Bystander first aid in trauma - prevalence and quality: a prospective observational study

Urban-rural disparities in fatal and non-fatal paediatric injuries after trauma - A national retrospective cohort study

INTRODUCTION

Paediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades.

MATERIALS AND METHODS

We conducted a retrospective cohort study of fatal and non-fatal paediatric injuries by accessing two national registries for all trauma-related patients under the age of 18. All cases were stratified into six groups according to level of centrality based on a national index used as a proxy for rurality. For inter-group comparison, urban-rural disparities were evaluated using Pearson`s Chi-square test, linear regression, and relative risk (RR).

RESULT

1,059 paediatric deaths were included in the study period from 2002 to 2021. The mortality rate increased linearly with increased rurality (r = 0.985, p < .001). The overall mortality risk was 2.4 times higher in the most rural group compared to the most urban (RR = 2.37, 95 %CI 1.78 - 3.14, p < .001). Most deaths occurred pre-hospital (73 %), the total number of fatalities was highest in the age group 16 to 17 (42 %), and transport-related injury (32 %) was the most common cause of death. The relative risk of non-fatal injury was significantly higher for all centrality groups compared to most urban, and the highest rate was seen in sub-rural areas (RR = 1.39, 95 %CI 1.37 - 1.42, p < .001).

CONCLUSION

The mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential.

Knowledge, Attitude, and Practice of Providing First Aid by Commercial Motorcyclists: A Cross-Sectional Study

INTRODUCTION

The mortality and morbidity due to road traffic crashes (RTCs) are increasing drastically world-wide. Poor prehospital care management contributes to dismal patient outcomes, especially in low- and middle-income countries (LMICs). This study aimed to assess the knowledge, attitude, and self-reported practice (KAP) of providing first aid for RTC victims by commercial motorcyclists. In addition, it determined the relationship between sociodemographic characteristics and the level of KAP, then the predicting factors of outcome variables.

METHODS

A cross-sectional study of 200 randomly selected commercial motorcyclists was conducted in May 2021. A chi-square test and multivariate analysis were used to analyze data.

RESULTS

The findings showed that most participants had a poor knowledge level (87.5 %), positive attitudes (74.5%), and poor self-reported practice (51.5%). Previous first-aid training and knowing an emergency call number for the police were predictors of good knowledge (AOR = 3.7064; 95% CI, 1.379-9.956 and AOR = 6.132; 95% CI,1.735-21.669, respectively). Previous first-aid training was also a predictor of positive attitudes (AOR = 3.087; 95% CI, 1.033-9.225). Moreover, the likelihood of having an excellent self-reported practice was less among participants under 40 years of age (AOR = 0.404; 95% CI, 0.182-0.897) and those who cared for up to five victims (AOR = 0.523; 95% CI, 0.282-0.969). Contrary, previous first-aid training (AOR = 2.410; 95% CI, 1.056-5.499) and educational level from high school and above increased the odds of having good self-reported practice (AOR = 2.533; 95% CI, 1.260-5.092).

CONCLUSION

Considering the study findings, training should be provided to improve the knowledge and skills of commercial motorcyclists since they are among the primary road users in Rwanda and involved in RTCs.

Differences in Injury Patterns and Delays in Care-Seeking Behaviors in the Anabaptist Population

BACKGROUND

The lifestyle differences of Anabaptists and their views on health care may yield different injury patterns than standard populations and require a customized approach to injury prevention and health care delivery.

OBJECTIVE

To identify differences in injury patterns and delays in care-seeking behaviors among the Anabaptists in Wisconsin.

METHODS

This single-center retrospective cohort study was conducted from (23 years) January 1, 2000, to December 31, 2023. Local Trauma Registry data collected patient demographics, injury details, morbidity outcomes, in-hospital mortality, and preexisting comorbidity. Anabaptist trauma patients were isolated by confirmed identification in the Trauma Registry. The analysis utilized both descriptive statistics and a logistic regression model with the outcome of Anabaptist.

RESULTS

A total of 14,431 patients were included in the analysis; 81 (0.4%) were confirmed as Anabaptist. The Anabaptist population showed a higher likelihood of helicopter transportation (odds ratio [OR] 4.64, p < .01) and an activation of Pediatric Level I (OR 4.07, p < .01). As the emergency department shock index increased by one unit, the odds of being Anabaptist increased by 9.87 (p < .01). The injury mechanisms that were associated with the Anabaptist population included buggy collisions (OR 312.58, p < .01), caught or crushed (OR 5.21, p = .01), machinery (OR 5.38, p < .01), near drowning (OR 14.09, p < .01), scooter (OR 13.93, p = .04), and woodworking (OR 12.81, p = .01).

CONCLUSIONS

This study identified differences in injury patterns and delays in care-seeking behaviors in the Anabaptist population.

Can video streaming improve first aid for injured patients? A prospective observational study from Norway

BACKGROUND

Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a leading cause of death and injuries are a frequent reason to contact EMCC. We aimed to investigate if video streaming is associated with recognition of a need for first aid during calls regarding injured patients and improve quality of bystander first aid.

METHODS

A prospective observational study including patients from three health regions in Norway, from November 2021 to February 2023 (registered in clinical trials 10/25/2021, NCT05121649). Cases where video streaming had been used as a supplement during the medical emergency call were compared to cases where video streaming was not used during the call. Patients were included by ambulance personnel on the scene of accident if they met the following criteria: 1. Ambulance personnel arrived at a patient who had an injury, 2. One or more bystanders had been present before their arrival, 3. One or more of the following first aid measures had been performed by bystander or should have been performed: airway management, control of external bleeding, recovery position, and hypothermia prevention. Ambulance personnel assessed quality of first aid performed by bystander, and information concerning use of video streaming and patient need for first aid measures recognized by dispatcher was collected through EMCC audio logs and patient charts. We present descriptive data and results from a logistic regression analysis.

RESULTS

Data was collected on 113 cases, and dispatchers used video streaming in addition to standard telephone communication in 12/113 (10%) of the cases. The odds for the dispatcher to recognize a need for first aid during a medical emergency call were more than five times higher when video streaming was used compared to no use of video streaming (OR 5.30, 95% CI 1.11-25.44). Overall quality of bystander first aid was rated as "high". The odds ratio for the patient receiving first aid of higher quality were 1.82 (p-value 0.46) when video streaming was used by dispatcher during the call.

CONCLUSION

Our findings show that video streaming is not frequently used by dispatchers in calls regarding patients with injuries, but that video streaming is associated with improved recognition of patients' first aid needs. We found no statistically significant difference in first aid quality comparing the calls where video streaming as a supplement were used with the calls with audio only.

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

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.

Fears and Concerns of Bystanders to Help People Injured in Traffic Accidents: A Qualitative Descriptive Study

In most traffic accidents, bystanders arrive at the scene before the rescuers. If they provide the right help, they can play an important and effective role in reducing the number of deaths and complications caused by these accidents. However, in many cases, fears and concerns prevent bystanders from providing assistance. This study aims to investigate and understand the fears and concerns of bystanders when they decide to help in traffic accidents. In 2022, this study was carried out in Iran using a qualitative content analysis approach. The data was collected through semistructured interviews. Participants were 15 males and females who had experience providing assistance in traffic accidents. Interviews, after digital recording, were transcribed verbatim. A purposeful and theoretical sampling method was performed. Data analysis and the determination of codes, categories, and subcategories were done using qualitative analysis software. O'Brien's qualitative research reporting standard was used. The results of the study include a category of fears and concerns and five subcategories. The subcategories include fear and concern caused by lack of information, fear of legal troubles, stress caused by previous experience, fear and anxiety caused by anticipation, and anxiety of unknown origin. The results of this study showed that some of the fears and concerns of the bystanders were related to a lack of information about providing assistance. By increasing bystanders' information about assistance, such as first aid training, fear and anxiety caused by a lack of information can be reduced. Another part of the fear and concern of bystanders is due to legal issues. Passing and implementing laws that protect bystanders can help reduce this fear and concern. Bystanders should be trained to provide assistance according to the rules of assistance so that they do not get into legal problems. A part of the bystander's fear and concern stems from their previous experiences providing assistance in traffic accidents. These experiences can also affect the fear and anxiety caused by anticipation. It is necessary to conduct more studies on the role of bystanders' experiences in creating fear and anxiety in them, as well as their effect on anticipatory fear.

