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Standifird CH, Kaisler S, Triplett H, Lauria MJ, Fisher AD, Harrell AJ, White CC. Implementing Tourniquet Conversion Guidelines for Civilian EMS and Prehospital Organizations : A Case Report and Review. Wilderness Environ Med 2024; 35:223-233. [PMID: 38509815 DOI: 10.1177/10806032241234667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Since the first documented use of a tourniquet in 1674, the popularity of tourniquets has waxed and waned. During recent wars and more recently in Emergency Medical Services systems, the tourniquet has been proven to be a valuable tool in the treatment of life-threatening hemorrhage. However, tourniquet use is not without risk, and several studies have demonstrated adverse events and morbidity associated with tourniquet use in the prehospital setting, particularly when left in place for more than 2 h. Consequently, the US military's Committee on Tactical Combat Casualty Care has recommended guidelines for prehospital tourniquet conversion to reduce the risk of adverse events associated with tourniquets once the initial hemorrhage has been controlled. Emergency Medical Services systems that operate in rural, frontier, and austere environments, especially those with transport times to definitive care that routinely exceed 2 h, may consider implementing similar tourniquet conversion guidelines.
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Affiliation(s)
| | - Sean Kaisler
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Hunter Triplett
- Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV
| | - Michael J Lauria
- Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- Lifeguard Air Emergency Services, Albuquerque, NM, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Andrew J Harrell
- Division of Prehospital, Austere, and Disaster Medicine, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- Dr George Kennedy Center for Law Enforcement Operational Medicine, Albuquerque, NM, USA
- Grand Canyon National Park, Arizona, and New Mexico State Police and State Search and Rescue, Sante Fe, NM, USA
| | - Chelsea C White
- Division of Prehospital, Austere, and Disaster Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
- UNM Center for Rural and Tribal Medicine, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Katzenschlager S, Schneider NRE, Weilbacher F, Weigand MA, Popp E. Evaluating time until ligation in a novel tourniquet - A crossover randomized-controlled trial. Am J Emerg Med 2024; 79:97-104. [PMID: 38412670 DOI: 10.1016/j.ajem.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/16/2024] [Accepted: 02/17/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION AND AIM Severe external hemorrhage is a significant reason for morbidity and mortality in adults; thus, the swift and correct application of a tourniquet by laypersons can be lifesaving. We conducted this randomized-controlled cross-over study to investigate the use of a novel tourniquet. METHODS Participants were recruited at the Heidelberg University Hospital. Eligible participants were ≥ 18 years old with a medical background but without prior experience in applying a tourniquet. Participants were 1:1 randomized to the intervention group (PAX tourniquet) or the control group (SAM or CAT tourniquet). In the control group, participants underwent another randomization to either the SAM or CAT tourniquet without a predefined allocation ratio. Hyperspectral measurements were undertaken (i) before ligation, (ii) 30 s after ligation, and (iii) 30 s after the reopening of the tourniquet. The primary outcome was time until ligation before crossover between the respective groups. The analysis of secondary endpoints included all attempts to assess a possible learning effect, intraoperator variability, and hyperspectral measurements. Participants were crossed to the other study group after a brief wash-out phase. RESULTS In total, 50 participants were recruited, resulting in 100 attempts. A success rate of 98% was observed across the study population. Time until ligation was 49 s and 56 s (p = 0.572) in the intervention and control group, respectively. However, there was a significant difference between the PAX and SAM (54 vs 75 s; p = 0.037) and the SAM and CAT tourniquet (75 vs. 47 s; p = 0.015). Further, we observed a significant learning effect in participants allocated to the control group first, with a median reduction of 9 s in the time until ligation. Hyperspectral measurements showed a significant decrease in perfusion and tissue oxygenation after ligation. Further, a significant increase in perfusion and tissue oxygenation was found after reopening the tourniquet compared to the baseline measurement. CONCLUSION The novel PAX tourniquet can be applied quickly and effectively by medical personnel without prior experience in applying a tourniquet.
