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Linz MS, Dossou-Kitti E, Padmanaban V, Maloney M, Jalloh S, Balarezo LL, Sule H, Johnston PF, Sifri ZC. Train the Trainer in Bleeding Control: A Two-Year Pilot Study in Low-Income and Middle-Income Countries. J Surg Res 2023; 284:17-23. [PMID: 36527766 DOI: 10.1016/j.jss.2022.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/12/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Traumatic hemorrhage represents a major cause of mortality in low-income and middle-income countries (LMICs). Thus, LMICs can benefit from improvements to prehospital hemorrhage management. One strategy is implementation of a bleeding control course using the "train the trainer" model (TTT) to increase course availability. The Stop the Bleed (STB) campaign provides laypeople with basic knowledge and skills of hemorrhage control. While the feasibility and success of the STB course have been demonstrated in the United States, course dissemination in LMICs has been slower and its feasibility using the TTT model has not been established. MATERIALS AND METHODS From December 2017 to January 2019, instructors from the International Surgical Health Initiative conducted seven surgical humanitarian trips and taught 10 index 1-h STB training sessions across six LMICs. LMIC instructors were encouraged to continue providing STB courses following departure of the visiting instructors. Course data were collected from sign-in sheets and analyzed using Microsoft Excel. RESULTS Ten index courses conducted by United States-trained STB experts trained 35 LMIC instructors over 2 y. Six of 35 offered 12 additional courses, certifying 323 new trainees, an 823% increase from the initial cohort. Overall, implementation of the TTT model yielded 22 STB courses in six LMICs, producing 358 new trainees. CONCLUSIONS This pilot study shows the STB TTT model was feasible and effective in expanding bleeding control trainer capacity in four of six LMICs. Use of the TTT model in LMICs may represent a means to increase STB course availability and is one strategy to improve prehospital hemorrhage control in LMICs.
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Affiliation(s)
| | | | - Vennila Padmanaban
- Rutgers New Jersey Medical School, Department of Surgery, Newark, New Jersey
| | - Monica Maloney
- University of Connecticut School of Medicine, Department of Surgery, Farmington, Connecticut
| | - Samba Jalloh
- University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | | | - Harsh Sule
- Rutgers New Jersey Medical School, Department of Emergency Medicine, Newark, New Jersey
| | | | - Ziad C Sifri
- Rutgers New Jersey Medical School, Department of Surgery, Newark, New Jersey
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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.
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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.
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Kirkpatrick AW, McKee JL, Conly JM, Flemons K, Hawkins W. Smarter faster just-in-time hemorrhage control: A pilot evaluation of remotely piloted aircraft system delivered STOP-THE-BLEED equipment with just-in-time remote telementored deployment. Heliyon 2023; 9:e12985. [PMID: 36820166 PMCID: PMC9938468 DOI: 10.1016/j.heliyon.2023.e12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Introduction Remotely Piloted Aircraft Systems (RPAS) can access patients inaccessible to traditional rescue. Just-in-time remote telementoring (RTM) of naïve users to self-care could potentially address challenges in salvaging exsanguination in remote environments. Methods An exsanguination self-application task was established in a wilderness location. Three volunteers-initiated distress calls to prompt RPAS precision delivered STOP-THE-BLEED kits, after which a remote mentor directed the volunteers how to self-care. Results Limited connectivity prevented video, however each volunteer delivered images and initiated conversation with the mentor pre-RPAS arrival. Thereafter, all subjects were able to unpack and deploy hemorrhage control adjuncts under verbal direction, and to simulate self-application. All subjects were able to successfully apply wound-clamps, tourniquets, and pack wounds although one had insufficient pressure. Discussion RPASs can deliver supplies long before human rescuers, and communication connectivity might allow remote mentoring in device application. Further development of technology and self-care paradigms for exsanguination are encouraged.
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Affiliation(s)
- Andrew W. Kirkpatrick
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada,Department of Critical Care Medicine, Canada,Department of Surgery, Canada,Trauma Program, Foothills Medical Centre, Calgary, Alberta, Canada,University of Calgary, Canada,Corresponding author. Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada.
