data were subjected to thematic analysis. RESULTS The quantitative results showed a significant improvement in both the overall mean first-aid knowledge scores and the subdimensions of the first-aid knowledge scores among healthcare providers post-training. There was a statistically significant difference between the baseline and immediate posttest and follow-up knowledge scores (p < 0.001). However, the difference in knowledge scores between the immediate posttest and three-month follow-up was not significant (p > 0.05). Three main themes emerged from the focus group discussions: perception of first-aid in remote areas, facilitators and barriers. Participants identified barriers, including infrastructure limitations, shortage of the primary healthcare workforce, inadequate competencies, and insufficient resources. Conversely, receiving considerable support from colleagues and the benefits of communication technologies in implementing first aid were mentioned as facilitators. The training bolstered the participants' confidence in their first-aid responses, and there was a desire for continued education. CONCLUSIONS Implementing periodic first-aid refresher training for PHPs in a nationwide resource-limited setting can contribute significantly to achieving universal health coverage goals. This approach potentially enhances the preparedness of healthcare providers in these areas to deliver timely and effective first aid during emergencies, which may lead to more consistent primary healthcare services despite various challenges.
Collapse
Affiliation(s)
- Ninh Do Thi
- College of Nursing, Ewha Womans University, Seoul, Korea.
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam.
| | - Giang Hoang Thi
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Yoonjung Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Khue Pham Minh
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Hai Nguyen Thanh
- Hai Phong University of Medicine and Pharmacy, 72 Nguyen Binh Khiem, Hai Phong, Vietnam
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, Seoul, Korea
| | - Tuyen Luong Xuan
- Vietnam National Institute of Maritime Medicine, Hai Phong, Vietnam
| |
Collapse
|
6
|
Saggar V, O'Donnell P, Moss H, Yoon A, Lutz C, Restivo A, Ahmed O, Guha D, Jafri F, Singh M. Effectiveness of a virtual reality trainer for retention of tourniquet application skills for hemorrhage control among emergency medicine residents. AEM EDUCATION AND TRAINING 2024; 8:e10986. [PMID: 38738183 PMCID: PMC11079436 DOI: 10.1002/aet2.10986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
Background With a rise in mass casualty incidents, training in hemorrhage control using tourniquets has been championed as a basic-and lifesaving-procedure for bystanders and medical professionals alike. The current standard for training is in-person (IP) courses, which can be limited based on instructor availability. Virtual reality (VR) has demonstrated the potential to improve the accuracy of certain medical tasks but has not yet been developed for hemorrhage control. The objective of this study was to evaluate the efficacy of a VR hemorrhage trainer in learner retention of tourniquet application when compared to traditional IP instructor teaching among a cohort of emergency medicine residents practicing in a Level I trauma center. Methods This was a prospective, observational study of 53 emergency medicine residents at an inner-city program. Participants were randomly assigned to either the control or the VR group. On Day 0, all residents underwent a training session (IP vs. VR) for the proper, stepwise application of a tourniquet, as defined by the American College of Trauma Surgeons. Each participant was then assessed on the application of a tourniquet by a blinded instructor using the National Registry Hemorrhage Control Skills Lab rubric. After 3 months, each resident was reevaluated on the same rubric, with subsequent data analysis on successful tourniquet placement (measured as under 90 s) and time to completion. Results Of the 53 participants, the IP training group had an initial pass rate of 97% (28/29) compared to 92% (22/24) in the VR group (p = 0.58). On retention testing, the IP training group had a pass rate of 95% (20/21) compared to 90% (18/20) in the VR group (p = 0.62). Stratifying the success of tourniquet placement by level of resident training did not demonstrate any statistically significant differences. Conclusions In this pilot study of emergency medicine residents, we found no significant differences in successful hemorrhage control by tourniquet placement between those trained with VR compared to a traditional IP course among emergency medicine residents. While more studies with greater power are needed, the results suggest that VR may be a useful adjunct to traditional IP medical training.
Collapse
Affiliation(s)
- Vinay Saggar
- Columbia Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
- Department of Emergency MedicineNewYork‐Presbyterian/Columbia Medical CenterBrooklynNew YorkUSA
| | - Philip O'Donnell
- Department of Emergency MedicineNewYork‐Presbyterian Brookyln Methodist HospitalBrooklynNew YorkUSA
| | - Hillary Moss
- Albert Einstein College of MedicineBronxNew YorkUSA
- Moses Division, Department of Emergency MedicineMontefiore Medical CenterNew YorkNew YorkUSA
| | - Andrew Yoon
- Albert Einstein College of MedicineBronxNew YorkUSA
- Moses Division, Department of Emergency MedicineMontefiore Medical CenterNew YorkNew YorkUSA
| | - Carlo Lutz
- Albert Einstein College of MedicineBronxNew YorkUSA
- Moses Division, Department of Emergency MedicineMontefiore Medical CenterNew YorkNew YorkUSA
| | - Andrew Restivo
- Albert Einstein College of MedicineBronxNew YorkUSA
- Weiler Division, Department of Emergency MedicineMontefiore Medical CenterNew YorkNew YorkUSA
| | - Oark Ahmed
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Emergency Medicine, Jacobi Medical CenterNYC Health + HospitalsBronxNew YorkUSA
| | - Debayan Guha
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Emergency Medicine, Jacobi Medical CenterNYC Health + HospitalsBronxNew YorkUSA
| | - Farrukh Jafri
- Department of Emergency MedicineWhite Plains HospitalWhite PlainsNew YorkUSA
| | - Maninder Singh
- Albert Einstein College of MedicineBronxNew YorkUSA
- Department of Emergency Medicine, Jacobi Medical CenterNYC Health + HospitalsBronxNew YorkUSA
| |
Collapse
|
7
|
Weiner SG, Goldberg SA, Lang C, Jarman M, Miller CJ, Li S, Stanek EW, Goralnick E. Implementation and Evaluation of a Bystander Naloxone Training Course. West J Emerg Med 2024; 25:320-324. [PMID: 38801036 PMCID: PMC11112654 DOI: 10.5811/westjem.60409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/26/2023] [Accepted: 01/12/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Bystander provision of naloxone is a key modality to reduce opioid overdose-related death. Naloxone training courses are available, but no standardized program exists. As part of a bystander empowerment course, we created and evaluated a brief naloxone training module. Methods This was a retrospective evaluation of a naloxone training course, which was paired with Stop the Bleed training for hemorrhage control and was offered to administrative staff in an office building. Participants worked in an organization related to healthcare, but none were clinicians. The curriculum included the following topics: 1) background about the opioid epidemic; 2) how to recognize the signs of an opioid overdose; 3) actions not to take when encountering an overdose victim; 4) the correct steps to take when encountering an overdose victim; 5) an overview of naloxone products; and 6) Good Samaritan protection laws. The 20-minute didactic section was followed by a hands-on session with nasal naloxone kits and a simulation mannequin. The course was evaluated with the Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales for take-home naloxone training evaluation. We used the paired Wilcoxon signed-rank test to compare scores pre- and post-course. Results Twenty-eight participants completed the course. The OOKS, measuring objective knowledge about opioid overdose and naloxone, had improved scores from a median of 73.2% (interquartile range [IQR] 68.3%-79.9%) to 91.5% (IQR 85.4%-95.1%), P < 0.001. The three domains on the OOAS score also showed statistically significant results. Competency to manage an overdose improved on a five-point scale from a median of 2.5 (IQR 2.4-2.9) to a median of 3.7 (IQR 3.5-4.1), P < 0.001. Concerns about managing an overdose decreased (improved) from a median of 2.3 (IQR 1.9-2.6) to median 1.8 (IQR 1.5-2.1), P < 0.001. Readiness to intervene in an opioid overdose improved from a median of 4 (IQR 3.8-4.2) to a median of 4.2 (IQR 4-4.2), P < 0.001. Conclusion A brief course designed to teach bystanders about opioid overdose and naloxone was feasible and effective. We encourage hospitals and other organizations to use and promulgate this model. Furthermore, we suggest the convening of a national consortium to achieve consensus on program content and delivery.
Collapse
Affiliation(s)
- Scott G. Weiner
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Scott A. Goldberg
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Cheryl Lang
- Brigham and Women’s Hospital, Department of Surgery, Boston, Massachusetts
| | - Molly Jarman
- Brigham and Women’s Hospital, Department of Surgery, Boston, Massachusetts
| | - Cory J. Miller
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Sarah Li
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Ewelina W. Stanek
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Eric Goralnick
- Brigham and Women’s Hospital, Department of Emergency Medicine, Boston, Massachusetts
| |
Collapse
|
8
|
Zhao W, Cao Y, Hu L, Lu C, Liu G, Gong M, He J. A randomized controlled trial comparison of PTEBL and traditional teaching methods in "Stop the Bleed" training. BMC MEDICAL EDUCATION 2024; 24:462. [PMID: 38671422 PMCID: PMC11055269 DOI: 10.1186/s12909-024-05457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The Stop the Bleed (STB) training program was launched by the White House to minimize hemorrhagic deaths. Few studies focused on the STB were reported outside the United States. This study aimed to evaluate the effectiveness of a problem-, team- and evidence-based learning (PTEBL) approach to teaching, compared to traditional teaching methods currently employed in STB courses in China. METHODS This study was a parallel group, unmasked, randomised controlled trial. We included third-year medical students of a five-year training program from the Xiangya School of Medicine, Central South University who voluntarily participated in the trial. One hundred fifty-three medical students were randomized (1:1) into the PTEBL group (n = 77) or traditional group (n = 76). Every group was led by a single instructor. The instructor in the PTEBL group has experienced in educational reform. However, the instructor in the traditional group follows a traditional teaching mode. The teaching courses for both student groups had the same duration of four hours. Questionnaires were conducted to assess teaching quality before and after the course. The trial was registered in the Central South University (No. 2021JY188). RESULTS In the PTEBL group, students reported mastery in three fundamental STB skills-Direct Finger Compression (61/77, 79.2%), Packing (72/77, 93.8%), and Tourniquet Placement (71/77, 92.2%) respectively, while 76.3% (58/76), 89.5% (68/76), and 88.2% (67/76) of students in the traditional group (P > 0.05 for each pairwise comparison). 96.1% (74/77) of students in the PTEBL group felt prepared to help in an emergency, while 90.8% (69/76) of students in the traditional group (P > 0.05). 94.8% (73/77) of students reported improved teamwork skills after the PTEBL course, in contrast with 81.6% (62/76) of students in the traditional course (P = 0.011). Furthermore, a positive correlation was observed between improved clinical thinking skills and improved teamwork skills (R = 0.82, 95% CI: 0.74-0.88; P < 0.001). CONCLUSIONS Compared with the traditional teaching method, the PTEBL method was superior in teaching teamwork skills, and has equally effectively taught hemostasis techniques in the emergency setting. The PTEBL method can be introduced to the STB training in China.