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Affiliation(s)
| | - Niko R E Schneider
- University of Southampton, Medical Faculty Campus Kassel, Department of Anaesthesiology and Critical Care Medicine.
| | - Frank Weilbacher
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology.
| | - Markus A Weigand
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology.
| | - Erik Popp
- Heidelberg University, Medical Faculty Heidelberg, Department of Anesthesiology.
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West C, Kaus B, Sullivan SO, Schneider H, Seifert O. Using infrared cameras in drones to detect bleeding events. BMC Emerg Med 2023; 23:142. [PMID: 38041028 PMCID: PMC10693069 DOI: 10.1186/s12873-023-00912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Hemorrhage is one of the main causes of death in trauma. Critical bleeding in patients needs to be detected as soon as possible to save the patient. Drones are gaining increasing importance in emergency services and can support rescue forces in accident scenarios such as a mass casualty incident. METHODS In this study, a simulated pelvic hemorrhage was detected using a drone from 7 m above the ground over a time span of 30 s. RESULTS The results allow a good detection of the pelvic hemorrhage. Nevertheless, the simulated blood cools down quickly. After 30 s, there was no significant temperature difference compared to the rest of the body. At this point, further assessment is only possible via the RGB image. CONCLUSION The findings suggest that bleeding from an open and continuously bleeding wound would most likely be detectable using the drone's thermal imaging camera, even over a longer period of time.
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Affiliation(s)
- Christoph West
- University of Applied Sciences Giessen, Wiesenstrasse 14, 35390, Giessen, Germany
| | - Bernhard Kaus
- University of Applied Sciences Giessen, Wiesenstrasse 14, 35390, Giessen, Germany
| | - Sean O' Sullivan
- Justus-Liebig-University Giessen, Ludwigstrasse 23, 35390, Giessen, Germany
| | - Henning Schneider
- University of Applied Sciences Giessen, Wiesenstrasse 14, 35390, Giessen, Germany
| | - Oskar Seifert
- University of Applied Sciences Giessen, Wiesenstrasse 14, 35390, Giessen, Germany.
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Steins K, Goolsby C, Grönbäck AM, Charlton N, Anderson K, Dacuyan-Faucher N, Prytz E, Andersson Granberg T, Jonson CO. Recommendations for Placement of Bleeding Control Kits in Public Spaces-A Simulation Study. Disaster Med Public Health Prep 2023; 17:e527. [PMID: 37852924 DOI: 10.1017/dmp.2023.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE Bleeding control measures performed by members of the public can prevent trauma deaths. Equipping public spaces with bleeding control kits facilitates these actions. We modeled a mass casualty incident to investigate the effects of public bleeding control kit location strategies. METHODS We developed a computer simulation of a bomb exploding in a shopping mall. We used evidence and expert opinion to populate the model with parameters such as the number of casualties, the public's willingness to aid, and injury characteristics. Four alternative placement strategies of public bleeding control kits in the shopping mall were tested: co-located with automated external defibrillators (AEDs) separated by 90-second walking intervals, dispersed throughout the mall at 10 locations, located adjacent to 1 exit, located adjacent to 2 exits. RESULTS Placing bleeding control kits at 2 locations co-located with AEDs resulted in the most victims surviving (18.2), followed by 10 kits dispersed evenly throughout the mall (18.0). One or 2 kit locations placed at the mall's main exits resulted in the fewest surviving victims (15.9 and 16.1, respectively). CONCLUSIONS Co-locating bleeding control kits with AEDs at 90-second walking intervals results in the best casualty outcomes in a modeled mass casualty incident in a shopping mall.
