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
|
Drake JH, Kiwango G, Mashili F, Kitapondya D, Kivlehan SM. Effectiveness of a Bleeding Control Course for Public Transit Drivers in Dar es Salaam, Tanzania. J Surg Res 2024; 301:447-454. [PMID: 39033595 DOI: 10.1016/j.jss.2024.06.039] [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: 01/10/2024] [Revised: 05/24/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION In Dar es Salaam, mortality from road traffic injuries is roughly double the global rate. Most civilians are transported to hospitals by laypeople. We examined the impact of a bleeding control course among taxi drivers. METHODS Before-after study; participants were trained in hemorrhage control and equipped with a first aid kit. Primary outcomes were perceived bleeding control knowledge, perceived ability to apply bleeding control skills, and intention to intervene. Surveys were administered before, after, and 3 mo after training. Data were measured on a 1-5 Likert scale. RESULTS Among 186 participants, knowledge increased from 1.70 (95% confidence interval [CI] 1.55-1.85) before training to 4.67 (95% CI 4.55-4.78) after training and was sustained at 3 mo 4.69 (95% CI 4.61-4.77). Ability to apply skills increased from 2.12 (95% CI 1.96-2.27) before training to 4.68 (95% CI 4.59-4.78) after training and was sustained at 3 mo 4.67 (95% CI 4.57-4.76). Intention to intervene increased from 2.69 (95% CI 2.47-2.92) before training to 4.66 (95% CI 4.55-4.76) after training and was sustained at 3 mo 4.57 (95% CI 4.48-4.67). 83 interventions occurred. Transport to health-care facilities occurred 58 times. Care was transferred to a doctor or nurse 39 times. CONCLUSIONS This course increased participant's perceived bleeding control knowledge, ability to apply skills, and intention to intervene. Participants utilized skills in the field, transported the injured, and handed off care. This course should be evaluated globally in similar contexts.
Collapse
Affiliation(s)
| | - George Kiwango
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fredirick Mashili
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deus Kitapondya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | |
Collapse
|
3
|
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
|
4
|
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
|
5
|
Narayan M, Chandramouli M, de Angelis P, Gupta A, An A, Dominguez M, Zappetti D, Winchell RJ, Barie PS. Video-Based Stop the Bleed Training: A New Era in Education. J Surg Res 2022; 280:535-542. [PMID: 36087350 DOI: 10.1016/j.jss.2022.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/26/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Uncontrolled bleeding is a leading cause of preventable death. The "Stop the Bleed" (StB) program trains laypersons in hemorrhage control. This study evaluated the efficacy of video-based StB training. METHODS Participants watched two different videos: a didactic video (DdV) and a technical video (TeV) demonstrating proper techniques for StB skills (i.e., direct pressure [DP], wound packing [WP], and tourniquet application [TA]). Then, they completed a standardized skills examination (SE). Participants were surveyed at three different time points (baseline, post-DdV, and post-SE) for comparison. We compared paired categorical and continuous variables with the McNemar-Bowker test and Wilcoxon signed-rank test, respectively. Alpha was set at 0.05. RESULTS One hundred six participants were enrolled: 52% were female and the median age was 23 y (22, 24). At baseline, 29%, 8%, and 13% reported being somewhat or extremely confident with DP, WP, and TA, respectively. These percentages increased to 92%, 79%, and 76%, respectively, after the DdV (all, P < 0.0001). After the TeV and SE, percentages increased further to 100%, 96%, and 100% (all, P < 0.0001). During the SE, 96%, 99%, and 89% of participants were able to perform DP, WP, and TA without prompting. Among participants, 98% agreed that the video course was effective and 79% agreed that the DdV and TeV were engaging. CONCLUSIONS We describe a novel paradigm of video-based StB learning combined with an in-person, standardized SE. Confidence scores in performing the three crucial StB tasks increased significantly during and after course completion. Through remote learning, StB could be disseminated more widely.
Collapse
Affiliation(s)
- Mayur Narayan
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Mathangi Chandramouli
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Paolo de Angelis
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York.
| | - Aakanksha Gupta
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Anjile An
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Maureen Dominguez
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Dana Zappetti
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Robert J Winchell
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York; Division of Medical Ethics, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Philip S Barie
- Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, New York
| |
Collapse
|
6
|
Day A. ENA Position Statement: Hemorrhage Control. J Emerg Nurs 2022; 48:460-464. [PMID: 35787775 DOI: 10.1016/j.jen.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
|
7
|
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
|
8
|
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
|