Collapse
Affiliation(s)
- Wanchen Zhao
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China
- QingFang Orthopaedic Hospital of Wugang City, Shaoyang, Hunan, 422499, China
- Xiangya Scool of Medicine, Central South University, Changsha, Hunan, 410013, China
| | - Yangbo Cao
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China
| | - Liangrong Hu
- QingFang Orthopaedic Hospital of Wugang City, Shaoyang, Hunan, 422499, China
| | - Chenxiao Lu
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China
- QingFang Orthopaedic Hospital of Wugang City, Shaoyang, Hunan, 422499, China
- Xiangya Scool of Medicine, Central South University, Changsha, Hunan, 410013, China
| | - Gaoming Liu
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China
- QingFang Orthopaedic Hospital of Wugang City, Shaoyang, Hunan, 422499, China
- Xiangya Scool of Medicine, Central South University, Changsha, Hunan, 410013, China
| | - Matthew Gong
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Jinshen He
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, Hunan, 410013, China.
| |
Collapse
|
9
|
DePolo N, Dellen M, Hughes E, Ike A, Lum S, Mukherjee K, Turay D, Burruss S. Opportunity for a Community Health Fair Model of Bleeding Control Training. Am Surg 2024:31348241241745. [PMID: 38562123 DOI: 10.1177/00031348241241745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Traumatic hemorrhage is a prevalent cause of death nationally, with >50% of civilian deaths estimated to be preventable with more timely intervention. This study investigated the efficacy of training large and diverse audiences in bleeding control methods including tourniquets in community health fair settings. METHODS A booth was utilized for bleeding control training at community health fairs via direct demonstrations of pressure, wound packing, and commercial and improvised tourniquet application followed by hands-on practice. Participants self-rated their perceived abilities while instructors rated the participant competency. RESULTS 117 community members participated during two fairs, though not every person completed every portion of the training. Average age was 33 (range 6-82) and the majority were female (65.0%). There was no difference in self-perceived skill compared to trainer grading of participant's ability to identify life-threatening bleeding (112 (97.4%) vs 106 (97.2%); P = 1), apply pressure (113 (98.3%) vs 106 (97.2%); P = .68), and pack a wound (102 (88.7%) vs 92 (84.4%); P = .43). No difference in difficulty was noted in placing commercial vs improvised tourniquets (16 (43%) vs 14 (45%); P = .87). However, participants were overconfident in their ability to place tourniquets compared to trainer grading, respectively (112 (98.2%) vs 100 (91.7%; P = .03)). DISCUSSION Community fair classes provide opportunities to train large and diverse audiences in bleeding control techniques. However, participants overestimated their ability to appropriately apply tourniquets. Further investigation is needed into best educational approaches to optimize the impact of bleeding control kits that have been distributed in multiple states.
Collapse
Affiliation(s)
- Nicole DePolo
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Matthew Dellen
- Department of Surgery, Dwight D. Eisenhower Army Medical Center, Ft Gordon, GA, USA
| | - Elizabeth Hughes
- Department of Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Andre Ike
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Sharon Lum
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Kaushik Mukherjee
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - David Turay
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sigrid Burruss
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, USA
- Department of Surgery, University of California, Irvine, CA, USA
| |
Collapse
|
10
|
Parvin-Nejad FP, Vegunta G, Mele G, Sifri ZC. Stop the Bleed in the Era of Virtual Learning: A Novel Strategy for Remote Teaching and Evaluation. J Surg Res 2024; 296:759-765. [PMID: 38377702 DOI: 10.1016/j.jss.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/16/2023] [Accepted: 01/06/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Traumatic hemorrhage is a leading cause of preventable mortality worldwide. The Stop the Bleed (STB) course was developed to equip layperson bystanders with basic bleeding control knowledge and skills. However, large in-person courses have been disrupted due to COVID-19. The aim of this study was to determine the feasibility of teaching and evaluating STB skills through remote video-based instruction. METHODS After undergoing COVID-19 screening, groups of up to eight STB-naive adults were seated in a socially distanced manner and given individual practice kits. A remote STB-certified instructor provided the standard STB lecture and led a 10-min skills practice session via videoconferencing. Participants' skills were evaluated on a 10-point rubric by one in-person evaluator and three remote evaluators. Participants completed a postcourse survey assessing their perceptions of the course. RESULTS Thirty-five participants completed the course, all scoring ≥8/10 after examination by the in-person evaluator. Remote instructors' average scores (9.8 ± 0.45) did not significantly differ from scores of the in-person evaluator (9.9 ± 0.37) (P = 0.252). Thirty-three participants (94%) completed the postcourse survey. All respondents reported being willing and prepared to intervene in scenarios of life-threatening hemorrhage, and 97% reported confidence in using all STB skills. CONCLUSIONS STB skills can be effectively taught and evaluated through a live video-based course. All participants scored highly when evaluated both in-person and remotely, and nearly all reported confidence in skills and knowledge following the course. Remote instruction is a valuable strategy to disseminate STB training to students without access to in-person courses, especially during pandemic restrictions.
Collapse
Affiliation(s)
| | | | - Giovanna Mele
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad C Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
11
|
Hedberg H, Hedberg P, Aléx J, Karlsson S, Haney M. Effects of an advanced first aid course or real-time video communication with ambulance personnel on layperson first response for building-site severe injury events: a simulation study. BMC Emerg Med 2024; 24:2. [PMID: 38185649 PMCID: PMC10773037 DOI: 10.1186/s12873-023-00917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND The risk of high-energy trauma injuries on construction sites is relatively high. A delayed response time could affect outcomes after severe injury. This study assessed if an advanced first aid course for first aid response for laypersons (employees or apprentices) in the construction industry or real-time video communication and support with ambulance personnel, or neither, together with access to an advanced medical kit, would have an effect on immediate layperson vital responses in a severe injury scenario. METHOD This was a controlled simulation study. Employees or apprentices at a construction site were recruited and randomly allocated into a group with video support or not, and advanced first aid course or not, and where one group had both. The primary outcomes were correct behavior to recognize and manage an occluded airway and correct behavior to stop life-threatening bleeding from a lower extremity injury. Secondary outcomes included head-to-toe assessment performed, placement of a pelvic sling, and application of remote vital signs monitors. RESULTS Ninety participants were included in 10 groups of 3 for each of 4 exposures. One group was tested first as a baseline group, and then later after having done the training course. Live video support was effective in controlling bleeding. A first aid course given beforehand did not seem to be as effective on controlling bleeding. Video support and the first aid course previously given improved the ability of bystanders to manage the airway, the combination of the two being no better than each of the interventions taken in isolation. Course exposure and video support together were not superior to the course by itself or video by itself, except regarding placing the biosensors on the injured after video support. Secondary results showed an association between video support and completing a head-to-toe assessment. Both interventions were associated with applying a pelvic sling. CONCLUSION These findings show that laypersons, here construction industry employees, can be supported to achieve good performance as first responders in a major injury scenario. Prior training, but especially live video support without prior training, improves layperson performance in this setting.
Collapse
Affiliation(s)
- Hans Hedberg
- Anesthesiology and Intensive Care Medicine, Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
| | - Pia Hedberg
- Nursing and Surgical and Perioperative Sciences, Center for Disaster Medicine, Umeå University, Umeå, Sweden
| | | | - Sofia Karlsson
- Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Michael Haney
- Anesthesiology and Intensive Care Medicine, Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| |
Collapse
|
12
|
Jones AR, Miller J, Brown M. Epidemiology of Trauma-Related Hemorrhage and Time to Definitive Care Across North America: Making the Case for Bleeding Control Education. Prehosp Disaster Med 2023; 38:780-783. [PMID: 37781932 PMCID: PMC10694464 DOI: 10.1017/s1049023x23006428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Uncontrolled trauma-related hemorrhage remains the primary preventable cause of death among those with critical injury. STUDY OBJECTIVE The purpose of this investigation was to evaluate the types of trauma associated with critical injury and trauma-related hemorrhage, and to determine the time to definitive care among patients treated at major trauma centers who were predicted to require massive transfusion. METHODS A secondary analysis was performed of the Pragmatic, Randomized, Optimal Platelet and Plasma Ratios (PROPPR) trial data (N = 680). All patients included were predicted to require massive transfusion and admitted to one of 12 North American trauma centers. Descriptive statistics were used to characterize patients, including demographics, type and mechanism of injury, source of bleeding, and receipt of prehospital interventions. Patient time to definitive care was determined using the time from activation of emergency services to responder arrival on scene, and time from scene departure to emergency department (ED) arrival. Each interval was calculated and then summed for a total time to definitive care. RESULTS Patients were primarily white (63.8%), male (80.3%), with a median age of 34 (IQR 24-51) years. Roughly one-half of patients experienced blunt (49.0%) versus penetrating (48.2%) injury. The most common types of blunt trauma were motor vehicle injuries (83.5%), followed by falls (9.3%), other (3.6%), assaults (1.8%), and incidents due to machinery (1.8%). The most common types of penetrating injuries were gunshot wounds (72.3%), stabbings (24.1%), other (2.1%), and impalements (1.5%). One-third of patients (34.5%) required some prehospital intervention, including intubation (77.4%), chest or needle decompression (18.8%), tourniquet (18.4%), and cardiopulmonary resuscitation (CPR; 5.6%). Sources of bleeding included the abdomen (44.3%), chest (20.4%), limb/extremity (18.2%), pelvis (11.4%), and other (5.7%). Patients waited for a median of six (IQR4-10) minutes for emergency responders to arrive at the scene of injury and traveled a median of 27 (IQR 19-42) minutes to an ED. Time to definitive care was a median of 57 (IQR 44-77) minutes, with a range of 12-232 minutes. Twenty-four-hour mortality was 15% (n = 100) with 81 patients dying due to exsanguination or hemorrhage. CONCLUSION Patients who experience critical injury may experience lengthy times to receipt of definitive care and may benefit from bystander action for hemorrhage control to improve patient outcomes.