Methodological analysis of a community-based training initiative using the EPIS framework: an ongoing initiative to empower 10 million bystanders in CPR and bleeding control

Background

Out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate of victims. While great efforts for bystander training have yielded positive results in high-income countries, the same has not been replicated in low and middle-income countries (LMICs) due to resources constraints. This article describes a replicable implementation model of a nationwide program, aimed at empowering 10 million bystanders with basic knowledge and skills of hands-only cardiopulmonary resuscitation (CPR) and bleeding control in a resource-limited setting.

Methods

Using the EPIS (Exploration, Preparation, Implementation and Sustainment) framework, we describe the application of a national bystander training program, named 'Pakistan Life Savers Programme (PLSP)', in an LMIC. We discuss the opportunities and challenges faced during each phase of the program's implementation and identify feasible and sustainable actions to make them reproducible in similar low-resource settings.

Results

A high mortality rate owing to OHCA and traumatic life-threatening bleeding was identified as a national issue in Pakistan. After intensive discussions during the exploration phase, PLSP was chosen as a potential solution. The preparation phase oversaw the logistical administration of the program and highlighted avenues using minimal resources to attain maximum outreach. National implementation of bystander training started as a pilot in suburban schools and expanded to other institutions, with 127 833 bystanders trained to date. Sustainability of the program was targeted through its addition in a single national curriculum taught in schools and the development of a cohesive collaborative network with entities sharing similar goals.

Conclusion

This article provides a methodological framework of implementing a national intervention based on bystander response. Such programs can increase bystander willingness and confidence in performing CPR and bleeding control, decreasing preventable deaths in countries having a high mortality burden.

Level of evidence

Level VI.

Effectiveness of first-aid education in road traffic crashes on non-healthcare professionals' knowledge, attitude, and skills: a systematic review

This review aimed to evaluate and synthesize information on the effects of first-aid education in road traffic crashes on knowledge, attitudes, and skills among non-healthcare professionals. A qualitative study was designed according to the Prepared Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards to evaluate three outcomes, knowledge, skills, and attitude. The search strategy was performed in five databases (Science Direct, Scopus, CINAHL Plus, PubMed, and Google Scholar) to retrieve primary studies published between January 2011 and December 2021. In addition, the full texts of randomized controlled trials conducted on adults were included. Among the 2,399 articles retrieved from the databases, 2,388 were discarded, and only five studies met the inclusion criteria and were used in the final analysis and synthesis. Three of the five studies suggested that knowledge and skills are crucial in differentiating outcome factors between intervention and control groups regarding the effectiveness of first aid education. However, two studies on attitude and behaviour toward first-aid found no discernible change between the intervention and the control group. Therefore, our review revealed that only a well-structured first aid education is crucial to leverage the knowledge and skills of non-healthcare professionals before first aid provision, not attitude or behaviours.

The Effects of Stress on Tourniquet Application and CPR Performance in Layperson and Professional Civilian Populations

OBJECTIVE

The purpose of this study was to compare laypeople's and professional first responders' ability to perform tourniquet application and cardiopulmonary resuscitation (CPR) during calm and stressful circumstances.

BACKGROUND

Life-threatening bleeding is a major cause of death that could be prevented by fast and appropriate first aid interventions. Therefore, laypeople are now being trained in bleeding control skills, transforming them from bystanders to immediate responders. However, critics have questioned whether laypeople are able to perform during more stressful conditions.

METHOD

Twenty-four laypersons and 31 professional first responders were tested in two conditions: a calm classroom scenario and a stressful scenario consisting of paintball fire and physical exertion. Stress and workload were assessed along with task performance.

RESULTS

The experimental manipulation was successful in terms of eliciting stress reactions. Tourniquet application performance did not decline in the stressful condition, but some aspects of CPR performance did for both groups. First responders experienced higher task engagement and lower distress, worry and workload than the laypeople in both the calm and stressful conditions.

CONCLUSION

Stress did not affect first responders and laypeople differently in terms of performance effects. Stress should therefore not be considered a major obstacle for teaching bleeding control skills to laypeople.

APPLICATION

Tourniquet application can be taught to laypeople in a short amount of time, and they can perform this skill during stress in controlled settings. Concerns about laypeople's ability to perform under stress should not exclude bleeding control skills from first aid courses for civilian laypeople.

Assessing bystander first aid: development and validation of a First Aid Quality Assessment (FAQA) tool

BACKGROUND

Injuries are one of the leading causes of death worldwide. Bystanders at the scene can perform first aid measures before the arrival of health services. The quality of first aid measures likely affects patient outcome. However, scientific evidence on its effect on patient outcome is limited. To properly assess bystander first aid quality, measure effect, and facilitate improvement, validated assessment tools are needed. The purpose of this study was to develop and validate a First Aid Quality Assessment (FAQA) tool. The FAQA tool focuses on first aid measures for injured patients based on the ABC-principle, as assessed by ambulance personnel arriving on scene.

METHODS

In phase 1, we drafted an initial version of the FAQA tool for assessment of airway management, control of external bleeding, recovery position and hypothermia prevention. A group of ambulance personnel aided presentation and wording of the tool. In phase 2 we made eight virtual reality (VR) films, each presenting an injury scenario where bystander performed first aid. In phase 3, an expert group discussed until consensus on how the FAQA tool should rate each scenario. Followingly, 19 respondents, all ambulance personnel, rated the eight films with the FAQA tool. We assessed concurrent validity and inter-rater agreement by visual inspection and Kendall's coefficient of concordance.

RESULTS

FAQA-scores by the expert group concurred with ± 1 of the median of the respondents on all first aid measures for all eight films except one case, where a deviation of 2 was seen. The inter-rater agreement was "very good" for three first aid measures, "good" for one, and "moderate" for the scoring of overall quality on first aid measures.

CONCLUSION

Our findings show that it is feasible and acceptable for ambulance personnel to collect information on bystander first aid with the FAQA tool and will be of importance for future research on bystander first aid for injured patients.

Prehospital clinical practice guidelines for unintentional injuries: a scoping review and prioritisation process

BACKGROUND

Globally, millions of people die and many more develop disabilities resulting from injuries each year. Most people who die from injuries do so before they are transported to hospital. Thus, reliable, pragmatic, and evidence-based prehospital guidance for various injuries is essential. We systematically mapped and described prehospital clinical practice guidelines (CPGs) for injuries in the global context, as well as prioritised injury topics for guidance development and adolopment.

METHODS

This study was sequentially conducted in three phases: a scoping review for CPGs (Phase I), identification and refinement of gaps in CPGs (Phase II), and ranking and prioritisation of gaps in CPGs (Phase III). For Phase I, we searched PubMed, SCOPUS, and Trip Database; guideline repositories and websites up to 23rd May 2021. Two authors in duplicate independently screened titles and abstract, and full-text as well as extracted data of eligible CPGs. Guidelines had to meet 60% minimum methodological quality according to rigour of development domain in AGREE II. The second and third phases involved 17 participants from 9 African countries and 1 from Europe who participated in a virtual stakeholder engagement workshop held on 5 April 2022, and followed by an online ranking process.