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Affiliation(s)
- Krisjanis Steins
- Department of Science and Technology, Linköping University, Sweden
| | - Craig Goolsby
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Nathan Charlton
- Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA
| | - Kevin Anderson
- F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole Dacuyan-Faucher
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Erik Prytz
- Department of Computer and Information Science, Linköping University, Sweden
- Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
| | | | - Carl-Oscar Jonson
- Center for Disaster Medicine and Traumatology, and Department of Biomedical and Clinical Sciences, Linköping University, Sweden
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Manteiga-Urbón JL, Fernández-Méndez F, Otero-Agra M, Fernández-Méndez M, Santos-Folgar M, Insa-Calderon E, Sobrido-Prieto M, Barcala-Furelos R, Martínez-Isasi S. Brief Training of Technical Bleeding Control Skills-A Pilot Study with Security Forces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2494. [PMID: 36767862 PMCID: PMC9915853 DOI: 10.3390/ijerph20032494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
Uncontrolled external bleeding is a common cause of preventable death, and due to the environment in which these events often occur, e.g., in hostile environments, the state security forces are usually the first responders, and in many cases, if they are injured their partners provide the initial assistance. The tourniquet is a fast, effective, and easy-to-learn intervention, although there is a knowledge gap concerning training techniques. The objective is to evaluate the effectiveness of a bleeding control training program on a high-fidelity mannequin in a simulated critical situation in a law enforcement training environment. A quasi-experimental study was carried out with 27 members of the state security forces. They underwent brief theoretical-practical training and were evaluated via a scenario involving a critically ill patient in a hostile environment. The results showed that no member of the state security forces completed all the tourniquet placement steps, 26 (96%) prepared the tourniquet correctly, 21 (77.8%) placed it on the leg, and all the participants adjusted the band to the thickness of the injured limb and secured the windlass to the triangular flange of the device. However, only 23 (85.2%) of the participants placed it effectively. The participants, who were members of the state security forces, were able to effectively resolve a critical situation with active bleeding in a simulation scenario with a high-fidelity mannequin after completing theoretical-practical training.
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Affiliation(s)
| | - Felipe Fernández-Méndez
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - María Fernández-Méndez
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Myriam Santos-Folgar
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- School of Nursing, University of Vigo, 36005 Pontevedra, Spain
| | - Esther Insa-Calderon
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra Affiliated, 08003 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - María Sobrido-Prieto
- Departamento de Ciencias da Saúde, Universidade de A Coruña (UDC), Campus de Esteiro, 15403 Ferrol, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, University of Vigo, 36005 Pontevedra, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15706 Santiago Compostela, Spain
- Faculty of Education and Sport Sciences, University of Vigo, 36005 Pontevedra, Spain
| | - Santiago Martínez-Isasi
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, 15706 Santiago Compostela, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
- Faculty of Nursing, Universidade de Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Invited Commentary: Doing It Right. J Am Coll Surg 2023; 236:187-188. [PMID: 36193895 DOI: 10.1097/xcs.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Levy MJ, Krohmer J, Goralnick E, Charlton N, Nemeth I, Jacobs L, Goolsby CA. A framework for the design and implementation of Stop the Bleed and public access trauma equipment programs. J Am Coll Emerg Physicians Open 2022; 3:e12833. [PMID: 36311340 PMCID: PMC9611563 DOI: 10.1002/emp2.12833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/06/2022] [Accepted: 09/27/2022] [Indexed: 12/03/2022] Open
Abstract
Traumatic injuries remain the leading cause of death for those under the age of 44 years old. Nearly a third of those who die from trauma do so from bleeding. Reducing death from severe bleeding requires training in the recognition and treatment of life-threatening bleeding, as well as programs to ensure immediate access to bleeding control resources. The Stop the Bleed (STB) initiative seeks to educate and empower people to be immediate responders and provide control of life-threatening bleeding until emergency medical services arrive. Well-planned and implemented STB programs will help ensure program effectiveness, minimize variability, and provide long-term sustainment. Comprehensive STB programs foster consistency, promote access to bleeding control education, contain a framework to guide the acquisition and placement of equipment, and promote the use of these resources at the time of a bleeding emergency. We leveraged the expertise and experience of the Stop the Bleed Education Consortium to create a resource document to help inform and guide STB program developers and implementers on the key areas for consideration when crafting strategy. These areas include (1) equipment selection, (2) logistics and kit placement, (3) educational program accessibility and implementation, and (4) program oversight, facilitation, and administration.