Collapse
Affiliation(s)
- Allison R. Jones
- Department of Acute, Chronic & Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AlabamaUSA
| | - Justin Miller
- Department of Acute, Chronic & Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AlabamaUSA
| | - Michelle Brown
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AlabamaUSA
| |
Collapse
|
13
|
Steins K, Goolsby C, Grönbäck AM, Charlton N, Anderson K, Dacuyan-Faucher N, Prytz E, Andersson Granberg T, Jonson CO. Recommendations for Placement of Bleeding Control Kits in Public Spaces-A Simulation Study. Disaster Med Public Health Prep 2023; 17:e527. [PMID: 37852924 DOI: 10.1017/dmp.2023.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Bleeding control measures performed by members of the public can prevent trauma deaths. Equipping public spaces with bleeding control kits facilitates these actions. We modeled a mass casualty incident to investigate the effects of public bleeding control kit location strategies. METHODS We developed a computer simulation of a bomb exploding in a shopping mall. We used evidence and expert opinion to populate the model with parameters such as the number of casualties, the public's willingness to aid, and injury characteristics. Four alternative placement strategies of public bleeding control kits in the shopping mall were tested: co-located with automated external defibrillators (AEDs) separated by 90-second walking intervals, dispersed throughout the mall at 10 locations, located adjacent to 1 exit, located adjacent to 2 exits. RESULTS Placing bleeding control kits at 2 locations co-located with AEDs resulted in the most victims surviving (18.2), followed by 10 kits dispersed evenly throughout the mall (18.0). One or 2 kit locations placed at the mall's main exits resulted in the fewest surviving victims (15.9 and 16.1, respectively). CONCLUSIONS Co-locating bleeding control kits with AEDs at 90-second walking intervals results in the best casualty outcomes in a modeled mass casualty incident in a shopping mall.
Collapse
Affiliation(s)
- Krisjanis Steins
- Department of Science and Technology, Linköping University, Sweden
| | - Craig Goolsby
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Nathan Charlton
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kevin Anderson
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole Dacuyan-Faucher
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Erik Prytz
- Department of Computer and Information Science, Linköping University, Sweden
- Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | | | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| |
Collapse
|
14
|
Pellegrino JL, Smith SE, Nolan A, Charlton N, Goolsby C. Learner's Stop the Bleed Outcomes Between Lay Instructor and Emergency Medical Services (EMS)-Trained Instructor Groups. Cureus 2023; 15:e45846. [PMID: 37881389 PMCID: PMC10594576 DOI: 10.7759/cureus.45846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND One of the most utilized Stop the Bleed courses, the "Bleeding Control Basic (BCon) course v. 1.0," requires instructors to have a specific healthcare license or pre-hospital credential (e.g., physician or paramedic) or specific emergency medical services (EMS) instructor certification and have completed the BCon provider course. This requirement provides a level of expertise in instructors but limits the potential workforce for sharing life-saving knowledge and skills. Other Stop the Bleed courses, such as the American Red Cross First Aid for Severe Trauma (FAST) course, do not have this requirement. This raises questions pertaining to the learners' outcomes between those facilitated by instructors with and without healthcare licenses or credentials. METHODS Learners' outcomes for applying a tourniquet (skill), knowledge (cognitive), and Intention to Aid (attitude for behavior) were compared between those taught by lay instructors and EMS-trained (emergency medical technician or paramedic) instructors. All were trained as new instructors in the FAST program. RESULTS For the study's primary outcome, all of the learners (n=135) properly applied a tourniquet to a simulated leg injury at the end of the training based on video evidence (skill). Learners in the EMS-trained instructor groups (n=84, mean age 25.5 years, 68% female), who were older and had more education, scored significantly higher on knowledge of tourniquet use on the Stop the Bleed Educational Assessment Tool (SBEAT) (mean=90.0 vs. 83.9 on a scale of 0-100, p=0.001) with a small effect size than the lay instructor group (n=51, mean age 16.6 years, 88% female). There was no statistical difference in attitude toward helping behaviors in a bleeding emergency between the two groups on the Intention to Aid (I2A) survey. IMPLICATIONS Lay instructors and EMS-trained instructors performed comparably in facilitating a widely available Red Cross Stop the Bleed course. Lay experience with tourniquets should not disqualify individuals from being a Stop the Bleed instructor. Using a standard curriculum with instructor development offers a way for people with and without an EMS background to teach life-saving competencies effectively.
Collapse
Affiliation(s)
| | - Stephen E Smith
- Emergency Management and Homeland Security, The University of Akron, Akron, USA
| | | | - Nathan Charlton
- Emergency Medicine, University of Virginia, Charlottesville, USA
| | - Craig Goolsby
- Emergency Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, USA
| |
Collapse
|
15
|
Jakob DA, Müller M, Jud S, Albrecht R, Hautz W, Pietsch U. The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study. Scand J Trauma Resusc Emerg Med 2023; 31:37. [PMID: 37550763 PMCID: PMC10405424 DOI: 10.1186/s13049-023-01107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed "the forgotten cohort", are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies. METHODS This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI). RESULTS Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group. CONCLUSION Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.
Collapse
Affiliation(s)
- Dominik A Jakob
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Sebastian Jud
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Roland Albrecht
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| | - Wolf Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Urs Pietsch
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
- Department of Anesthesiology and Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Swiss Air-Ambulance, Rega (Rettungsflugwacht/Guarde Aérienne), Zurich, Switzerland
| |
Collapse
|
16
|
Dragset E, Blix S, Melau J, Wilson T, Lund-Kordahl I. Assessing Firefighters' Tourniquet Skill Attainment and Retention: A Controlled Simulation-Based Experiment. Disaster Med Public Health Prep 2023; 17:e409. [PMID: 37317556 DOI: 10.1017/dmp.2023.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND The aim of this study was to train and assess firefighters' skill attainment in the use of tourniquets, and to assess their skill retention after 3 mo. The purpose is to show if firefighters can successfully apply a tourniquet after a short course based on the Norwegian national recommendation for civil prehospital tourniquet use. METHODS This is a prospective experimental study. The study population were firefighters, and the inclusion criterion was any on-duty firefighter. The first phase consisted of baseline precourse testing (T1), a 45-min course, followed by immediate retesting (T2). The second phase consisted of retesting of skill retention after 3 mo (T3). RESULTS A total of 109 participants at T1, 105 at T2, and 62 participants at T3. The firefighters achieved a higher proportion of successful tourniquet applications at T2 (91.4%; 96 of 105) as well as T3 (87.1%; 54 of 62) compared with 50.5% at T1 (55 of 109) (P = 0.009). Mean application time was 59.6 s (55.1-64.2) in T1, 34.9 s (33.3-36.6) in T2 and 37.7 s (33.9-41.4) in T3. CONCLUSION A sample of firefighters can successfully apply a tourniquet after a 45-min course based on the 2019 Norwegian recommendation for civil prehospital tourniquet use. Skill retention after 3 mo was satisfactory for both successful application and application time.
Collapse
Affiliation(s)
- Erik Dragset
- UiT - The Arctic University of Norway, Tromsø, Troms, Norway
- Vestfold Hospital Trust, Tønsberg, Vestfold, Norway
| | - Sigurd Blix
- UiT - The Arctic University of Norway, Tromsø, Troms, Norway
- Finnmark Hospital Trust, Kirkenes, Finnmark, Norway
- Norwegian Home Guard, Rapid Task Force Ida&Lyra, Lillehammer, Norway
| | - Jørgen Melau
- Joint Medical Services, Norwegian Armed Forces, Ullensaker, Akershus, Norway
| | - Thomas Wilson
- University Hospital of North Norway, Tromsø, Troms, Norway
| | - Inger Lund-Kordahl
- National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Haukeland University Hospital, Bergen, Norway
- Inland University of Applied Sciences, Norway
| |
Collapse
|
17
|
Linz MS, Dossou-Kitti E, Padmanaban V, Maloney M, Jalloh S, Balarezo LL, Sule H, Johnston PF, Sifri ZC. Train the Trainer in Bleeding Control: A Two-Year Pilot Study in Low-Income and Middle-Income Countries. J Surg Res 2023; 284:17-23. [PMID: 36527766 DOI: 10.1016/j.jss.2022.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/12/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Traumatic hemorrhage represents a major cause of mortality in low-income and middle-income countries (LMICs). Thus, LMICs can benefit from improvements to prehospital hemorrhage management. One strategy is implementation of a bleeding control course using the "train the trainer" model (TTT) to increase course availability. The Stop the Bleed (STB) campaign provides laypeople with basic knowledge and skills of hemorrhage control. While the feasibility and success of the STB course have been demonstrated in the United States, course dissemination in LMICs has been slower and its feasibility using the TTT model has not been established. MATERIALS AND METHODS From December 2017 to January 2019, instructors from the International Surgical Health Initiative conducted seven surgical humanitarian trips and taught 10 index 1-h STB training sessions across six LMICs. LMIC instructors were encouraged to continue providing STB courses following departure of the visiting instructors. Course data were collected from sign-in sheets and analyzed using Microsoft Excel. RESULTS Ten index courses conducted by United States-trained STB experts trained 35 LMIC instructors over 2 y. Six of 35 offered 12 additional courses, certifying 323 new trainees, an 823% increase from the initial cohort. Overall, implementation of the TTT model yielded 22 STB courses in six LMICs, producing 358 new trainees. CONCLUSIONS This pilot study shows the STB TTT model was feasible and effective in expanding bleeding control trainer capacity in four of six LMICs. Use of the TTT model in LMICs may represent a means to increase STB course availability and is one strategy to improve prehospital hemorrhage control in LMICs.
Collapse
Affiliation(s)
| | | | - Vennila Padmanaban
- Rutgers New Jersey Medical School, Department of Surgery, Newark, New Jersey
| | - Monica Maloney
- University of Connecticut School of Medicine, Department of Surgery, Farmington, Connecticut
| | - Samba Jalloh
- University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | | | - Harsh Sule
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey
| | | | - Ziad C Sifri
- Rutgers New Jersey Medical School, Department of Surgery, Newark, New Jersey
| |
Collapse
|
18
|
Tang X, Nie Y, Wu S, DiNenna MA, He J. Effectiveness of "Stop the Bleed" Courses: A Systematic Review and Meta-analysis. JOURNAL OF SURGICAL EDUCATION 2023; 80:407-419. [PMID: 36333171 DOI: 10.1016/j.jsurg.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/27/2022] [Accepted: 10/16/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Our object was to comprehensively analyze the existing body of evidence to evaluate the Stop the Bleed (STB) course effectiveness and satisfaction and find the direction of improvement for the future. STUDY DESIGN A literature search with the term "Stop the Bleed" in the electronic databases PubMed, Web of Science, EMBASE, Cochrane Library was performed, retrieving records from January 1, 2013 to April 13, 2022 based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. In addition, all selected papers' references were examined for qualified studies that were missed during the first search. Original publications were included that reported on (1) clinical studies of the STB course implementation; and (2) studies comparing students' hemostasis ability and attitude (comfort, confidence, and willingness) before and after the STB course. The literature search and data extraction were done independently by 2 writers. To establish consensus, disagreements will be handled with the help of a third reviewer. For data synthesis, the most inclusive data from studies with repeated data were abstracted. Changes in hemostasis questionnaire scoring and operation evaluation after the STB course were the main outcomes. RESULTS This systematic review and meta-analysis includes 36 trials with a total of 11,561 trainees. Thirty-one of them were undertaken in the USA, while the other 5, accounting for 13.9%, were conducted in other regions. Among various evaluation methods, 3 trials with 927 trainees indicated that scores of correct uses of tourniquet significantly increased after the STB course (mean difference of post versus pre groups, 44.28; 95% CI 41.24-47.32; p < 0.001). Significant difference was also observed in the willingness to apply a hemostatic dressing in a real-world situation (risk ratio for post versus pre groups, 1.28; 95% CI 1.08-1.52; p = 0.004) (7 studies and 2360 participants). The results indicate that hemostasis knowledge and skills after the STB course had improved, but statistics indicated that STB courses implemented in the USA were more effective than other regions. CONCLUSIONS AND RELEVANCE Meta-analysis showed that comparison before and after the STB course were significantly different. However, the outcome measures in each study were different and could not, therefore, be compiled in all cases. The effectiveness and worth of implementation of STB in different countries should be continuously evaluated in the future.