RESULTS

Fifty-eight CPGs were included out of 3,427 guidance documents obtained and screened. 39/58 (67%) were developed de novo compared to 19 that were developed using alternative approaches. Twenty-five out of 58 guidelines (43%) were developed by bodies in countries within the WHO European Region, while only one guideline was targeted to the African context. Twenty-five (43%) CPGs targeted emergency medical service providers, while 13 (22%) targeted first aid providers (laypeople). Forty-three CPGs (74%) targeted people of all ages. The 58 guidance documents contained 32 injury topics. Injuries linked to road traffic accidents such as traumatic brain injuries and chest injuries were among the top prioritised topics for future guideline development by the workshop participants.

CONCLUSION

This study highlights the availability, gaps and priority injury topics for future guideline development/adolopment, especially for the African context. Further research is needed to evaluate the recommendations in the 58 included CPGs for possible adaptation to the African context.

Tailoring First Aid Courses to Older Adults Participants

Relevant organizations emphasize the importance of first aid (FA) for older adults due to the increased risk of injuries and sudden illnesses in old age. Even though FA training guidelines have been developed, no program for an FA course adapted for the older adults has been formally adopted in Europe. This study's objective is to identify older adults' needs, beliefs, desires, advantages, and possible limitations in connection with FA. This qualitative study used semistructured interviews with 22 laypersons and retired health professionals older than 60 years old. The qualitative content analysis indicated that the major themes elicited by the older adults are motivation to participate in the FA training, older adults' specific features as a resource or obstacle for participating in FA training, general suggestions, and content suggestions for FA training. Older adults are very differently motivated to participate in FA training due to the heterogeneity of their psychophysical abilities. They need and want to obtain additional knowledge from the field of FA and health protection for which any psychophysical limitations are not as relevant as when learning cardiopulmonary resuscitation. They want to learn how to recognize emergency situations and more about calling emergency services with the use of modern technology. In addition to cardiopulmonary resuscitation without rescue breaths, they also want to learn about topics related to the treatment of injuries. Those who had practiced FA in their work-life think that they can be a good source to transfer their knowledge to persons from their generation. While planning an FA training course, it has to be taken into consideration that older adults want a short course, adjusted to their varied psychophysical abilities. Due to the wide array of contents they want to learn, it would be reasonable to prepare a selection of different programs for short training courses.

The importance of elderly people knowing basic first-aid measures

BACKGROUND

In the event of a sudden illness or injury, elderly individuals are often dependent on self-help and mutual assistance from partners. With poor access to medical services during natural and other disasters, the importance of first aid knowledge of elderly individuals increases even more. We assessed the opinions of different generations of Slovenian population regarding the importance of knowing the basic first aid measures. In addition, we aimed to examine the knowledge of first aid in the most common emergencies that threaten elderly people's health and lives, focusing on the knowledge of elderly.

METHODS

A structured questionnaire was conducted with a representative Slovenian adult population (n = 1079). Statistically significant differences in average ratings of the importance of first aid knowledge were compared among different age groups with one-way ANOVA followed by a post hoc test. Significant differences in percentages of correct answers in particular cases of health conditions between different age groups were determined using the χ 2 test followed by post hoc tests.

RESULTS

Slovenes are well aware of the importance of first aid knowledge and feel personally responsible for acquiring this knowledge. The general opinion is that older retirees need less first aid knowledge than individuals in younger populations. We found a high level of knowledge about symptoms and first aid measures for some of the most common health conditions that occur in old age. The level of knowledge in the group of the oldest respondents was comparable with that of younger age groups. However, their recognition of health conditions was also somewhat worse, especially when recognising the symptoms and signs of hypoglycaemia and heart attack. Most of the tested knowledge did not depend on a person's age but on the time since that person was last educated in first aid.

CONCLUSIONS

The knowledge of people older than 80 years is somewhat poorer than that in the younger population, mainly because too much time has passed since they were last educated in first aid. Public awareness of first aid needs to be increased and appropriate guidelines should be given with a focus on the elderly population.

Creation and application of war trauma treatment simulation software for first aid on the battlefield based on undeformed high-resolution sectional anatomical image (Chinese Visible Human dataset)

BACKGROUND

Effective first aid on the battlefield is vital to minimize deaths caused by war trauma and improve combat effectiveness. However, it is difficult for junior medical students, which have relatively poor human anatomy knowledge and first aid experience. Therefore, we aim to create a treatment simulation software for war trauma, and to explore its application for first aid training. METHODS : This study is a quantitative post-positivist study using a survey for data collection. First, high-resolution, thin-sectional anatomical images (Chinese Visible Human (CVH) dataset) were used to reconstruct three-dimensional (3D) wound models. Then, the simulation system and the corresponding interactive 3D-PDF, including 3D models, graphic explanation, and teaching videos, were built, and used for first aid training in army medical college. Finally, the interface, war trauma modules, and training effects were evaluated using a five-point Likert scale questionnaire. All measurements are represented as mean and standard deviations. Moreover, free text comments from questionnaires were collected and aggregated.

RESULTS

The simulation software and interactive 3D-PDF were established. This included pressure hemostasis of the vertex, face, head-shoulder, shoulder-arm, upper forearm, lower limb, foot, and punctures of the cricothyroid membrane, pneumothorax, and marrow cavity. Seventy-eight medical students participated in the training and completed the questionnaire, including 66 junior college students and 12 graduate students. The results indicated that they were highly satisfied with the software (score: 4.64 ± 0.56). The systems were user-friendly (score: 4.40 ± 0.61) and easy to operate (score: 4.49 ± 0.68). The 3D models, knowledge of hemostasis, and puncture were accurate (scores: 4.41 ± 0.67, and 4.53 ± 0.69) and easily adopted (scores: 4.54 ± 0.635, and 4.40 ± 0.648). They provided information about hemostasis and puncture (all scores > 4.40), except for cricothyroid membrane puncture (scores: 4.39 ± 0.61), improved the learning enthusiasm of medical students (score: 4.55 ± 0.549), and increased learning interest (score: 4.54 ± 0.57).

CONCLUSION

Our software can effectively help medical students master first aid skills including hemostasis, cricothyroid membrane and bone marrow puncture, and its anatomy. This may also be used for soldiers and national first aid training.

Deep Learning-Based Medical Information System in First Aid of Surgical Trauma

The aim of this study was to explore the application of process reengineering integration in trauma first aid based on deep learning and medical information system. According to the principles and methods of process reengineering, based on the analysis of the problems and causes of the original trauma first aid process, a new set of trauma first aid integration process is established. The Deep Belief Network (DBN) in deep learning is used to optimize the travel path of emergency vehicles, and the accuracy of travel path prediction of emergency vehicles under different environmental conditions is analyzed. DBN is applied to the surgical clinic of the hospital to verify the applicability of this method. The results showed that in the analysis of sample abscission, the abscission rates of the two groups were 2.23% and 0.78%, respectively. In the analysis of the trauma severity (TI) score between the two groups, more than 60% of the patients were slightly injured, and there was no significant difference (P > 0.05). In the comparative analysis of treatment effect and family satisfaction between the two groups, the proportion of rehabilitation patients in the experimental group (55.91%) was significantly better than that in the control group, and the satisfaction of the experimental group (7.93 ± 0.59) was significantly higher than that of the control group (5.87 ± 0.43) (P < 0.05). Therefore, integrating Wireless Sensor Network (WSN) measurement and process reengineering under the medical information system provides feasible suggestions and scientific methods for the standardized trauma first aid.

Assessment of knowledge, attitude and practice of first aid among taxi operators in a Kampala City Taxi Park, Uganda: A cross-sectional study

INTRODUCTION

Road traffic accidents are among the leading causes of death in Uganda. Taxi operators are at a high risk of RTA and can potentially be first responders. This study, aimed to assess knowledge, attitude, and practice of first aid among taxi operators in the new taxi park, Kampala Uganda.