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Affiliation(s)
- Matthew J. Levy
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- National Center for Disaster Medicine and Public HealthBethesdaMarylandUSA
| | - Jon Krohmer
- Department of Emergency MedicineMichigan State UniversityGrand RapidsMichiganUSA
| | - Eric Goralnick
- Department of Emergency MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Nathan Charlton
- Department of Emergency MedicineUniversity of Virginia School of MedicineCharlottesvilleVirginiaUSA
| | - Ira Nemeth
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Lenworth Jacobs
- Hartford Health CareAcademic Affairs, Hartford HospitalHartfordConnecticutUSA
| | - Craig A. Goolsby
- Department of Emergency Medicine, Harbor‐UCLA Medical CenterDavid Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
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Terrorist Attacks Against Performing Arts Venues: Global Trends and Characteristics Spanning 50 Years. Prehosp Disaster Med 2022; 37:593-599. [PMID: 35942627 PMCID: PMC9474675 DOI: 10.1017/s1049023x22001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In fostering community and culture through entertainment in shared spaces, performing arts venues have also become targets of terrorism. A greater understanding of these attacks is needed to assess the risk posed to different types of venues, to inform medical disaster preparedness, to anticipate injury patterns, and to reduce preventable deaths. METHODS A search of the Global Terrorism Database (GTD) was conducted from the year 1970 through 2019. Using pre-coded variables for target/victim type and target subtype, attacks involving "business" and "entertainment/cultural/stadium/casino" were identified. Attacks targeting performing arts venues were selected using the search terms "theater," "theatre," "auditorium," "center," "hall," "house," "concert," "music," "opera," "cinema," and "movie." Manual review by two authors was performed to confirm appropriateness for inclusion of entries involving venues where the primary focus of the audience was to view a performance. Descriptive statistics were performed using R (version 3.6.1). RESULTS A total of 312 terrorist attacks targeting performing arts venues were identified from January 1, 1970 through December 31, 2019. Two-hundred nine (67.0%) attacks involved cinemas or movie theaters, 80 (25.6%) involved unspecified theaters, and 23 (7.4%) specifically targeted live music performance venues. Two-hundred thirty-four (75.0%) attacks involved a bombing or explosion, 50 (16.0%) damaged a facility or infrastructure, and 17 (5.4%) included armed assault. Perpetrators used explosives in 234 (75.0%) attacks, incendiary weapons in 50 (16.0%) attacks, and firearms in 19 (6.1%) attacks. In total, attacks claimed the lives of 1,307 and wounded 4,201 persons. Though fewer in number, attacks against music venues were responsible for 29.4% of fatalities and 35.0% of those wounded, and more frequently involved the use of firearms. Among 95 attacks falling within the highest quartile for victims killed or wounded (>two killed and/or >ten wounded), 83 (87.4%) involved explosives, seven (7.4%) involved firearms, and three (3.2%) involved incendiary methods. CONCLUSION While uncommon, terrorist attacks against performing arts venues carry the risk for mass casualties, particularly when explosives and firearms are used.
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Stop the Bleed®. Curr Probl Surg 2022; 59:101193. [DOI: 10.1016/j.cpsurg.2022.101193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Day A. ENA Position Statement: Hemorrhage Control. J Emerg Nurs 2022; 48:460-464. [PMID: 35787775 DOI: 10.1016/j.jen.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 03/11/2022] [Indexed: 11/19/2022]
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Kawano F, Munakata S, Tashiro K, Ikenoue M, Furukawa K, Ochiai H, Nakamura K, Nanashima A. Knowledge survey regarding blast wound education of student doctors at a local academic medical university in Japan. Turk J Surg 2022; 38:74-80. [DOI: 10.47717/turkjsurg.2022.5537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022]
Abstract
Objective: To improve knowledge about blast injury for medical student doctors or surgeons. In the modern uncertain era, education and training programs for blast injuries for medical student doctors or surgeons are recently necessary worldwide.