Collapse
Affiliation(s)
- Xiaohong Tang
- Clinical Skills Training Center, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Yubing Nie
- Department of Orthopedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Shiying Wu
- Department of Orthopedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Michael A DiNenna
- Department of Mechanical and Material Science Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jinshen He
- Department of Orthopedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
19
|
Manteiga-Urbón JL, Fernández-Méndez F, Otero-Agra M, Fernández-Méndez M, Santos-Folgar M, Insa-Calderon E, Sobrido-Prieto M, Barcala-Furelos R, Martínez-Isasi S. Brief Training of Technical Bleeding Control Skills-A Pilot Study with Security Forces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2494. [PMID: 36767862 PMCID: PMC9915853 DOI: 10.3390/ijerph20032494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Uncontrolled external bleeding is a common cause of preventable death, and due to the environment in which these events often occur, e.g., in hostile environments, the state security forces are usually the first responders, and in many cases, if they are injured their partners provide the initial assistance. The tourniquet is a fast, effective, and easy-to-learn intervention, although there is a knowledge gap concerning training techniques. The objective is to evaluate the effectiveness of a bleeding control training program on a high-fidelity mannequin in a simulated critical situation in a law enforcement training environment. A quasi-experimental study was carried out with 27 members of the state security forces. They underwent brief theoretical-practical training and were evaluated via a scenario involving a critically ill patient in a hostile environment. The results showed that no member of the state security forces completed all the tourniquet placement steps, 26 (96%) prepared the tourniquet correctly, 21 (77.8%) placed it on the leg, and all the participants adjusted the band to the thickness of the injured limb and secured the windlass to the triangular flange of the device. However, only 23 (85.2%) of the participants placed it effectively. The participants, who were members of the state security forces, were able to effectively resolve a critical situation with active bleeding in a simulation scenario with a high-fidelity mannequin after completing theoretical-practical training.
Collapse
Affiliation(s)
| | - Felipe Fernández-Méndez
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - María Fernández-Méndez
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Myriam Santos-Folgar
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Esther Insa-Calderon
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - María Sobrido-Prieto
- Departamento de Ciencias da Saúde, Universidade de A Coruña (UDC), Campus de Esteiro, 15403 Ferrol, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15706 Santiago Compostela, Spain
- Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Santiago Martínez-Isasi
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15706 Santiago Compostela, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
| |
Collapse
|
20
|
Kirkpatrick AW, McKee JL, Conly JM, Flemons K, Hawkins W. Smarter faster just-in-time hemorrhage control: A pilot evaluation of remotely piloted aircraft system delivered STOP-THE-BLEED equipment with just-in-time remote telementored deployment. Heliyon 2023; 9:e12985. [PMID: 36820166 PMCID: PMC9938468 DOI: 10.1016/j.heliyon.2023.e12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction Remotely Piloted Aircraft Systems (RPAS) can access patients inaccessible to traditional rescue. Just-in-time remote telementoring (RTM) of naïve users to self-care could potentially address challenges in salvaging exsanguination in remote environments. Methods An exsanguination self-application task was established in a wilderness location. Three volunteers-initiated distress calls to prompt RPAS precision delivered STOP-THE-BLEED kits, after which a remote mentor directed the volunteers how to self-care. Results Limited connectivity prevented video, however each volunteer delivered images and initiated conversation with the mentor pre-RPAS arrival. Thereafter, all subjects were able to unpack and deploy hemorrhage control adjuncts under verbal direction, and to simulate self-application. All subjects were able to successfully apply wound-clamps, tourniquets, and pack wounds although one had insufficient pressure. Discussion RPASs can deliver supplies long before human rescuers, and communication connectivity might allow remote mentoring in device application. Further development of technology and self-care paradigms for exsanguination are encouraged.
Collapse
Affiliation(s)
- Andrew W. Kirkpatrick
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada,Department of Critical Care Medicine, Canada,Department of Surgery, Canada,Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada,University of Calgary, Canada,Corresponding author. Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada.
| | - Jessica L. McKee
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada
| | - John M. Conly
- University of Calgary, Canada,Department of Medicine, University of Calgary, Calgary, Alberta, Canada,W21C, O’ Brien Institute for Public Health University of Calgary, Calgary, Alberta, Canada
| | - Kristin Flemons
- University of Calgary, Canada,W21C, O’ Brien Institute for Public Health University of Calgary, Calgary, Alberta, Canada
| | - Wade Hawkins
- Centre for Innovation and Research in Unmanned Systems (CIRUS), Southern Alberta Institute of Technology (SAIT), Calgary, Alberta, Canada
| |
Collapse
|
21
|
The Untrained Public's Ability to Apply the Layperson Audiovisual Assist Tourniquet vs a Combat Application Tourniquet: A Randomized Controlled Trial. J Am Coll Surg 2023; 236:178-186. [PMID: 36165504 DOI: 10.1097/xcs.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the Stop the Bleed campaign's impact is encouraging, gaps remain. These gaps include rapid skill decay, a lack of easy-to-use tourniquets for the untrained public, and training barriers that prevent scalability. A team of academic and industry partners developed the Layperson Audiovisual Assist Tourniquet (LAVA TQ)-the first audiovisual-enabled tourniquet for public use. LAVA TQ addresses known tourniquet application challenges and is novel in its design and technology. STUDY DESIGN This study is a prospective, randomized, superiority trial comparing the ability of the untrained public to apply LAVA TQ to a simulated leg vs their ability to apply a Combat Application Tourniquet (CAT). The study team enrolled participants in Boston, MA; Frederick, MD; and Linköping, Sweden in 2022. The primary outcome was the proportion of successful applications of each tourniquet. Secondary outcomes included: mean time to application, placement position, reasons for failed application, and comfort with the devices. RESULTS Participants applied the novel LAVA TQ successfully 93% (n = 66 of 71) of the time compared with 22% (n = 16 of 73) success applying CAT (relative risk 4.24 [95% CI 2.74 to 6.57]; p < 0.001). Participants applied LAVA TQ faster (74.1 seconds) than CAT (126 seconds ; p < 0.001) and experienced a greater gain in comfort using LAVA TQ than CAT. CONCLUSIONS The untrained public is 4 times more likely to apply LAVA TQ correctly than CAT. The public also applies LAVA TQ faster than CAT and has more favorable opinions about its usability. LAVA TQ's highly intuitive design and built-in audiovisual guidance solve known problems of layperson education and skill retention and could improve public bleeding control.
Collapse
|
22
|
Invited Commentary: Doing It Right. J Am Coll Surg 2023; 236:187-188. [PMID: 36193895 DOI: 10.1097/xcs.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
23
|
Ronconi RWF, Moreira LH, de Lima CJ, Neto OP, Osorio RAL. Tourniquets, types and techniques in emergency prehospital care: A narrative review. Med Eng Phys 2023; 111:103923. [PMID: 36792231 DOI: 10.1016/j.medengphy.2022.103923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/19/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
Massive uncontrolled hemorrhage is an important cause of preventable death in trauma. Therefore, applying an arterial tourniquet (TQ) is recommended as a pre-hospital measure to control bleeding after severe traumatic bleeding. Limb TQ applies circumferential compression proximally to the injury site to compress the arteries, resulting in blood flow and consequently hemorrhage interruption. The use of commercial tourniquets (C-TQ), which are designed, tested, and registered to control hemorrhages in pre-hospital care, is a consensus. However, they are still uncommon in many prehospital emergency services and the overall level of evidence in most studies is low. This narrative review aimed to characterize the importance of tourniquets use in prehospital emergency care and its application techniques. Furthermore, it proposes to stimulate the development of new devices, more accessible and easier to use, to suggest new directions of studies and medical education demands, with manikin and simulation development.
Collapse
Affiliation(s)
- Roger William Freire Ronconi
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil; Tacmed Brasil, Taubaté, São Paulo, Brazil.
| | - Livia Helena Moreira
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil
| | - Carlos José de Lima
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil
| | - Osmar Pinto Neto
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil; Arena235 Research Lab, São José dos Campos, São Paulo, Brazil
| | - Rodrigo Alexis Lazo Osorio
- Biomedical Engineering Institute, Universidade Anhembi Morumbi UAM, São José dos Campos, São Paulo, Brazil; Biomedical Engineering Department, Center for Innovation, Technology and Education CITE, São José dos Campos, São Paulo, Brazil
| |
Collapse
|
24
|
Zhang X, Shi L, Xiao W, Wang Z, Wang S. Design of Adhesive Hemostatic Hydrogels Guided by the Interfacial Interactions with Tissue Surface. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202200115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Xiaobin Zhang
- Key Laboratory of Bio-inspired Materials and Interface Science Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
- University of Chinese Academy of Sciences Beijing 100049 P.R. China
| | - Lianxin Shi
- Key Laboratory of Bio-inspired Materials and Interface Science Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
- Binzhou Institute of Technology Binzhou 256600 P.R. China
| | - Wuyi Xiao
- Key Laboratory of Bio-inspired Materials and Interface Science Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
- University of Chinese Academy of Sciences Beijing 100049 P.R. China
| | - Zhao Wang
- Key Laboratory of Bio-inspired Materials and Interface Science Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
| | - Shutao Wang
- Key Laboratory of Bio-inspired Materials and Interface Science Technical Institute of Physics and Chemistry Chinese Academy of Sciences Beijing 100190 P.R. China
- University of Chinese Academy of Sciences Beijing 100049 P.R. China
- Qingdao Casfuture Research Institute Co. Ltd Qingdao 266109 P.R. China
| |
Collapse
|
25
|
Minna S, Leena H, Tommi K. How to evaluate first aid skills after training: a systematic review. Scand J Trauma Resusc Emerg Med 2022; 30:56. [DOI: 10.1186/s13049-022-01043-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To be able to help and save lives, laypersons are recommended to undergo first aid trainings. The aim of this review was to explore the variety of the elements of the measuring systems to assess the effects of first aid trainings on different aspects of first aid skills including practical skills, knowledge, and emotional perspectives.