METHODS

A descriptive cross-sectional study was conducted in 2021 among taxi drivers and conductors in the New Taxi Park, Kampala City, Uganda. A semi-structured questionnaire was used to collect quantitative data from taxi operators after informed consent. Chi-square or Fisher's exact test and logistic regression were performed in STATA 16 to assess the association between first aid knowledge and demographics. P < 0.05 was statistically significant.

RESULTS

A total of 345 participants, majority males (n = 338, 98%) aged between 18 and 45 years (76.5%), were recruited. Although 97.7% (n = 337) had heard about first aid, only 19.4% (n = 67) had prior first aid training. Overall mean knowledge score was 40.1% (SD = 14.5%), with 29.9% (n = 103) having good knowledge (≥50%). Participants who had witnessed more than five accidents (aOR = 2.9, 95% CI = 1.7-4.8, p < 0.001), those with first aid kits (aOR = 1.7, 95% CI = 1.0-3.0, p = 0.38) were more likely to have good knowledge while those below post-secondary education level i.e., Primary (AOR = 0.2, 95% CI = 0.1-0.5, p ≤0.001) and secondary (aOR = 0.2, 95% CI = 0.1-0.6, p = 0.001), were less likely to have good knowledge. About 97% and 93% perceived first aid as important and were willing to undergo training, respectively; however, only 69% were willing to give first aid. Only 181(52.5%) had ever attended to accident victims.

CONCLUSION

Majority of taxi operators had poor first aid knowledge. Factors associated with good knowledge included level of education, number of accidents witnessed, having first aid kits. Although their attitudes were favorable, practice was poor. Comprehensive training and refresher courses can help increase first aid knowledge, and improving practice.

Tourniquet Application for Bleeding Control in a Rural Trauma System: Outcomes and Implications for Prehospital Providers

Introduction: Uncontrolled bleeding is a preventable cause of death in rural trauma. Herein, we examined the appropriateness, effectiveness, and safety of tourniquet application for bleeding control in a rural trauma system.Methods: Medical records of adult patients admitted to our academic Level I trauma center between July 2015 and December 2018 were retrospectively reviewed. Demographics (age, gender), injury (Injury severity score, Glascow Coma scale, mechanism of injury), tourniquet (type, tourniquet application site, tourniquet duration, place of application and removal, indication), and outcome data (complications such as amputation, acute kidney injury, rhabdomyolysis, or nerve palsy and mortality) were collected. Tourniquet indications, effectiveness, and complications were evaluated. Data were compared to those in urban settings.Results: Ninety-two patients (94 tourniquets) were identified, of which 58.7% incurred penetrating injuries. Eighty-seven tourniquets (92.5%) were applied in the prehospital setting. Twenty tourniquets (21.3%) were applied to patients without an appropriate indication. Two of these tourniquets were applied in a hospital setting, while 18 occurred in the prehospital setting (p = 0.638). Patients with a non-indicated tourniquet presented with a higher hemoglobin level on admission, received less packed red blood cell units within the first 24 hours of hospitalization, and were less likely to require surgery for hemostasis. None of the non-indicated tourniquets led to a complication. Indicated tourniquets were deemed ineffective in seven cases (9.5%); they were all applied in the prehospital setting. The average tourniquet time was 123 min in rural vs. 48 min in urban settings, p < 0.001. There was no significant difference in mortality, amputation rates and incidence of nerve palsy between the rural and urban settings.Conclusion: Even with long transport times, early tourniquet application for hemorrhage control in rural settings is safe with no significant attributable morbidity and mortality compared to published studies on urban civilian tourniquet use. The observed rates of non-indicated and ineffective tourniquets indicate suboptimal tourniquet usage and application. Opportunity exists for standardized hemorrhage control training on the use of direct pressure and pressure dressings, indications for tourniquet use, and effective tourniquet application.

Causes of death and characteristics of non-survivors rescued during recreational mountain activities in Japan between 2011 and 2015: a retrospective analysis

OBJECTIVES

This study aimed to describe the cause of death and characteristics at the prehospital setting associated with care and rescue processes of non-survivors rescued in the mountain of Japan.

DESIGN

Retrospective analysis.

SETTING

Prehospital setting of mountain searches and rescues in Japan. A total of 10 prefectural police headquarters with >10 cases of mountain death from 2011 to 2015.

PARTICIPANTS

Data were generated from the existing records. Of the total 6159 rescued subjects, 548 mountain deaths were caused by recreational activities.

RESULTS

Among the 548 mountain deaths, 83% were men, and major causes of death were trauma (49.1%), hypothermia (14.8%), cardiac death (13.1%) and avalanche-related death (6.6%). The alive rate at rescue team arrival in all non-survivors was 3.5%, with 1, 4 and 14 cases of cardiac, hypothermia and trauma, respectively. Cardiac deaths occurred in 93.1% (67/72) of men and individuals aged >41 years, and 88.7% (63/71) were found on mountain trails. In hypothermia, callouts were made between 17:00 and 6:00 at 49% (40/81) and by persons not on-site in 59.7% (46/77). People with >6 hours in trauma or >1 hour in cardiac death already died on rescue team arrival, but some with hypothermia after 6 hours were alive.

CONCLUSION

This study is one of the first large-scale retrospective analyses of prehospital non-survivors in mountain emergencies. The alive rate at rescue arrival in all mountain deaths was only 3.5%. These data showed that the circumstances related to onset and the process until the rescue team arrives have different characteristics, depending on the cause of death. Survival may be enhanced by targeting better use of the time before rescue team arrival and by providing further education, particularly mountain rescue-related medical problems to rescuers including bystanders.

Effects of different crash data variables on EMS response time for a rural county in Alabama

Response time of Emergency Medical Services (EMS) is an important factor related to preventable deaths in road crash incidents. This study focuses on analyzing the effects of different independent variables on the EMS Response Time (ERT). Independent variables considered for this investigation are travel time, day of the week, crash severity, weather, time of the day, and lighting condition. Understanding outcomes resulting from variations of the considered parameters on ERT is crucial to minimize the possibility of adverse outcomes which are tied to different types of injuries, and vital to limit the prospect of fatalities. Crash data used for this study is from a rural county in Alabama where only one EMS control location is available. Results from the analysis indicate that ERT becomes larger as travel time increases. ERT is also larger on weekends than on weekdays. ERT is larger in the evening and night when compared with morning. When the weather is clear or cloudy, the ERT parameter is shorter. But when the weather is extreme, with mist, fog, or rain, the parameter is longer. When roads are dark, ERT is long. When daylight is present, the ERT is shorter. If the crash is fatal, the parameter is longer compared with situations when crash injuries are non-severe.

Geographical risk of fatal and non-fatal injuries among adults in Norway

INTRODUCTION

A rural gradient in trauma mortality disfavoring remote inhabitants is well known. Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002-2016.

METHODS

All traumatic injuries and deaths among persons with a residential address in Norway from 2002-2016 were included. Data were collected from the Norwegian National Cause of Death Registry and the Norwegian Patient Registry. All cases were stratified into six groups of centrality based on Statistics Norway's classification system, from most urban (group one) to least urban/most rural (group six). Mortality and injury rates were calculated per 100,000 inhabitants per year.

RESULTS

The mortality rate differed significantly among the centrality groups (p<0.05). The rate was 64.2 per 100,000 inhabitants/year in the most urban group and 78.6 per 100,000 inhabitants/year in the most rural group. The lowest mortality rate was found in centrality group 2 (57.9 per 100,000 inhabitants/year). For centrality group 6 versus group 2, the risk of death was increased (relative risk, 1.36; 95%CI: 1.11-1.66; p<0.01). The most common causes of death were transport injury, self-harm, falls, and other external causes. The steepest urban-rural gradient was seen for transport injuries, with a relative risk of 3.32 (95%CI: 1.81-6.10; p<0.001) for group 6 compared with group 1. There was a significantly increasing risk for severe non-fatal injuries from urban to rural areas. Group 2 had the lowest risk for non-fatal injuries (1531 per 100,000 inhabitants/year) and group 6 the highest (1803 per 100,000 inhabitants/year). The risk for non-fatal injuries increased with increasing rurality, with a relative risk of 1.07 (95%CI: 1.02-1.11; p<0.01) for group 6 versus group 1.