Material and Methods: To understand primary corresponding ability to treat blast injuries, leading to improvement of the trauma education curriculum, a retrospective study by a knowledge survey was performed between 2018 and 2019. The subject had the title of Student Doctor (SD) at university.
Results: The answers of 183 participants who answered the interview questionnaire with 16 questions were summarized. Although most SDs received basic lectures for trauma medicine and majority of SDs knew about mass casualty incidents and primary treatment, the existence of knowledge on soft targets is limited. One-fourth of the SDs knew the characteristics of blast wounds. Most SDs understood priority triage for a conscious person with massive bleeding from a limb with hemostasis to save lives. The 17% selected cardiopulmonary resuscitation first and 72% of SDs could explain hemorrhagic shock; however, only four could explain adequate hemostatic procedures. Most had no interest regarding necessity of their knowledge in the field of serious blast trauma wounds.
Conclusion: Experience in trauma surgery training from stages in SDs and authorized education are important for raising students’ knowledge of unexpected serious blast incidents.
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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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Roman P, Rodriguez-Alvarez A, Bertini-Perez D, Ropero-Padilla C, Martin-Ibañez L, Rodriguez-Arrastia M. Tourniquets as a haemorrhage control measure in military and civilian care settings: An integrative review. J Clin Nurs 2021. [PMID: 33969561 DOI: 10.1111/jocn.15834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim of review was to describe and synthesise the evidence on the use of tourniquets to control haemorrhages, summarising both civilian and military use. BACKGROUND Trauma-related haemorrhage constitutes one of the most preventable deaths among injured patients, particularly in multi-casualty incidents and disasters. In this context, safe instruments such as tourniquets are essential to help healthcare professionals to minimise loss of life and maximise patient recovery. DESIGN AND METHODS An integrative review was conducted in Medline, Nursing & Allied Health Premium, and Health & Medical Collection, using published data until March 2021 and following the PRISMA guidelines. RESULTS A total of 25 articles were included. Evidence has been synthesised to understand the use of different types of tourniquets, environment of application, indication for their placement and potential complications associated with tourniquet placement. CONCLUSIONS Commercial tourniquets such as Combat Application Tourniquet or Emergency Tourniquet models are a valuable and safe instrument for haemorrhage control in both military and civilian out-of-hospital care settings. Nurses, as part of emergency teams, and other professionals should be aware that there is a possibility of adverse complications, but they are directly proportional to the time of tourniquet placement and generally temporary. In addition, national and international guidelines ensure the need for all civilian emergency services to be equipped with these devices, as well as for the training of healthcare professionals and first responders in their use. RELEVANCE TO CLINICAL PRACTICE Despite the lack of complications in the use of tourniquets in these cases, their use has been a matter of debate for decades. In this sense, this review yields up-to-date guidelines in the use of tourniquets, their recommendations and their significance among professionals to manage complicated situations.