Methods
This systematic literature review used Scopus and PubMed databases and searched for studies published between January, 2000, and December, 2020. Out of 2,162 studies meeting the search criteria, 15 studies with quantitative and repeatable evaluation methods to assess first aid skills after first aid training for adults were included in the final analysis.
Results
Practical skills, especially on the ability to perform cardiopulmonary resuscitation (CPR) and to use an automated external defibrillator, were the most studied first aid skills after first aid training. This evaluation was based on several standardized measurements and assessed often with the help of a combination of resuscitation manikin and observer. Evaluation methods of performance in other emergency situations are not well standardized. Questionnaires used to assess knowledge of first aid, though seemingly based on guidelines, were also not standardized, either. Emotional aspects of first aid (willingness or self-confidence) were evaluated by highly simplified questionnaires, and answers were graded by five-point Likert scale.
Conclusion
According to our review, the focus of evaluation methods after first aid training has been on practical skills and especially on CPR. Though the evaluation of first-aid knowledge seems to be straightforward, it is not performed systematically. Evaluation methods for emotional aspects are highly simplified. Overall, standardized measurements and evaluation methods to assess all aspects of first aid skills are needed.
Collapse
|
26
|
Arkoubi AY, Salati SA, Almughira AI, Abuharb AI, Almutairi KA, Alosaimi FA, Aldayel M. Awareness, Attitude, and Willingness Toward Bleeding Control by Bystanders in Riyadh. Cureus 2022; 14:e30468. [DOI: 10.7759/cureus.30468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 11/07/2022] Open
|
27
|
Precise Limb Tourniquet Arterial Occlusion Pressure Determination using Real-Time Ultrasonography and a Capacitive-Based Force Sensor. Prehosp Disaster Med 2022; 37:772-777. [PMID: 36254701 DOI: 10.1017/s1049023x2200142x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hemorrhage control prior to shock onset is increasingly recognized as a time-critical intervention. Although tourniquets (TQs) have been demonstrated to save lives, less is known about the physiologic parameters underlying successful TQ application beyond palpation of distal pulses. The current study directly visualized distal arterial occlusion via ultrasonography and measured associated pressure and contact force. METHODS Fifteen tactical officers participated as live models for the study. Arterial occlusion was performed using a standard adult blood pressure (BP) cuff and a Combat Application Tourniquet Generation 7 (CAT7) TQ, applied sequentially to the left mid-bicep. Arterial flow cessation was determined by radial artery palpation and brachial artery pulsed wave doppler ultrasound (US) evaluation. Steady state maximal generated force was measured using a thin-film force sensor. RESULTS The mean (95% CI) systolic blood pressure (SBP) required to occlude palpable distal pulse was 112.9mmHg (109-117); contact force was 23.8N [Newton] (22.0-25.6). Arterial flow was visible via US in 100% of subjects despite lack of palpable pulse. The mean (95% CI) SBP and contact force to eliminate US flow were 132mmHg (127-137) and 27.7N (25.1-30.3). The mean (95% CI) number of windlass turns to eliminate a palpable pulse was 1.3 (1.0-1.6) while 1.6 (1.2-1.9) turns were required to eliminate US flow. CONCLUSIONS Loss of distal radial pulse does not indicate lack of arterial flow distal to upper extremity TQ. On average, an additional one-quarter windlass turn was required to eliminate distal flow. Blood pressure and force measurements derived in this study may provide data to guide future TQ designs and inexpensive, physiologically accurate TQ training models.
Collapse
|
28
|
Mokhtari AK, Mikdad S, Luckhurst C, Hwabejire J, Fawley J, Parks JJ, Mendoza AE, Kaafarani HMA, Velmahos GC, Bloemers FW, Saillant NN. Prehospital extremity tourniquet placements-performance evaluation of non-EMS placement of a lifesaving device. Eur J Trauma Emerg Surg 2022; 48:4255-4265. [PMID: 35538361 DOI: 10.1007/s00068-022-01973-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/26/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The education of civilians and first responders in prehospital tourniquet (PT) utilization has spread rapidly. We aimed to describe trends in emergency medical services (EMS) and non-EMS PT utilization, and their ability to identify proper clinical indications and to appropriately apply tourniquets in the field. METHODS A retrospective cohort study was conducted to evaluate all adult patients with PTs who presented at two Level I trauma centers between January 2015 and December 2019. Data were collected via an electronic patient query tool and cross-referenced with institutional Trauma Registries. Medically trained abstractors determined if PTs were clinically indicated (limb amputation, vascular hard signs, injury requiring hemostasis procedure, or significant documented blood loss). PTs were further designated as appropriately or inappropriately applied (based on tourniquet location, venous tourniquet, greater than 2-h ischemic time). Descriptive statistics and univariate analyses were performed. RESULTS 146 patients met inclusion criteria. The incidence of yearly PT placements increased between 2015 and 2019, with an increase in placement by non-EMS personnel (police, firefighter, bystander, and patient). Improvised PTs were frequently utilized by bystanders and patients, whereas first responders had high rates of commercial tourniquet use. A high proportion of tourniquets were placed without indication (72/146, 49%); however, the proportion of PTs placed without a proper indication across applier groups was not statistically different (p = 0.99). Rates of inappropriately applied PTs ranged from 21 to 46% across all groups applying PTs. CONCLUSIONS PT placement was increasingly performed by non-EMS personnel. Present data indicate that non-EMS persons applied PTs at a similar performance level of those applied by EMS. Study LevelLevel III.
Collapse
Affiliation(s)
- Ava K Mokhtari
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA.
| | - Sarah Mikdad
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
- Department of Trauma Surgery, VU Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Casey Luckhurst
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - John Hwabejire
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Jason Fawley
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Jonathan J Parks
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - April E Mendoza
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Haytham M A Kaafarani
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| | - Frank W Bloemers
- Department of Trauma Surgery, VU Medical Center, Amsterdam UMC, Amsterdam, The Netherlands
| | - Noelle N Saillant
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Suite 810, Boston, MA, 02114, USA
| |
Collapse
|
29
|
Levy MJ, Krohmer J, Goralnick E, Charlton N, Nemeth I, Jacobs L, Goolsby CA. A framework for the design and implementation of Stop the Bleed and public access trauma equipment programs. J Am Coll Emerg Physicians Open 2022; 3:e12833. [PMID: 36311340 PMCID: PMC9611563 DOI: 10.1002/emp2.12833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/06/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022] Open
Abstract
Traumatic injuries remain the leading cause of death for those under the age of 44 years old. Nearly a third of those who die from trauma do so from bleeding. Reducing death from severe bleeding requires training in the recognition and treatment of life-threatening bleeding, as well as programs to ensure immediate access to bleeding control resources. The Stop the Bleed (STB) initiative seeks to educate and empower people to be immediate responders and provide control of life-threatening bleeding until emergency medical services arrive. Well-planned and implemented STB programs will help ensure program effectiveness, minimize variability, and provide long-term sustainment. Comprehensive STB programs foster consistency, promote access to bleeding control education, contain a framework to guide the acquisition and placement of equipment, and promote the use of these resources at the time of a bleeding emergency. We leveraged the expertise and experience of the Stop the Bleed Education Consortium to create a resource document to help inform and guide STB program developers and implementers on the key areas for consideration when crafting strategy. These areas include (1) equipment selection, (2) logistics and kit placement, (3) educational program accessibility and implementation, and (4) program oversight, facilitation, and administration.
Collapse
Affiliation(s)
- Matthew J. Levy
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- National Center for Disaster Medicine and Public HealthBethesdaMarylandUSA
| | - Jon Krohmer
- Department of Emergency MedicineMichigan State UniversityGrand RapidsMichiganUSA
| | - Eric Goralnick
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Nathan Charlton
- Department of Emergency MedicineUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Ira Nemeth
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Lenworth Jacobs
- Hartford Health CareAcademic Affairs, Hartford HospitalHartfordConnecticutUSA
| | - Craig A. Goolsby
- Department of Emergency Medicine, Harbor‐UCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| |
Collapse
|
30
|
Stop the Bleed®. Curr Probl Surg 2022; 59:101193. [DOI: 10.1016/j.cpsurg.2022.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
31
|
Evaluation of Stop the Bleed Training Among High School Personnel: A Qualitative Study. J Trauma Nurs 2022; 29:119-124. [PMID: 35536339 DOI: 10.1097/jtn.0000000000000651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uncontrolled hemorrhage is the primary preventable cause of death following trauma. Stop the Bleed training exists to promote identification and basic treatment of life-threatening bleeding in the prehospital or community setting. Limited qualitative research is available on participant evaluation of hemorrhage control training for laypersons. OBJECTIVE To evaluate the experience and satisfaction with Stop the Bleed training among lay community members in an urban public school setting. METHODS Three group interviews were conducted with public high school personnel (faculty and staff) who received Stop the Bleed training. Personnel were asked to evaluate the training and provide suggestions for improvement. Responses were digitally recorded and transcribed verbatim. Content analysis for common themes was performed using NVivo. RESULTS A total of eight participants were interviewed. Participants expressed satisfaction with hands-on training and dissatisfaction with crowded and rushed training conditions. Major themes included: (1) skill acquisition, retention, and decay, (2) training format and setting, and (3) use of simulation. CONCLUSIONS Current Stop the Bleed training is considered satisfactory among public school educators. Suggestions for improvement include annual retraining programs and simulation-enhanced training opportunities.
Collapse
|
32
|
Tatebe LC, Schlanser V, Hampton D, Chang G, Hanson I, Doherty J, Issa N, Ghandour H, Kingsley S, Stewart A, Anstadt M, Dennis A. The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation. J Trauma Acute Care Surg 2022; 92:890-896. [PMID: 34882594 DOI: 10.1097/ta.0000000000003491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As tourniquets have become more prevalent, device use has been questioned. This study sought to characterize the incidence, indication, and efficacy of tourniquet placement in acute trauma resuscitation. METHODS Nine regional level 1 trauma centers prospectively enrolled for 12 months adult patients (18 years or older) who had a tourniquet placed. Age, sex, mechanism, tourniquet type, indication, applying personnel, location placed, level of occlusion, and degree of hemostasis were collected. Major vascular injury, imaging and operations performed, and outcomes were assessed. Analyses were performed with significance at p < 0.05. RESULTS A total of 216 tourniquet applications were reported on 209 patients. There were significantly more male patients (183 [88%]) and penetrating injuries (186 [89%]) with gunshots being most common (127 [61%]). Commercial tourniquets were most often used (205 [95%]). Ninety-two percent were placed in the prehospital setting (by fire/paramedics, 56%; police, 33%; bystanders, 2%). The most common indications were pooling (47%) and pulsatile (32%) hemorrhage. Only 2% were for amputation. The most frequent location was high proximal extremity (70%). Four percent were placed over the wound, and 0.5% were distal to the wound. Only 61% of applications were arterial occlusive. Median application time was 30 minutes (interquartile range, 20-40 minutes). Imaging was performed in 54% of patients. Overall, 36% had a named arterial injury. Tourniquet application failed to achieve hemostasis in 22% of patients with a named vascular injury. There was no difference in hemostasis between those with and without vascular injury (p = 0.12) or between who placed the tourniquet (p = 0.07). Seventy patients (34%) required vascular operations. Thirty-four percent of patients were discharged home without admission. CONCLUSION Discerning which injuries require tourniquets over pressure dressings remains elusive. Trained responders had high rates of superfluous and inadequate deployments. As tourniquets continue to be disseminated, emphasis should be placed on improving education, device development, and quality control. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level III.
