Blood loss estimation by out-of-hospital emergency care providers

Abstract

Prehospital care providers are not accurate at estimating spilled blood volumes. This ability can be improved with limited education. Slides appear to be as effective as viewing actual spill sites.

Emergency Physician Estimation of Blood Loss

“…The large range of answers seen suggests that physicians are imprecise in addition to being inaccurate. This is consistent with prior studies that have examined other specialties' estimates of blood loss in a variety of scenarios, including active patient blood loss, 1–3, 6 blood spilled on the ground, 5 blood spilled onto drapes and sponges, 4 blood placed in a commode, 8 and blood loss estimated at the scene of trauma. 7 …”

“…Prior studies have suggested that health professionals tend to overestimate small losses (<150 mL) and underestimate large ones (>150 mL). 3,5–8 Our study found similar results. Comparing the larger blood loss on the bed sheet scenario (500 mL) to the smaller blood loss in the T-shirt scenario (100 mL), there were considerably more underestimates with the larger loss.…”

“…5 There was, however, a strong trend toward superior attending physician performance, with residents demonstrating approximately double the mean error in all scenarios but the bed sheet. Also, there was no significant difference when comparing gender within the scenarios, although the small numbers used likely did not have the power to show a difference; other studies have not found a gender difference.…”

“…9 Whether there would be utility in instituting some form of training is unclear. In the study by Moscati et al 5 , the blood loss was revealed to the subjects in the study, then slide show presentations were used to train subjects on the appearance of various amounts of blood loss. The subjects were retested at a later date and found to have significantly improved.…”

Do patients assess rectal bleeding accurately?

“…In a study using paramedics as subjects it was found that estimations of spilled blood volumes were not accurate, but that after limited training with the repeated viewing of actual spilled volumes or of slides of similar spilled volumes, the ability to estimate the volume of spilt blood was significantly improved 3 …”