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Affiliation(s)
- Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
- Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain
- Health Research Centre, University of Almeria, Almeria, Spain
| | | | | | - Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain
- Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
| | - Luis Martin-Ibañez
- Field Artillery Group, Light Infantry Brigade "King Alfonso XIII" II of the Legion, Almeria, Spain
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castellon de la Plana, Spain
- Research Group CYS, Faculty of Health Sciences, Jaume I University, Castello de la Plana, Spain
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El Bashtaly A, Khalil E, Méthot F, Ledoux-Hutchinson L, Franc JM, Homier V. Tourniquet application by schoolchildren-a randomized crossover study of three commercially available models. J Trauma Acute Care Surg 2021; 90:666-672. [PMID: 33405474 DOI: 10.1097/ta.0000000000003055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Life-threatening hemorrhage is a major cause of preventable mortality in trauma. Studies have demonstrated the effectiveness and safety of commercial tourniquets when used by adult civilians. However, there are no data about tourniquet application by children.This study's goal is to determine which of three commercially available tourniquets is most effective when used by children. METHODS A randomized crossover study was conducted in four elementary schools in Montreal to compare three commercially available tourniquets. The study population is primary school children aged 10 to 12 years (5th-6th grade). A total of 181 students were invited to participate; 96 obtained parental approval and were recruited. Participants underwent a short 7-minute video training on the use of three commercial tourniquets and were subsequently given a 2-minute practice period. Students were evaluated on their ability to successfully apply the tourniquet and the time to complete application. After applying all three tourniquets, the students selected their favorite model. The primary outcome is the proportion of successful applications per tourniquet model. Secondary outcomes include time to successful application for each tourniquet model and tourniquet model preference. RESULTS The mechanical advantage tourniquet (MAT) outperformed the combat application tourniquet (CAT) and the stretch wrap and tuck tourniquet (SWATT) in terms of success rate (MAT, 67%; CAT, 44%; SWATT, 24%; p < 0.0001), time to application (MAT, 57 seconds; CAT, 80 seconds; SWATT, 90 seconds; p < 0.0001), and preference (MAT, 64%; CAT, 30%; SWATT, 6%; p < 0.0001). CONCLUSION In this study, the MAT performs better in terms of success rate, time to application, and preference when used by school-aged children. This study can be helpful when facilities are purchasing tourniquets for use by students.
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Affiliation(s)
- Alaa El Bashtaly
- From the Faculty of Medicine (A.E.B., F.M., L.L.-H.), Université de Montreal; Pediatric Emergency Medicine (E.K.), Montreal Children's Hospital, Montreal, Quebec; Faculty of Medicine (J.M.F.), University of Alberta, Edmonton, Alberta; and Adult Emergency Medicine (V.H.), McGill University Health Centre, Montreal, Quebec, Canada
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15
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Zhang J, Li X. IMPACT OF PUBLIC HEALTH EMERGENCIES ON THE COMPREHENSIVE EDUCATION OF MEDICAL STUDENTS IN COLLEGES AND UNIVERSITIES FROM THE PERSPECTIVE OF NARRATIVE MEDICINE. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127012020_0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The impact of traditional public health emergencies on the comprehensive education of medical students in colleges and universities is mainly reflected in the test of comprehensive literacy. Based on this, this paper studies the construction of a public health emergency impact analysis platform from a medical perspective and cloud computing. From the platform’s database construction, event collection methods, impact evaluation rules and other aspects to achieve accurate analysis of the impact of emergencies, using the cloud computing method for comprehensive analysis and evaluation, the algorithm can analyze and intelligently classify information data on the Internet in the process of multiple input, and respond to potential public health emergencies according to cloud computing technology, in order to analyze the impact on the comprehensive quality of medical students. The experimental results show that the public health emergency analysis platform has the advantages of high feasibility and high data utilization, and can effectively improve the impact of public health emergencies on the comprehensive literacy of medical students.