Collapse
Affiliation(s)
- Leah Carey Tatebe
- From the Department of Trauma and Burn Surgery (L.C.T., V.S., A.D.), Cook County Health, Rush University, Midwestern University, Chicago, Illinois; Department of Surgery (D.H.), University of Chicago, Chicago, Illinois; Department of Surgery (G.C., I.H.), Mount Sinai Hospital, Chicago, Illinois; Department of Surgery (J.D.), Advocate Christ Medical Center, Oak Lawn, Illinois; Department of Surgery (N.I.), Northwestern University, Chicago, Illinois; Department of Surgery (H.G., S.K.), Advocate Illinois Masonic Medical Center, Chicago, Illinois; Department of Surgery (A.S.), Advocate Lutheran General Hospital, Park Ridge, Illinois; and Department of Surgery (M.A.), Loyola University, Maywood, Illinois
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Chen S, Li J, DiNenna MA, Gao C, Chen S, Wu S, Tang X, He J. Comparison of two teaching methods for stopping the bleed: a randomized controlled trial. BMC MEDICAL EDUCATION 2022; 22:281. [PMID: 35421954 PMCID: PMC9009024 DOI: 10.1186/s12909-022-03360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The "Stop the Bleed" (STB) campaign has achieved remarkable results since it was launched in 2016, but there is no report on the teaching of an STB course combined with a trauma patient simulator. This study proposes the "problem-, team-, and evidence-based learning" (PTEBL) teaching method combined with Caesar (a trauma patient simulator) based on the STB course and compares its effect to that of the traditional teaching method among outstanding doctoral candidates training in haemostasis skills. METHOD Seventy-eight outstanding doctoral candidate program students in five and eight-year programs were selected as the research subjects and were randomly divided into a control group (traditional teaching method, n = 34) and an experimental group (PTEBL teaching method combined with Caesar, n = 44). Their confidence in their haemostasis skills and willingness to rescue injured victims were investigated before and after the course in both groups. RESULT Students' self-confidence in their STB skills and the willingness to rescue improved after the class in both groups. Compared with the control group, students in the experimental group were more confident in compressing with bandages and compressing with a tourniquet after a class (compressing with bandages: control group 3.9 ± 0.8 vs. experimental group 4.3 ± 0.7, P = 0.014; compressing with a tourniquet: control group 3.9 ± 0.4 vs. experimental group 4.5 ± 0.8, P = 0.001) More students in the experimental group than the control group thought that the use of Caesar for scenario simulation could improve learning (control group 55.9% vs. experimental group 81.8%, P = 0.024), and using this mannequin led to higher teacher-student interaction (control group 85.3% vs. experimental group 97.7%, P = 0.042). The overall effectiveness of the teaching was better in the experimental group than in the control group (control group 85.3% vs. experimental group 97.7%, P = 0.042). There was a significant positive correlation between teacher-student interactions and the overall effectiveness of teaching (R = 1.000; 95% CI, 1.000-1.000; P < 0.001). CONCLUSION The PTEBL teaching method combined with Caesar can effectively improve student mastery of STB skills and overcome the shortcomings of traditional teaching methods, which has some promotional value in the training of outstanding doctoral candidates in STB skills.
Collapse
Affiliation(s)
- Shuangyi Chen
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
- Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Jinfei Li
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
- Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Michael A DiNenna
- Department of Mechanical and Material Science Engineering, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Chen Gao
- Department of Transplantation, The Second Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Shijie Chen
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Song Wu
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Xiaohong Tang
- Clinical Skills Training Center, The Third Xiangya Hospital of Central South University, Changsha, 410013, China
| | - Jinshen He
- Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, China.
| |
Collapse
|
34
|
A randomized controlled pilot trial of video-modelling versus telementoring for improved hemorrhage control wound packing. Am J Surg 2022; 224:769-774. [DOI: 10.1016/j.amjsurg.2022.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
|
35
|
A Reproducible Strategy to Solve Problems. J Trauma Acute Care Surg 2022; 93:e5-e11. [DOI: 10.1097/ta.0000000000003568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Nichols R, Horstman J. Recommendations for Improving Stop the Bleed: A Systematic Review. Mil Med 2022; 187:e1338-e1345. [PMID: 35084491 DOI: 10.1093/milmed/usac019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION In response to mass casualty events, The Hartford Consensus brought together subject matter experts across multiple disciplines in health care and public safety to create guidelines and publications intended to improve survivability in active shooter events. Among the recommendations was the earlier recognition and treatment application of life-threatening hemorrhage control. These recommendations culminated in efforts to create the Stop the Bleed Campaign, which aims to empower the layperson to render aid in a life-threatening bleeding emergency. As of February 2020, the program has held over 86,000 courses, trained over 1.4 million attendees, and over 77,000 instructors since its inception. In addition to spreading within the United States, American College of Surgeons (ACS) Stop the Bleed (StB) classes have been held in 118 different countries. This systematic narrative review aims to answer the following research question: What does the ACS StB Initiative do well, and where can it improve? MATERIALS AND METHODS The following search terms were utilized: "Stop the Bleed," "American College of Surgeons," "bleeding control," "first-aid," tourniquet, "wound pack," "direct pressure" hemorrhage, and bystander. The inclusion criteria were that the article needed to speak to the program or some aspect of bystander first aid, the article needed to be in a civilian setting, the article needed to be more than a case study or overview, and the first aid tools needed to be in the StB curriculum. 4 databases were searched, which produced 138 articles for screening. One hundred four full-text articles were able to be retrieved, and 56 articles were determined to meet the inclusion criteria once the full text was reviewed. RESULTS Fifty-six articles were included in the final review and were placed into the following categories: Needs Within the Community, Confidence and Knowledge, Training Modalities, Barriers and Gaps in Training, Instructor Selection, Skill Retention, and Patient Outcomes. The articles were then organized into each outcome for synthesis and reporting of the results. The program overwhelmingly improves short-term confidence, but gaps in skill retention, data collection on patient outcomes, and settings that would benefit were identified. CONCLUSION StB is an effective tool in building confidence in laypersons, which is its biggest strength. A review of the literature shows several areas where the curriculum and materials could be better developed. Research can also be further refined to better quantify the program's impact.
Collapse
Affiliation(s)
- Ryoma Nichols
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202-2131, USA
| | - Jordan Horstman
- Kansas City University School of Osteopathic Medicine, Kansas City University, Kansas City, MO 64106, USA
| |
Collapse
|
37
|
Jacobs L. 2021 Scudder Oration: Trauma, Education, Communication, and Implementing Change. J Am Coll Surg 2022; 234:771-772. [DOI: 10.1097/xcs.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Sidwell RA, Spilman SK, Feist B, Fuchsen EA, Taber PS, Pelaez CA. Hemorrhage Control Training: Preparing Adolescents to Act at Home, at School, or in Public. Pediatr Emerg Care 2022; 38:4-8. [PMID: 32530841 DOI: 10.1097/pec.0000000000002164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Uncontrolled bleeding is the leading cause of preventable death after a traumatic event, and early intervention to control bleeding improves opportunities for survival. It is imperative to prepare for local and national disasters by increasing public knowledge on how to control bleeding, and this preparation should extend to both adults and children. The purpose of this study is to describe a training effort to teach basic hemorrhage control techniques to early adolescent children. METHODS The trauma and emergency departments at a combined level I adult and level II pediatric trauma center piloted a training initiative with early adolescents (grades 6-8) focused on 2 skills: packing a wound and holding direct pressure, and applying a Combat Application Tourniquet. Students were evaluated on each skill and completed presurveys and postsurveys indicating their likelihood to use the skills. RESULTS Of the 194 adolescents who participated in the trainings, 97% of the students could successfully pack a wound and hold pressure, and 97% of the students could apply a tourniquet. Before the training, 71% of the adolescents indicated that they would take action to assist a bleeding victim; this increased to 96% after the training. CONCLUSIONS Results demonstrate that basic hemorrhage control skills can be effectively taught to adolescents as young as 6th grade (ages 11-12 years) in a small setting with age-appropriate content and hands-on opportunities to practice the skills and such training increases students' perceived willingness to take action to assist a bleeding victim.
Collapse
|
39
|
Jafri FN, Dadario NB, Kumar A, Silverstein SR, Quintero F, Larsen EA, Fasciglione K, Mirante D, Ellsworth K, Amicucci B, Ricca J. The Addition of High-Technology Into the Stop the Bleed Program Among School Personnel Improves Short-Term Skill Application, Not Long-Term Retention. Simul Healthc 2021; 16:e159-e167. [PMID: 33600137 DOI: 10.1097/sih.0000000000000546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The Stop the Bleed (STB) program trains the general public on identifying and treating life-threatening bleeding. Data on efficacy and retention of skills taught through this program are limited, with the role of high-technology modalities to augment the program, such as simulation and feedback devices, untested. METHODS A convenience sample of 66 school personnel participated in an open-label observational study from January to August 2019. The control group received the standard bleeding control course, while the intervention group received the bleeding control course with addition of a simulation and a feedback device for wound packing. Assessment was performed by STB instructors using performance metrics from prior studies as well as a feedback device. Retention testing was performed 2 to 8 months after intervention. The study was approved by the hospital's institutional review board. RESULTS The intervention group performed better than the control group on correct tourniquet application [90.3% vs. 71.0%; odds ratio (OR) = 11.28; P = 0.015; 95% confidence interval (CI) = 1.86 to 104.67] wound packing scores (59.5% vs. 29.6%; OR = 0.33; P = 0.007; 95% CI = 9.36 to 56.00) and were more likely to assess their safety (OR = 5.49; P = 0.034; 95% CI = 1.28 to 27.66), and reported higher comfort scores on stepping into an emergency scenario (OR = 11.19; P = 0.004; 95% CI = 2.51 to 63.11), wound packing (OR = 5.16; P = 0.025; 95% CI = 1.35 to 22.46), and using a tourniquet (OR = 11.41; P = 0.003; 95% CI = 2.57 to 67.59). Thirty-one participants (46.9%) were assessed again at retention 2 to 8 months later where scores for tourniquet placement and wound packing were not significantly different in the two groups. CONCLUSIONS Augmenting STB with simulation and feedback improved both self-reported comfort level and skill set of participants, but the retention of skills was poor in both groups.