CONCLUSIONS

Fatal and non-fatal injury risks increased in parallel with increasing rurality. The lowest risk was in the second most urban region, followed by the most urban (capital) region, yielding a J-shaped risk curve. Transport injuries had the steepest urban-rural gradient.

Assessment of prehospital care in canine trauma patients presented to Veterinary Trauma Centers: A VetCOT registry study

OBJECTIVE

To analyze the epidemiology of veterinary care in canine trauma patients prior to presentation to a Veterinary Trauma Center (VTC).

DESIGN

Retrospective observational cross-sectional study.

METHODS

 Retrospective descriptive analysis from 22,998 canine case records from the Veterinary Trauma Registry from September 2013 through April 2018. Analysis was focused on the type of injury, care provider, and care provided prior presentation to a VTC (pre-VTC care). A log-likelihood ratio test was used to test for association of outcome and pre-VTC care. Mann-Whitney U tests were used to compare modified Glasgow Coma Scale and Animal Trauma Triage (ATT) scores between pre-VTC and non-pre-VTC care groups.

MEASUREMENTS AND MAIN RESULTS

Pre-VTC care was provided in 5636 out of 22,998 dogs (24.5%) by veterinarians (81%), owners (19.6%), and first responders (0.03%). The most common nonveterinary interventions included wound care and bandaging in 42% and 39% of the patients, respectively. Mortality was higher in the pre-VTC care group (8.7% vs 7.5%); dogs receiving pre-VTC care were 1.5 times (95% confidence interval [CI], 1.15-1.88) more likely to die and 1.2 times (95% CI, 1.07-1.37) more likely to be euthanized. The ATT scores were significantly higher in dogs receiving pre-VTC care (mean = 2.53 vs 1.78; p < 0.0001).

CONCLUSION

Our data demonstrate that the majority of more severely injured dogs receiving pre-VTC care obtained care by a veterinarian. Dogs receiving pre-VTC care possessed a greater mortality rate but also a greater ATT score; therefore, mortality rate is more likely related to severity of trauma rather than reception of pre-VTC care. We propose that these data should prompt further research and education about prehospital care in veterinary medicine.

Cardiopulmonary resuscitation (CPR) training strategies in the times of COVID-19: a systematic literature review comparing different training methodologies

BACKGROUND

Traditional, instructor led, in-person training of CPR skills has become more challenging due to COVID-19 pandemic. We compared the learning outcomes of standard in-person CPR training (ST) with alternative methods of training such as hybrid or online-only training (AT) on CPR performance, quality, and knowledge among laypersons with no previous CPR training.

METHODS

We searched PubMed and Google Scholar for relevant articles from January 1995 to May 2020. Covidence was used to review articles by two independent researchers. Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess quality of the manuscripts.

RESULTS

Of the 978 articles screened, twenty met the final inclusion criteria. All included studies had an experimental design and moderate to strong global quality rating. The trainees in ST group performed better on calling 911, time to initiate chest compressions, hand placement and chest compression depth. Trainees in AT group performed better in assessing scene safety, calling for help, response time including initiating first rescue breathing, adequate ventilation volume, compression rates, shorter hands-off time, confidence, willingness to perform CPR, ability to follow CPR algorithm, and equivalent or better knowledge retention than standard teaching methodology.

CONCLUSION

AT methods of CPR training provide an effective alternative to the standard in-person CPR for large scale public training.

Emergency service experience following the terrorist attack in Mogadishu, 14 October 2017, a scene of lay rescuer triage

BACKGROUND

A suicide bomber attack occurred in Somalia's capital city of Mogadishu on October 14, 2017. Over 500 people died, making it the third largest suicide bombing attack in world history. In this study, we aimed to share our experience and to discuss the importance of triage and prehospital care systems.

METHODS

These retrospective data included data from patients who suffered from severe explosions. Patient triage was performed using the START (Simple Triage and Rapid Treatment) triage algorithm at the entrance of the hospital. The patients included in the study were classified according to their age, sex, triage code, location of their major injury, department to which they were admitted, and discharge and/or exit status.

RESULTS

The patients included 188 (74.6%) males, and the mean age was 30.94 ± 12.23 years (range, 1-80 years). Eighty-six (34.1%) patients were marked with a red code indicating major injury, and 138 (54.8%) patients had superficial injuries. A total of 173 (68.7%) patients were managed in the emergency department (ED), and 7 (2.8%) patients died in the first 24 h. Multiple trauma injuries were detected in 43 (17.1%) patients, and 31 (12.3%) patients were admitted to the orthopedics department.

CONCLUSION

Disaster management in a terrorist event requires rapid transport, appropriate triage, effective surgical approaches, and specific postoperative care. In this event, almost all patients were brought to the ED by lay rescuers. Appropriate triage algorithms for the public can be designed; for instance, green code: walking patient; yellow code: patient who is moving and asking for help; red code: unmoving or less mobile patient who is breathing; black code: nonbreathing patient.

Immediate response to major incidents: defining an immediate responder!

PURPOSE

There is a gap in time between the occurrence of a mass casualty incident (MCI) and the arrival of the first responders to the scene, which offers an opportunity for the public (immediate responders) to perform life-saving measures. The purpose of this study was to identify these measures and the public's willingness to conduct them.

METHOD

An extensive literature review was performed to identify the possible measures that can be undertaken by the public. A group of experts were asked to prioritize and rank the feasibility of performing the measures by the public. Finally, the public was asked whether they were willing to do the chosen measures before and after an appropriate education.

RESULTS

Twenty different measures were identified and presented in a questionnaire as statements, which were prioritized and ranked by the expert group into four categories: what (1) should be done, (2) is good to know how, (3) is not necessary to know, and (4) should not be done. All statements were converted into understandable statements and were sent to the public. There were some differences and some agreements between the experts and the public regarding what an immediate responder should do. However, the willingness of the public to perform most of the measures was high and increased after being offered an appropriate education.

CONCLUSION

The use of immediate responders is a life-saving approach in MCIs and in situations when every minute counts and every human resource is an invaluable asset. Multiple steps, such as education, empowerment, and access, should be taken into consideration to enable bystanders to effectively help struggling survivors.

Visual estimates of blood loss by medical laypeople: Effects of blood loss volume, victim gender, and perspective

A severe hemorrhage can result in death within minutes, before professional first responders have time to arrive. Thus, intervention by bystanders, who may lack medical training, may be necessary to save a victim's life in situations with bleeding injuries. Proper intervention requires that bystanders accurately assess the severity of the injury and respond appropriately. As many bystanders lack tools and training, they are limited in terms of the information they can use in their evaluative process. In hemorrhage situations, visible blood loss may serve as a dominant cue to action. Therefore, understanding how medically untrained bystanders (i.e., laypeople) perceive hemorrhage is important. The purpose of the current study was to investigate the ability of laypeople to visually assess blood loss and to examine factors that may impact accuracy and the classification of injury severity. A total of 125 laypeople watched 78 short videos each of individuals experiencing a hemorrhage. Victim gender, volume of blood lost, and camera perspective were systematically manipulated in the videos. The results revealed that laypeople overestimated small volumes of blood loss (from 50 to 200 ml), and underestimated larger volumes (from 400 to 1900 ml). Larger volumes of blood loss were associated with larger estimation errors. Further, blood loss was underestimated more for female victims than male victims and their hemorrhages were less likely to be classified as life-threatening. These results have implications for training and intervention design.