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Affiliation(s)
- Jing Zhang
- Hebei University of Chinese Medicine, China
| | - Xiaowei Li
- Hebei University of Chinese Medicine, China
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16
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Strauss‐Riggs K, Kirsch TD, Prytz E, Hunt RC, Jonson C, Krohmer J, Nemeth I, Goolsby C. Recommended Process Outcome Measures for Stop the Bleed Education Programs. AEM EDUCATION AND TRAINING 2021; 5:139-142. [PMID: 33521502 PMCID: PMC7821051 DOI: 10.1002/aet2.10443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Kandra Strauss‐Riggs
- Henry M Jackson Foundation for the Advancement of Military Medicine, Inc.RockvilleMA
- National Center for Disaster Medicine and Public Health and the Department of Military & Emergency MedicineUniformed Services University of the Health SciencesBethesdaMD
| | - Thomas D. Kirsch
- National Center for Disaster Medicine and Public Health and the Department of Military & Emergency MedicineUniformed Services University of the Health SciencesBethesdaMD
| | | | | | | | - Jon Krohmer
- U.S. Department of TransportationWashingtonDC
| | - Ira Nemeth
- Department Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMA
| | - Craig Goolsby
- National Center for Disaster Medicine and Public Health and the Department of Military & Emergency MedicineUniformed Services University of the Health SciencesBethesdaMD
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17
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Muret-Wagstaff SL, Faber DA, Gamboa AC, Lovasik BP. Increasing the Effectiveness of "Stop the Bleed" Training Through Stepwise Mastery Learning with Deliberate Practice. JOURNAL OF SURGICAL EDUCATION 2020; 77:1146-1153. [PMID: 32245715 DOI: 10.1016/j.jsurg.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 02/24/2020] [Accepted: 03/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The Stop the Bleed (STB) Campaign supported by the American College of Surgeons Committee on Trauma (ACSCT) and numerous other national organizations aspires to translate lifesaving military successes into reductions in civilian hemorrhagic deaths. While a curricular framework has been described, precise approaches to hands-on training are not specified and training success rates are not yet optimized. Our aim was to test the feasibility and effectiveness of an STB program enhanced by stepwise mastery learning with deliberate practice. STUDY DESIGN Learners participated in an STB program combining evidence-based training models: the Peyton 4-stage model and simulation-based mastery learning with deliberate practice. ASCTC-certified STB coaches used a 3-point, behaviorally explicit checklist to test 4 skills: apply direct pressure; apply standard and improvised tourniquets; pack a wound. An anonymous questionnaire was administered. SETTING Simulation Center, Emory University School of Medicine. PARTICIPANTS College students (N = 30) with no previous trauma training. RESULTS 100% of participants reached mastery level for all 4 hemorrhage control skills within 4 tries. Additionally, 87% could state a definitive sign of life-threatening bleeding. 76% predicted comfort using a tourniquet in a real-life emergency; among 6 who would be very uncomfortable, 5 nonetheless would definitely recommend the course. CONCLUSIONS We demonstrate feasibility and increased effectiveness of an STB course using evidence-based procedural training techniques. Adopting these techniques in current STB programs could close the current trainee performance gap and substantially increase the annual number of successfully trained laypersons over current reported levels with no increase required in enrollees, programs, or resources. Future studies should address the challenges of knowledge retention and skill decay, just-in-time innovations, implementation science methods to broaden access, and barriers to responding to real-life crisis events. Surgery education leaders can close performance gaps and make a unique contribution to the Hartford Consensus principle: No one should die from uncontrolled bleeding.
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Affiliation(s)
- Sharon L Muret-Wagstaff
- Department of Surgery, Emory University School of Medicine; Emory University Hospital, Atlanta, Georgia.
| | - David A Faber
- Department of Surgery, Emory University School of Medicine; Emory University Hospital, Atlanta, Georgia
| | - Adriana C Gamboa
- Department of Surgery, Emory University School of Medicine; Emory University Hospital, Atlanta, Georgia
| | - Brendan P Lovasik
- Department of Surgery, Emory University School of Medicine; Emory University Hospital, Atlanta, Georgia
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18
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Kim-Farley RJ. Community Preparedness: "It Takes a Village". Am J Public Health 2019; 109:S256-S257. [PMID: 31505140 PMCID: PMC6737825 DOI: 10.2105/ajph.2019.305263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Robert James Kim-Farley
- Robert James Kim-Farley is with the Departments of Epidemiology and Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles and is an associate editor of AJPH
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