Collapse
Affiliation(s)
- Farrukh N Jafri
- From the Albert Einstein College of Medicine (F.N.J.), New York City; Department of Emergency Medicine (F.N.J.), White Plains Hospital (F.N.J., N.B.D., S.R.S., F.Q., E.A.L., B.A., J.R.), White Plains; NYIT College Of Osteopathic Medicine (K.F.), Old Westbury, NY; Rutgers Robert Wood Johnson Medical School (N.B.D.), New Brunswick, NJ; MGH Institute of Health Professions (A.K.), Boston, MA; Albert Einstein School of Medicine (E.A.L.), New York City; and Departments of Emergency Medicine (D.M.) and Critical Care (K.E.), White Plains Hospital, White Plains, NY
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Zickler W, Martus JE, Upperman JS, Feliz A. Pediatric peripheral vascular injuries and associated orthopedic considerations. Semin Pediatr Surg 2021; 30:151127. [PMID: 34930593 DOI: 10.1016/j.sempedsurg.2021.151127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pediatric peripheral vascular trauma is a rare but highly morbid injury in children and is frequently associated with concomitant orthopedic injuries. These children require multidisciplinary care by pediatric, vascular, and orthopedic surgery. In this review, we describe elements of the complex care required for children with peripheral vascular trauma.
Collapse
Affiliation(s)
- William Zickler
- Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Ave., 2nd Fl., Memphis, TN 38163, USA.
| | - Jefferey E Martus
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 4202 DOT, 2200 Children's Way, Nashville, TN 37232-9565, USA.
| | - Jeffrey S Upperman
- Division of Pediatric Orthopaedics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, TN, USA; Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 7100, Nashville, TN 37232, USA.
| | - Alexander Feliz
- Departments of Surgery & Pediatrics, The University of Tennessee Health Science Center, Le Bonheur Children's Hospital, 49 N. Dunlap St., 2nd Floor, Memphis, TN 38105, USA.
| |
Collapse
|
41
|
Schlanser VL, Tatebe LC, Karalius VP, Liesen E, Pekarek S, Impens A, Ivkovic K, Bajani F, Khalifa A, Dennis AJ. The Windlass Tourniquet: Is It Taking the Wind Out of the "Stop the Bleed" Sails? J Surg Res 2021; 271:91-97. [PMID: 34856457 DOI: 10.1016/j.jss.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/07/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Civilians are often first-line responders in hemorrhage control; however, windlass tourniquets are not intuitive. Untrained users reading enclosed instructions failed in 38.2% of tourniquet applications. This prospective follow-up study replicated testing following Stop the Bleed (STB) training. MATERIALS AND METHODS One and six months following STB, first-year medical students were randomly assigned a windlass tourniquet with enclosed instructions. Each was given one minute to read instructions and two minutes to apply the windlass tourniquet on the TraumaFX HEMO trainer. Demographics, time to read instructions and stop bleeding, blood loss, and simulation success were analyzed. RESULTS 100 students received STB training. 31 and 34 students completed tourniquet testing at one month and six months, respectively. At both intervals, 38% of students were unable to control hemorrhage (P = 0.97). When compared to the pilot study without STB training (median 48 sec, IQR 33-60 sec), the time taken to read the instructions was shorter one month following STB (P <0.001), but there was no difference at 6 months (P = 0.1). Incorrect placement was noted for 19.4% and 23.5% of attempts at 1 and 6 months. Male participants were more successful in effective placement at one month (93.3% versus 31.3%, P = 0.004) and at six months (77.8% versus 43.8%, p = 0.04). CONCLUSIONS Skills decay for tourniquet application was observed between 1 and 6 months following STB. Instruction review and STB produced the same hemorrhage control rates as reading enclosed instructions without prior training. Training efforts must continue; but an intuitive tourniquet relying less on mechanical advantage is needed.
Collapse
Affiliation(s)
- Victoria L Schlanser
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois.
| | - Leah C Tatebe
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois
| | - Vytas P Karalius
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Emergency Medicine, Northwestern University, Chicago, Illinois
| | - Erik Liesen
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois
| | - Sydney Pekarek
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois
| | - Ann Impens
- Institute for Healthcare Innovation, Midwestern University, Downers Grove, Illinois
| | - Katarina Ivkovic
- Institute for Healthcare Innovation, Midwestern University, Downers Grove, Illinois
| | - Francesco Bajani
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew Khalifa
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois
| | - Andrew J Dennis
- Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois
| |
Collapse
|
42
|
Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
Collapse
Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
| |
Collapse
|
43
|
Tobias J, Cunningham A, Krakauer K, Nacharaju D, Moss L, Galindo C, Roberts M, Hamilton NA, Olsen K, Emmons M, Quackenbush J, Schreiber MA, Burns BS, Sheridan D, Hoffman B, Gallardo A, Jafri MA. Protect Our Kids: a novel program bringing hemorrhage control to schools. Inj Epidemiol 2021; 8:31. [PMID: 34517905 PMCID: PMC8436006 DOI: 10.1186/s40621-021-00318-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Following the shooting at Sandy Hook Elementary School, the Hartford Consensus produced the Stop the Bleed program to train bystanders in hemorrhage control. In our region, the police bureau delivers critical incident training to public schools, offering instruction in responding to violent or dangerous situations. Until now, widespread training in hemorrhage control has been lacking. Our group developed, implemented and evaluated a novel program integrating hemorrhage control into critical incident training for school staff in order to blunt the impact of mass casualty events on children. METHODS The staff of 25 elementary and middle schools attended a 90-minute course incorporating Stop the Bleed into the critical incident training curriculum, delivered on-site by police officers, nurses and doctors over a three-day period. The joint program was named Protect Our Kids. At the conclusion of the course, hemorrhage control kits and educational materials were provided and a four-question survey to assess the quality of training using a ten-point Likert scale was completed by participants and trainers. RESULTS One thousand eighteen educators underwent training. A majority were teachers (78.2%), followed by para-educators (5.8%), counselors (4.4%) and principals (2%). Widely covered by local and state media, the Protect Our Kids program was rated as excellent and effective by a majority of trainees and all trainers rated the program as excellent. CONCLUSIONS Through collaboration between trauma centers, police and school systems, a large-scale training program for hemorrhage control and critical incident response can be effectively delivered to schools.
Collapse
Affiliation(s)
- Joseph Tobias
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA
| | - Aaron Cunningham
- Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239 USA
| | - Kelsi Krakauer
- School of Medicine, Oregon Health & Science University, Portland, OR USA
| | - Deepthi Nacharaju
- School of Medicine, Oregon Health & Science University, Portland, OR USA
| | - Lori Moss
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | | | | | - Nicholas A. Hamilton
- Department of Surgery, Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR USA
| | - Kyle Olsen
- Portland Public Schools, Portland, OR USA
| | | | | | - Martin A. Schreiber
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR USA
| | - Beech S. Burns
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR USA
| | - David Sheridan
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR USA
| | - Benjamin Hoffman
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | - Adrienne Gallardo
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR USA
| | - Mubeen A. Jafri
- Department of Surgery, Division of Pediatric Surgery, Oregon Health & Science University, Portland, OR USA
- Division of Pediatric Surgery, Randall Children’s Hospital at Legacy Emanuel, Portland, OR USA
| |
Collapse
|
44
|
The Impact of a Mobile Phone Application for Retention of Bleeding Control Skills. J Surg Res 2021; 267:669-677. [PMID: 34273797 DOI: 10.1016/j.jss.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The American College of Surgeons Bleeding Control Course (B-Con) empowers bystanders with hemorrhage control skills to manage prehospital emergencies, but demonstrates poor skill retention. The point of care use of a free Stop the Bleed mobile phone application on the retention of hemorrhage control skills from the B-Con Course was explored. METHODS Convenience sample of college students previously trained in B-Con were randomized into mobile application (MA) or control groups. The use of a mobile application during a simulated emergency scenario with tourniquet and situational awareness skills was assessed. Wound packing skill retention without intervention was also assessed. Survey data allowed for comparison of participant perceptions of skills with actual performances. RESULTS MA (n = 30) was superior to control (n = 32) in correct tourniquet application (62.5% versus 30.0%; P = 0.01) with longer placement times (163 sec versus 95 sec; P < 0.001) and in calling 911 (31.3% versus 3.3%, P = 0.004). Participants maintain inflated perceptions of their skills, but generally feel underprepared for a future bleeding emergency. CONCLUSIONS Mobile apps improve tourniquet and situational awareness skills and may serve as potential aids to improve bystander hemorrhage control skills in real-time, but require further prospective investigation into its use.
Collapse
|
45
|
Goolsby C, Schuler K, Rodzik R, Charlton N, Lala V, Anderson K, Pellegrino J. The FAST VIP (First Aid for Severe Trauma “Virtual” in-Person) Educational Study. West J Emerg Med 2021; 22:951-957. [PMID: 35354006 PMCID: PMC8328158 DOI: 10.5811/westjem.2021.2.50033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/19/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Trauma is the leading cause of death for young Americans. Increased school violence, combined with an emphasis on early hemorrhage control, has boosted demand to treat injuries in schools. Meanwhile, coronavirus disease 2019 (COVID-19) has made educating the public about trauma more difficult. A federally funded high school education program in development, called First Aid for Severe Trauma™ (FAST™), will teach students to aid the severely injured. The program will be offered in instructor-led, web-based, and blended formats. We created a program to prepare high school teachers to become FAST instructors via “virtual” in-person (VIP) instruction. We used a webinar followed by VIP skills practice, using supplies shipped to participants’ homes. To our knowledge, no prior studies have evaluated this type of mass, widely distributed, VIP education. Methods This study is a prospective, single-arm, educational cohort study. We enrolled a convenience sample of all high school teachers attending FAST sessions at the Health Occupations Students of America–Future Health Professionals International Leadership Conference. Half of the participants were randomized to complete the Stop the Bleed Education Assessment Tool (SBEAT) prior to the webinar, and the other completed it afterward; SBEAT is a validated tool to measure learning of bleeding competencies. We then performed 76 VIP video-training sessions from June–August 2020. The FAST instructors assessed each participant’s ability to apply a tourniquet and direct pressure individually, then provided interactive group skills training, and finally re-evaluated each participant’s performance post-training. Results A total of 190 (96%) participants successfully applied a tourniquet after VIP training, compared to 136 (68%) prior to training (P < 0.001). Participants significantly improved their ability to apply direct pressure: 116 (56%) pre-assessment vs 204 (100%) post-assessment (P < 0.001). The mean score for the SBEAT increased significantly from pre-training to post-training: 2.09 with a standard deviation (SD) of 0.97 to 2.55 post-training with a SD of 0.72 (P < 0.001). Conclusion This study suggests that a webinar combined with VIP training is effective for teaching tourniquet and direct-pressure application skills, as well as life-threatening bleeding knowledge. VIP education may be useful for creating resuscitative medicine instructors from distributed locations, and to reach learners who cannot attend classroom-based instruction.