"Stop the Bleed" Education Assessment Tool (SBEAT): Development and Validation

As part of the national Stop the Bleed campaign in the United States, more than a million people have received bleeding control training through the work of many organizations. These public and professional educational experiences are ideally grounded in health sciences, clinical, and educational evidence to be most effective. However, there is currently no standard tool for evaluating the educational quality of these programs. We developed and validated the Stop the Bleed Education Assessment Tool (SBEAT) to provide a standard measure of life-threatening bleeding educational programs knowledge learning outcomes to aid in evaluation and development of this public health program.

The SBEAT development included medical, clinical, and educational experts to derive and validate learning outcomes. Specific item writing incorporated focus groups for input on language and then pilot testing before a full community pilot test established a data set, for which a Rasch methodology was applied. The resulting tool used 34 items embedded in 19 survey questions, with item separation statistic of 5.56 (0.97 reliability) and person separation statistic of 2.09 (0.81 reliability) for 171 persons. Overall, the Cronbach Alpha (KR-20) person score “test reliability” equaled 0.85 (SEM = 2.24).

The SBEAT project establishes a standardized assessment tool to evaluate the cognitive aspects of first aid for life threatening bleeding. Comparison of outcomes from different teaching styles and methods will allow for the development of best practices for future bleeding control education and help organizations demonstrate value to learners, funders, and policy makers, and advance health sciences education. SBEAT offers a measure for which educational efficiency and efficacy can be judged within a larger effort to prepare people for personal emergencies or large-scale disasters.

Cardiopulmonary resuscitation level of knowledge among allied health university students in Jordan: a cross-sectional study

OBJECTIVE

To explore the level of cardiopulmonary resuscitation (CPR) knowledge among allied health professions (AHPs) students and its associated factors.

METHODS

This is a cross-sectional study assessing CPR knowledge among AHP students. A multidisciplinary expert panel designed a survey, which then was piloted to 20 potential participants. The survey had two sections, including demographics and knowledge questions. Knowledge questions scores ranged from 0 to 10, where 10 indicates all questions were answered correctly.

RESULTS

A total of 883 students completed the surveys and were included in the study. The mean age was 21 years (±1.6) and the majority were females (73.1%). A total of 693 (78.5%) students did not receive previous CPR training and the top barriers to receiving CPR training were unawareness of training opportunities and a lack of time. Participants had a mean CPR knowledge score of 3.9 (±1.7) out of 10 maximum potential points. Trained participants had a higher mean score compared with the untrained (4.6 (±1.6) vs 3.8 (±1.6), p<0.001). Previous training (adjusted β=0.6; 95% CI 0.2 to 0.9; p<0.001) and being in the physical therapy programme (adjusted β=0.5; 95% CI 0.1 to 0.8; p=0.01) were associated with higher knowledge.

CONCLUSION

There is poor knowledge of CPR among AHP students including trained individuals. Efforts to increase the awareness of CPR should target students and professionals who are highly likely to encounter patients requiring CPR. Compulsory training courses, shorter training periods as well as recurrent and regular refreshing courses and use of various media devices are recommended.

Medical Students Can be Trained to be Life-Saving First Aid Instructors for Laypeople: A Feasibility Study from Gaza, Occupied Palestinian Territory

INTRODUCTION

Bystanders can improve the outcome in emergencies by activating the "chain of survival." Gaza's (Palestine) population has little, if any, access to training in Basic Life Support (BLS) and cardiopulmonary resuscitation (CPR). The goal was to recruit local medical students to be life-saving first aid instructors, and have them train 3,000 laypeople in BLS and CPR.

METHODS

One hundred and seventeen medical students from Al Azhar University-Gaza (Gaza City, Palestine) were trained as BLS and CPR instructors. Twelve training hours were delivered in practical BLS and CPR skills, plus four in communication and didactical skills, to enable training of laypeople. Students answered a questionnaire exploring demographics, prior training experience, expectations, and motivation to join the training. Teaching material were developed after the European Resuscitation Council (ERC; Niel, Belgium) guidelines and similar training at The Arctic University of Norway (Tromsø, Norway).

RESULTS

A total of 117 medical students (52.1% female; 47.9% male), from third through sixth year, completed training, and all were in their early twenties. Ninety-five (81.2%) agreed to answer the questionnaire. Of those, five students lost family members during Israeli military operations. Eighty-two (70.1%) never had hands-on first aid training. Seventy-six (80.0%) hoped the training would improve their community's response to emergencies. With 58 training sessions completed, 1,312 laypeople (596 males; 716 females) were trained: 5.52 lay trainees per student instructor. The majority (n = 1,012; 77.1%) were school students aged 13-20 years.

CONCLUSION

It is feasible to recruit local medical students for practical BLS and CPR trainings targeting laypeople in communities under stress. The training impact on local resilience and patients' outcomes need further studies.

Management of Preventable Deaths due to Road Traffic Injuries in Prehospital Phase; a Qualitative Study

INTRODUCTION

Prehospital care plays an important role in decreasing the number of deaths due to road traffic injuries (RTIs). This study aimed to identify the challenges of preventable deaths due to RTIs in the prehospital phase based on the attitudes of stakeholders.

METHODS

Conventional content analysis of qualitative study was used to analyze the data. The participants were 24 RTI prevention experts from fire-fighting organization, traffic police, the Red Crescent, Emergency Medical Services staff, emergency medicine specialists, and hospital emergency nurses who were selected by means of purposive sampling. Data were collected using unstructured interviews and analyzed by means of data coding, followed by extracting sub-categories, and main categories.

RESULTS

Six main categories were extracted as the major challenges of preventable deaths in RTIs in the prehospital phase including "poor management of the crash scene" with two subcategories of lack of rapid access to the patient and lack of scene safety, "lack of adequate rules and regulations" with two subcategories of lack of protocols and guidelines and lack of clear duties checklists, "poor management of time" with two subcategories of elongated response time at the crash scene and elongated time of victim transport, "low quality of training" with two subcategories of insufficient training of Emergency Medical Services (EMS) staff and inadequate public training, "poor communication and coordination" with two subcategories of poor communication of EMS staff and lack of uniform commandership at the crash scene, and "low quality of victim management" with two subcategories of low quality of clinical care and lack of accurate clinical assessment.

CONCLUSION

The following measures are necessary to reduce preventable deaths due to RTIs in the prehospital phase: accurate clinical assessment of the victim on the scene, provision of high quality and accurate clinical care, enforcement of legal obligations and using protocols in the field of victim management, coordination of the involved organizations through identifying the duties and responsibilities of each organization, and full management of the crash scene by assigning a unique commander to each unit and creation of the highest level of safety on crash scene.

Empowering Bystanders to Intervene: Trauma Responders Unify to Empower (TRUE) Communities

BACKGROUND

Timely and effective bystander first aid can improve outcomes for trauma victims. Bystanders are present at most traumas and are more likely to assist with prior training.

MATERIALS AND METHODS

An evidence-based course was created for the general public in high-risk Chicago neighborhoods focused on basic traumatic first aid, including scene management, hemorrhage control, and mitigating the psychological impact of trauma to overcome the bystander effect. Prospectively, participants completed knowledge-based and self-efficacy assessments precourse, postcourse, and 6 mo follow-up. The change in self-efficacy and knowledge scores was analyzed.

RESULTS

Over 32 courses, 503 participants were taught; 474 and 460 participants completed precourse and postcourse surveys, respectively, whereas 60 of 327 who consented for follow-up completed the 6-mo survey. Postcourse, participants were more likely to assist trauma victims and felt more confident in the quality of care they could provide; the effect remained significant at 6 mo (all P < 0.001). All seven self-efficacy empowerment-based questions individually demonstrated improvement from precourse to postcourse (P < 0.001), with an overall mean (SD) increase of 2.8 (2.1, P < 0.001); six maintained significance at follow-up with an overall mean increase of 2.8 (1.9, P < 0.001). Knowledge scores improved from 6.2 of 10 to 7.2 postcourse and 7.7 at follow-up (P < 0.001). Most improved were the ability to render first aid and apply tourniquets.