| | - Jessica L. McKee
- Tele-Mentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group, Calgary, Alberta, Canada
| | - John M. Conly
- University of Calgary, Canada,Department of Medicine, University of Calgary, Calgary, Alberta, Canada,W21C, O’ Brien Institute for Public Health University of Calgary, Calgary, Alberta, Canada
| | - Kristin Flemons
- University of Calgary, Canada,W21C, O’ Brien Institute for Public Health University of Calgary, Calgary, Alberta, Canada
| | - Wade Hawkins
- Centre for Innovation and Research in Unmanned Systems (CIRUS), Southern Alberta Institute of Technology (SAIT), Calgary, Alberta, Canada
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Stadeli KM, Sonett D, Conrick KM, Moore M, Riesenberg M, Bulger EM, Meischke H, Vavilala MS. Perceptions of Prehospital Care for Patients With Limited English Proficiency Among Emergency Medical Technicians and Paramedics. JAMA Netw Open 2023; 6:e2253364. [PMID: 36705920 DOI: 10.1001/jamanetworkopen.2022.53364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Patients with limited English proficiency (LEP) experience disparities in prehospital care. On-scene interactions between patients with LEP and emergency medical services (EMS) providers (ie, firefighters/emergency medical technicians [EMTs] and paramedics) are critical to high-quality care and have been minimally explored. OBJECTIVE To identify EMS-perceived barriers and facilitators to providing high-quality prehospital care for patients with LEP. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, semi-structured focus groups were conducted with firefighters/EMTs and paramedics with all levels of experience from urban areas with a high proportion of residents with LEP from July to September 2018. Data were analyzed from July 2018 to May 2019. EXPOSURES Providing prehospital care for patients with LEP. MAIN OUTCOMES AND MEASURES The main outcomes were barriers and facilitators to prehospital care for patients with LEP, assessed using thematic analysis. Four domains of interest were examined: (1) overall impressions of interactions with patients with LEP, (2) barriers and facilitators to communication, (3) barriers and facilitators to providing care, and (4) ideas for improving prehospital care for patients with LEP. RESULTS Thirty-nine EMS providers participated in 8 focus groups: 26 firefighters/EMTs (66%) and 13 paramedics (33%). The median age of participants was 46 years (range, 23-63 years), and 35 (90%) were male. Participants described barriers to optimal care as ineffective interpretation, cultural differences, high-stress scenarios (eg, violent events), unclear acuity of patient's condition, provider bias, and distrust of EMS. Perceived facilitators to optimal care included using an on-scene interpreter, high-acuity disease, relying on objective clinical findings, building trust and rapport, and conservative decision-making regarding treatment and transport. Providers reported transporting most patients with LEP to hospitals regardless of illness severity due to concern for miscommunication and unrecognized problems. Better speed and technology for interpretation, education for communities and EMS providers, and community-EMS interactions outside emergencies were cited as potential strategies for improvement. CONCLUSIONS AND RELEVANCE In this study, EMS providers described many barriers to high-quality care during prehospital emergency response for patients with LEP yet were unaware that these barriers impacted quality of care. Barriers including ineffective interpretation, provider bias, distrust of EMS, and cultural differences may contribute to outcome disparities and overutilization of resources. Future work should focus on the development of targeted interventions to improve modifiable barriers to care, such as improving interpretation and cultural humility and increasing trust.
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Affiliation(s)
- Kathryn M Stadeli
- Department of Surgery, University of California, Davis, Sacramento
- Department of Surgery, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Dylan Sonett
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- Physical Sciences Division, University of Washington Bothell, Seattle
| | - Kelsey M Conrick
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Social Work, University of Washington, Seattle
| | - Megan Moore
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- School of Social Work, University of Washington, Seattle
| | - Matthew Riesenberg
- King County Medic One, King County Emergency Medical Services, Seattle, Washington
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Hendrika Meischke
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
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A randomized controlled pilot trial of video-modelling versus telementoring for improved hemorrhage control wound packing. Am J Surg 2022; 224:769-774. [DOI: 10.1016/j.amjsurg.2022.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
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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.
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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
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Matinrad N, Reuter-Oppermann M. A review on initiatives for the management of daily medical emergencies prior to the arrival of emergency medical services. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2021; 30:251-302. [PMID: 34566490 PMCID: PMC8449697 DOI: 10.1007/s10100-021-00769-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 05/31/2023]
Abstract
Emergency services worldwide face increasing cost pressure that potentially limits their existing resources. In many countries, emergency services also face the issues of staff shortage-creating extra challenges and constraints, especially during crisis times such as the COVID-19 pandemic-as well as long distances to sparsely populated areas resulting in longer response times. To overcome these issues and potentially reduce consequences of daily (medical) emergencies, several countries, such as Sweden, Germany, and the Netherlands, have started initiatives using new types of human resources as well as equipment, which have not been part of the existing emergency systems before. These resources are employed in response to medical emergency cases if they can arrive earlier than emergency medical services (EMS). A good number of studies have investigated the use of these new types of resources in EMS systems, from medical, technical, and logistical perspectives as their study domains. Several review papers in the literature exist that focus on one or several of these new types of resources. However, to the best of our knowledge, no review paper that comprehensively considers all new types of resources in emergency medical response systems exists. We try to fill this gap by presenting a broad literature review of the studies focused on the different new types of resources, which are used prior to the arrival of EMS. Our objective is to present an application-based and methodological overview of these papers, to provide insights to this important field and to bring it to the attention of researchers as well as emergency managers and administrators.
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Affiliation(s)
- Niki Matinrad
- Department of Science and Technology, Linköping University, Norrköping, 60174 Sweden
| | - Melanie Reuter-Oppermann
- Information Systems - Software and Digital Business Group, Technical University of Darmstadt, 64289 Darmstadt, Germany
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Chen H. From the Editor-in-Chief: the top papers from the North Pacific Surgical Association. Am J Surg 2020; 219:731. [PMID: 32418584 DOI: 10.1016/j.amjsurg.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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