Collapse
Affiliation(s)
- Craig Goolsby
- Uniformed Services University of the Health Sciences, Department of Military & Emergency Medicine, Bethesda, Maryland; Uniformed Services University of the Health Science, National Center for Disaster Medicine and Public Health Medicine, Bethesda, Maryland
| | - Keke Schuler
- Uniformed Services University of the Health Science, National Center for Disaster Medicine and Public Health Medicine, Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Raphaelle Rodzik
- Uniformed Services University of the Health Science, National Center for Disaster Medicine and Public Health Medicine, Bethesda, Maryland; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland
| | - Nathan Charlton
- University of Virginia School of Medicine, Department of Emergency Medicine, Charlottesville, Virginia
| | - Vidya Lala
- Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland
| | - Kevin Anderson
- Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland
| | - Jeffrey Pellegrino
- University of Akron, Department of Disaster Sciences and Emergency Services, Akron, Ohio
| |
Collapse
|
46
|
Design and Development of a Hemorrhagic Trauma Simulator for Lower Limbs: A Pilot Study. SENSORS 2021; 21:s21113816. [PMID: 34073020 PMCID: PMC8198904 DOI: 10.3390/s21113816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022]
Abstract
One of the main preventable leading causes of death after a trauma injury is the hemorrhagic shock. Therefore, it is extremely important to learn how to control hemorrhages. In this paper, a hemorrhagic trauma simulator for lower limb has been developed and a pilot study has been accomplished to trail the simulator. Four different bleeding scenarios have been tested per participant, gathering information about the manual pressure exerted to control the bleeding. Data, altogether, from 54 hemorrhagic scenarios managed by final year medical students and doctors were gathered. Additionally, a post-simulation questionnaire, related to the usability of the simulator, was completed. All the participants managed to control the simulated bleeding scenarios, but the pressure exerted to control the four different scenarios is different depending if the trainee is a student or a doctor, especially in deep venous hemorrhages. This research has highlighted the different approach to bleeding control treatment between medical students and doctors. Moreover, this pilot study demonstrated the need to deliver a more effective trauma treatment teaching for hemorrhagic lesions and that hemorrhagic trauma simulators can be used to train and evaluate different scenarios.
Collapse
|
47
|
A Survey of Hospitalized Trauma Patients in Hemorrhage Control Education: Are Trauma Victims Willing to Stop the Bleed? J Surg Res 2021; 264:469-473. [PMID: 33852987 DOI: 10.1016/j.jss.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Stop the Bleed (STB) campaign was developed in part to educate the lay public about hemorrhage control techniques aimed at reducing preventable trauma deaths. Studies have shown this training increases bystanders' confidence and willingness to provide aid. One high-risk group might be better solicited to take the course: individuals who have been a victim of previous trauma, as high rates of recidivism after trauma are well-established. Given this group's risk for recurrent injury, we evaluated their attitudes toward STB concepts. METHODS We surveyed trauma patients admitted to 3 urban trauma centers in Baltimore from January 8, 2020 to March 14, 2020. The survey was terminated prematurely due to the COVID-19 pandemic. Trauma patients hospitalized on any inpatient unit were invited to complete the survey via an electronic tablet. The survey asked about demographics, prior exposure to life-threatening hemorrhage and first aid training, and willingness to help a person with major bleeding. The Johns Hopkins IRB approved waiver of consent for this study. RESULTS Fifty-six patients completed the survey. The majority of respondents had been hospitalized before (92.9%) and had witnessed severe bleeding (60.7%). The majority had never taken a first aid course (60.7%) nor heard of STB (83.9%). Most respondents would be willing to help someone with severe bleeding form a car crash (98.2%) or gunshot wound (94.6%). CONCLUSIONS Most patients admitted for trauma had not heard about Stop the Bleed, but stated willingness to respond to someone injured with major bleeding. Focusing STB education on individuals at high-risk for trauma recidivism may be particularly effective in spreading the message and skills of STB.
Collapse
|
48
|
Wend CM, Goolsby C, Schuler K, Fischer ST, Levy MJ. Tourniquet Use in Animal Attacks: An Analysis of News Media Reports. Cureus 2021; 13:e13926. [PMID: 33880274 PMCID: PMC8051424 DOI: 10.7759/cureus.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Animal attacks pose a significant public health problem in the United States. Non-venomous animals are the leading cause of mortality in these attacks, and extremity injuries leading to hemorrhage are a common pattern. The Stop the Bleed campaign advocates for public training in bleeding control tactics and public access to bleeding control kits. Controlling life-threatening bleeding, as promoted by the Stop the Bleed campaign, may be a method to reduce preventable death in these attacks. Methodology We searched the Nexus Uni database, which compiles international news media articles, to collect newspaper articles in the United States between 2010 and 2019 that referenced animal attacks on humans in which a tourniquet was applied. We screened articles to assess for inclusion criteria and isolated a single report for each attack. Results A total of 50 individual attacks met the inclusion criteria and were included for data collection. Overall, 92% (n = 46) of the victims survived the attacks, and the average victim age was 33. California was the most common location of the attacks (n = 12, 24%), sharks caused the most attacks (n = 26, 52%), and victims most often sustained isolated extremity injuries (n = 24, 48% for arm and n = 24, 48% for leg). Laypeople applied the most tourniquets (n = 29, 58%), and appliers most frequently used improvised tourniquets (n = 30, 60%). Conclusions While mortality in this series was low, there are hundreds of fatalities from non-venomous animal attacks each year. Equipping and training the at-risk public to stop bleeding may save additional lives. Future Stop the Bleed efforts should improve access to public hemorrhage control equipment and expand educational outreach to people engaged in high-risk activities with animals.
Collapse
Affiliation(s)
- Christopher M Wend
- Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Craig Goolsby
- Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA.,National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, USA
| | - Keke Schuler
- Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, USA.,National Center for Disaster Medicine and Public Health, The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, USA
| | - Steven T Fischer
- Emergency Medical Services, Dix Hills Volunteer Fire Department, Dix Hills, USA
| | - Matthew J Levy
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.,National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, USA
| |
Collapse
|
49
|
Goolsby C, Rojas LE, Rodzik RH, Gausche-Hill M, Neal MD, Levy MJ. High-School Students Can Stop the Bleed: A Randomized, Controlled Educational Trial. Acad Pediatr 2021; 21:321-328. [PMID: 32473216 DOI: 10.1016/j.acap.2020.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine high-school students' ability to learn hemorrhage control skills and knowledge via 3 educational modalities. BACKGROUND Trauma is the leading cause of death for young Americans, and there are calls to teach children about hemorrhage control. However, little is known about adolescents' ability to perform hemorrhage control, and the ideal way(s) to teach them. METHODS This randomized controlled trial enrolled high-school students from 39 states at a 2019 national conference. After answering questions about their willingness to use tourniquets, participants received hemorrhage control education in 1 of 3 formats: instructor-led, web-only, or blended (combining web and instructor-led). Participants were then assessed on their ability to apply a tourniquet and to identify wounds that require a tourniquet. Finally, they completed an attitude questionnaire. RESULTS Two hundred and four (82%) of 248 participants applied a tourniquet correctly: 72 (88%) instructor-led, 50 (61%) web-only, and 79 (94%) blended. The instructor-led and blended arms were superior to the web-only arm (P < .001). Nearly all participants passed an assessment requiring them to identify wounds warranting a tourniquet (99% instructor-led and blended, and 98% web-only). All modalities improved participants' self-reported willingness and comfort in using tourniquets (P < .001). CONCLUSIONS This is the first study to demonstrate that high-school students can learn hemorrhage control via multiple methods. Blended and instructor-led education led to highly successful skill performance. Students learned to identify wounds requiring tourniquets and showed an improved willingness to aid from all modalities. These findings should encourage educators to offer multiple educational modalities.
Collapse
Affiliation(s)
- Craig Goolsby
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences (C Goolsby), Bethesda, Md; National Center for Disaster Medicine and Public Health (C Goolsby, LE Rojas, and RH Rodzik), Rockville, Md.
| | - Luis E Rojas
- National Center for Disaster Medicine and Public Health (C Goolsby, LE Rojas, and RH Rodzik), Rockville, Md; The Henry M. Jackson Foundation for the Advancement of Military Medicine (LE Rojas and RH Rodzik), Bethesda, Md
| | - Raphaelle H Rodzik
- National Center for Disaster Medicine and Public Health (C Goolsby, LE Rojas, and RH Rodzik), Rockville, Md; The Henry M. Jackson Foundation for the Advancement of Military Medicine (LE Rojas and RH Rodzik), Bethesda, Md
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency (M Gausche-Hill), Los Angeles, Calif; Departments of Emergency Medicine and Pediatrics, David Geffen School of Medicine at the University of California (M Gausche-Hill), Los Angeles, Calif; Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center (M Gausche-Hill), Torrance, Calif
| | - Matthew D Neal
- Departments of Surgery, Critical Care Medicine, and the Clinical and Translational Science Institute (CTSI), University of Pittsburgh (MD Neal), Pittsburgh, Pa; University of Pittsburgh Medical Center (MD Neal), Pittsburgh, Pa
| | - Matthew J Levy
- Department of Emergency Medicine, Johns Hopkins University School of Medicine (MJ Levy), Baltimore, Md; Howard County Department of Fire and Rescue Services (MJ Levy), Columbia, Md
| |
Collapse
|
50
|
Strauss‐Riggs K, Kirsch TD, Prytz E, Hunt RC, Jonson C, Krohmer J, Nemeth I, Goolsby C. Recommended Process Outcome Measures for Stop the Bleed Education Programs. AEM EDUCATION AND TRAINING 2021; 5:139-142. [PMID: 33521502 PMCID: PMC7821051 DOI: 10.1002/aet2.10443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Kandra Strauss‐Riggs
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc.RockvilleMA
- National Center for Disaster Medicine and Public Health and the Department of Military & Emergency MedicineUniformed Services University of the Health SciencesBethesdaMD
| | - Thomas D. Kirsch
- National Center for Disaster Medicine and Public Health and the Department of Military & Emergency MedicineUniformed Services University of the Health SciencesBethesdaMD
| | | | | | | | - Jon Krohmer
- U.S. Department of TransportationWashingtonDC
| | - Ira Nemeth
- Department Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Craig Goolsby
- National Center for Disaster Medicine and Public Health and the Department of Military & Emergency MedicineUniformed Services University of the Health SciencesBethesdaMD
| |
Collapse
|