CONCLUSIONS

The TFRC increased self-efficacy, successfully teaching initial trauma care, particularly hemorrhage control and scene safety, suggesting that a grassroots approach to trauma care may improve outcomes in communities that experience high violence rates.

What Happens After a Stop the Bleed Class? The Contrast Between Theory and Practice

OBJECTIVE

The Department of Homeland Security launched the Stop the Bleed initiative, a campaign intended to teach bystanders hemorrhage control strategies. Despite the program's popularity, little is known about actions taken by participants afterwards. We sought to determine how often participants acquired the equipment that is necessary in applying the skills taught.

DESIGN

A standardized survey instrument was distributed to all American College of Surgeons Bleeding Control Basic (B-Con) class participants from 05/2017 to 01/2018. The instrument queried about the likelihood of applying skills and obtaining materials. A web-based survey was administered one month later inquiring whether materials were obtained and barriers that would prohibit acquisition.

SETTING

Academic, urban, Level I trauma center.

PARTICIPANTS

Healthcare and nonhealthcare personnel.

RESULTS

There were 336 and 183 participants who completed the initial and subsequent web-based survey, respectively. Participants indicated a high likelihood of applying a tourniquet (95.5%), applying pressure (97.9%), and packing a wound (96.4%), if required. Additionally, 74.7% and 76.2% reported a high likelihood of obtaining a tourniquet and packing material, respectively. However, only 21.3% and 50.8% obtained a tourniquet and packing material, respectively, 1 month later. Cost, time, and accessibility of items during a time of need were cited to be common reasons for not obtaining these materials.

CONCLUSIONS

Despite reporting a high likelihood of utilizing hemorrhage control skills upon completion of the B-Con class, few went on to acquire the materials needed to apply these skills among those who responded. These results may be impacted by loss of follow up and response bias. Developing strategies that allow for easy access to materials is imperative and may lead to both better implementation of the purposes of the program and improved dissemination of its principles within the community.

Can they stop the bleed? Evaluation of tourniquet application by individuals with varying levels of prior self-reported training

BACKGROUND

Application of extremity tourniquets is a central tenet of multiple national initiatives to empower laypersons to provide hemorrhage control (HC). However, the efficacy of the general population who self-report prior first-aid (FA) or HC training on individual's ability to control bleeding with a tourniquet remains unknown. Therefore, the objective of this study was to assess the effectiveness of laypeople with self-reported prior FA or HC training to control bleeding with a tourniquet.

STUDY DESIGN

Employees of a stadium were assessed via simulation in their ability to apply a Combat Application Tourniquet. As a subgroup analysis of a larger study, participants who self-reported: 1) No prior training, 2) FA training only or 2) FA + HC training were compared. Logistic regression adjusting for age, gender, education, willingness-to-assist, and comfort level in HC was performed.

RESULTS

317 participants were included. Compared to participants with no prior training (14.4%,n = 16/111), those with FA training only (25.2%,n = 35/139) had a 2.12-higher odds (95%CI:1.07-4.18) of correct tourniquet application while those with FA + HC (35.8%,n = 24/67) had a 3.50-higher odds (95%CI:1.59-7.72) of correct application. Participants with prior FA + HC were more willing-to-assist and comfortable performing HC than those without prior training (p < 0.05). However, reporting being very willing-to-assist [OR0.83,95%CI:0.43-1.60] or very comfortable [OR1.11,95%CI:0.55-2.25] was not associated with correct tourniquet application.

CONCLUSION

Self-reported prior FA + HC training, while associated with increased likelihood to correctly apply a tourniquet, results in only 1/3 of individuals correctly performing the skill. As work continues in empowering and training laypeople to act as immediate responders, these findings highlight the importance of effective layperson education techniques.

Nursing students' knowledge, willingness, and attitudes toward the first aid behavior as bystanders in traffic accident trauma: A cross-sectional survey

Objectives

The purpose of the study was to investigate the nursing students’ levels of the knowledge, willingness, and attitudes toward first aid behavior as bystanders in road traffic accident and the related factors.

Methods

A total of 475 nursing students were recruited by convenience choosing in Tianjin University of Traditional Chinese Medicine. The nursing students’ self-efficacy, core self-evaluation, knowledge, willingness and attitudes toward first aid behavior as bystanders in traffic accidents were investigated with a self-designed questionnaire.

Results

The scores of knowledge, willingness, and attitudes toward first aid behavior in traffic accident trauma were 7.51 ± 1.93, 15.54 ± 5.03, and 7.73 ± 1.56, respectively. Students who once gained training of first aid showed lower levels of attitude toward first aid behavior than those untrained (t = −2.345, P = 0.019). It was found that self-efficacy was correlated to the knowledge (r = 0.150, P < 0.001), willingness (r = 0.182, P < 0.004) and attitudes toward behavior of the first aid (r = 0.371, P < 0.001) among nursing students. Core self-evaluation was correlated to knowledge (r = 0.193, P < 0.001) and attitudes toward behavior of the first aid (r = 0.199, P < 0.001).

Conclusions

The first aid knowledge among nursing students was not satisfactory. The study suggested that an unsustainable short first-aid training program may bring negative effects. Countermeasures should be taken to ensure both quality and continuity of first aid training. Meanwhile, more attention should be paid to improving the self-efficacy and core self-evaluation of the nursing students.

Response times by the police and ambulance services at motor vehicle crashes in the West Mercia region

The relative response times of the ambulance and police services at serious motor vehicle crashes in the West Mercia region of the UK are reported. The police often arrive before the ambulance service. The types of immediate medical care which the police and other non-medical responders might administer are discussed.

Laypeople roles at road traffic crash scenes: a systematic review

This study aimed to identify the roles of laypeople at road traffic injuries (RTIs). A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of 'laypeople', 'layman', 'layperson', 'bystander', 'first responder', 'lay first responder', 'road traffic', 'road traffic injury', 'crash injury', 'crash scene', 'emergency', 'trauma care', and 'prehospital trauma care' were used in combination with the Boolean operators OR and AND. We did electronic search on Google Scholar, PubMed, ISI Web of Science, CINAHL, Science Direct, Scopus, ProQuest. Based on the reviewed studies, some factors such as cultural conditions, knowledge, relief agencies, and demographic factors affect the interventions of laypeople at the crash scene in functional areas. Regarding the permanent presence of people at the crash scene, the present study can provide an opportunity to reduce different side effects of RTIs imposed on the society.

Expanding Understanding of Response Roles: An Examination of Immediate and First Responders in the United States

2017 was a record year for disasters and disaster response in the U.S. Redefining and differentiating key response roles like “immediate responders” and “first responders” is critical. Traditional first responders are not and cannot remain the only cadre of expected lifesavers following a mass casualty event. The authors argue that the U.S. needs to expand its understanding of response roles to include that of the immediate responders, or those individuals who find themselves at the incident scene and are able to assist others. Through universal training and education of the citizenry, the U.S. has the opportunity increase overall disaster resiliency and community outcomes following large-scale disasters. Such education could easily be incorporated into high school curriculums or other required educational experiences in order to provide all persons with the knowledge, skills, and basic abilities needed to save lives immediately following a disaster.

Are prehospital deaths from trauma and accidental injury preventable? A direct historical comparison to assess what has changed in two decades

BACKGROUND & OBJECTIVES

In 1994, Hussain and Redmond revealed that up to 39% of prehospital deaths from accidental injury might have been preventable had basic first aid care been given. Since then there have been significant advances in trauma systems and care. The exclusion of prehospital deaths from the analysis of trauma registries, giv en the high rate of those, is a major limitation in prehospital research on preventable death. We have repeated the 1994 study to identify any changes over the years and potential developments to improve patient outcomes.

METHODS

We examined the full Coroner's inquest files for prehospital deaths from trauma and accidental injury over a three-year period in Cheshire. Injuries were scored using the Abbreviated-Injury-Scale (AIS-1990) and Injury Severity Score (ISS), and probability of survival estimated using Bull's probits to match the original protocol.

RESULTS

One hundred and thirty-four deaths met our inclusion criteria; 79% were male, average age at death was 53.6 years. Sixty-two were found dead (FD), fifty-eight died at scene (DAS) and fourteen were dead on arrival at hospital (DOA). The predominant mechanism of injury was fall (39%). The median ISS was 29 with 58 deaths (43%) having probability of survival of >50%. Post-mortem evidence of head injury was present in 102 (76%) deaths. A bystander was on scene or present immediately after injury in 45% of cases and prior to the Emergency Medical Services (EMS) in 96%. In 93% of cases a bystander made the call for assistance, in those DAS or DOA, bystander intervention of any kind was 43%.

CONCLUSIONS

The number of potentially preventable prehospital deaths remains high and unchanged. First aid intervention of any kind is infrequent. There is a potentially missed window of opportunity for bystander intervention prior to the arrival of the ambulance service, with simple first-aid manoeuvres to open the airway, preventing hypoxic brain injury and cardiac arrest.

Prehospital deaths from trauma: Are injuries survivable and do bystanders help?

BACKGROUND AND OBJECTIVES

Deaths from trauma occurring in the prehospital phase of care are typically excluded from analysis in trauma registries. A direct historical comparison with Hussain and Redmond's study on preventable prehospital trauma deaths has shown that, two decades on, the number of potentially preventable deaths remains high. Using updated methodology, we aimed to determine the current nature, injury severity and survivability of traumatic prehospital deaths and to ascertain the presence of bystanders and their role following the point of injury including the frequency of first-aid delivery.

METHODS

We examined the Coroners' inquest files for deaths from trauma, occurring in the prehospital phase, over a three-year period in the Cheshire and Manchester (City), subsequently referred to as Manchester, Coronial jurisdictions. Injuries were scored using the Abbreviated-Injury-Scale (AIS-2008), Injury Severity Score (ISS) calculated and probability of survival estimated using the Trauma Audit and Research Network's outcome prediction model.

RESULTS

One hundred and seventy-eight deaths were included in the study (one hundred and thirty-four Cheshire, forty-four Manchester). The World Health Organisation's recommendations consider those with a probability of survival between 25-50% as potentially preventable and those above 50% as preventable. The median ISS was 29 (Cheshire) and 27.5 (Manchester) with sixty-two (46%) and twenty-six (59%) respectively having a probability of survival in the potentially preventable and preventable ranges. Bystander presence during or immediately after the point of injury was 45% (Cheshire) and 39% (Manchester). Bystander intervention of any kind was 25% and 30% respectively. Excluding those found dead and those with a probability of survival less than 25%, bystanders were present immediately after the point of injury or "within minutes" in thirty-three of thirty-five (94%) Cheshire and ten of twelve (83%) Manchester. First aid of any form was attempted in fourteen of thirty-five (40%) and nine of twelve (75%) respectively.

CONCLUSIONS

A high number of prehospital deaths from trauma occur with injuries that are potentially survivable, yet first aid intervention is infrequent. Following injury there is a potential window of opportunity for the provision of bystander assistance, particularly in the context of head injury, for simple first-aid manoeuvres to save lives.

We need to include bystander first aid in trauma research

Background

The chain of trauma survival is a concept that originated in the area of out-of-hospital cardiac arrest (OHCA) and was adapted to the treatment of trauma. In out-of-hospital cardiac arrest research into bystander first aid has resulted in improved outcome. Whereas, in trauma research the first link of the chain of survival is almost ignored.

Methods

In OHCA, cardiopulmonary resuscitation (CPR) from bystanders has been subject of a vast amount of research, as well as measures and programs to raise the rate of bystander CPR to cardiac arrest victims. These efforts have resulted in improved survival. The research effort has been well grounded in the research community, as demonstrated by its natural inclusion in the uniform reporting template (Utstein) for the treatment of OHCA. In trauma the bystander may contribute by providing an open airway, staunch bleedings, or prevent hypothermia. In trauma however, while the chain of survival has been adopted along with it distinct links, including bystander first aid, the consensus-based uniform reporting template for trauma (the Utstein template) does not include the bystander first aid efforts. There is extremely little research on what first aid measures bystanders provide to trauma victims, and on what impact such measures have on outcome. An important step to improve research on bystander first aid in trauma would be to include this as part of the uniform reporting template for trauma

Conclusion

The lack of research on bystander first aid makes the first link in the trauma chain of survival the weakest link. We, the trauma research community, should either improve our research and knowledge in this area, or remove the link from the chain of survival

Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study

BACKGROUND

Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated.

METHODS

For 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed.

RESULTS

A total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid.

DISCUSSION

Overall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect.

CONCLUSION

This study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers' possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.

A nationwide survey of first aid training and encounters in Norway

Background

Bystander first aid can improve survival following out-of-hospital cardiac arrest or trauma. Thus, providing first aid education to laypersons may lead to better outcomes. In this study, we aimed to establish the prevalence and distribution of first aid training in the populace, how often first aid skills are needed, and self-reported helping behaviour.

Methods

We conducted a telephone survey of 1000 respondents who were representative of the Norwegian population. Respondents were asked where and when they had first aid training, if they had ever encountered situations where first aid was necessary, and stratified by occupation. First aid included cardio-pulmonary resuscitation (CPR) and basic life support (BLS). To test theoretical first aid knowledge, respondents were subjected to two hypothetical first aid scenarios.

Results

Among the respondents, 90% had received first aid training, and 54% had undergone first aid training within the last 5 years. The workplace was the most common source of first aid training. Of the 43% who had been in a situation requiring first aid, 89% had provided first aid in that situation. There were considerable variations among different occupations in first aid training, and exposure to situations requiring first aid. Theoretical first aid knowledge was not as good as expected in light of the high share who had first aid training. In the presented scenarios 42% of respondent would initiate CPR in an unconscious patient not breathing normally, and 46% would provide an open airway to an unconscious road traffic victim. First aid training was correlated with better theoretical knowledge, but time since first aid training was not.

Conclusions

A high proportion of the Norwegian population had first aid training, and interviewees reported high willingness to provide first aid. Theoretical first aid knowledge was worse than expected. While first aid is part of national school curriculum, few have listed school as the source for their first aid training.

Electronic supplementary material

The online version of this article (doi:10.1186/s12873-017-0116-7) contains supplementary material, which is available to authorized users.

Bystander first aid in trauma - prevalence and quality: a prospective observational study

Background

Bystander first aid and basic life support can likely improve victim survival in trauma. In contrast to bystander first aid and out‐of‐hospital cardiac arrest, little is known about the role of bystanders in trauma response. Our aim was to determine how frequently first aid is given to trauma victims by bystanders, the quality of this aid, the professional background of first‐aid providers, and whether previous first‐aid training affects aid quality.

Methods

We conducted a prospective 18‐month study in two mixed urban–rural Norwegian counties. The personnel on the first ambulance responding to trauma calls assessed and documented first aid performed by bystanders using a standard form.

Results

A total of 330 trauma calls were included, with bystanders present in 97% of cases. Securing an open airway was correctly performed for 76% of the 43 patients in need of this first‐aid measure. Bleeding control was provided correctly for 81% of 63 patients for whom this measure was indicated, and prevention of hypothermia for 62% of 204 patients. Among the first‐aid providers studied, 35% had some training in first aid. Bystanders with documented first‐aid training gave better first aid than those where first‐aid training status was unknown.

Conclusions

A majority of the trauma patients studied received correct pre‐hospital first aid, but still there is need for considerable improvement, particularly hypothermia prevention. Previous first‐aid training seems to improve the quality of first aid provided. The effect on patient survival needs to be investigated.