Brief, Web‐based Education Improves Lay Rescuer Application of a Tourniquet to Control Life‐threatening Bleeding

Goolsby, Craig; Strauss‐Riggs, Kandra; Klimczak, Victoria; Gulley, Kelly; Rojas, Luis; Godar, Cassandra; Raiciulescu, Sorana; Kellermann, Arthur L.; Kirsch, Thomas D.

doi:10.1002/aet2.10093

Cited by 37 publications

(39 citation statements)

References 20 publications

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“…It does not provide evidence about people's ability to delineate life-threatening from non-life-threatening bleeding, although there is some evidence that the public can make this distinction. 20,21 Although tourniquet placement in the general population is considered reasonably safe for short duration applications, inappropriate tourniquet placement could cause unique harm in a vascular access population that depends on hemodialysis. 22 However, in 1 retrospective case series of 26 patients with potentially fatal vascular access hemorrhage, only 16% had tourniquet application in the ED, but all patients required emergency operating room intervention, making it unlikely that the tourniquet itself resulted in the need for surgical repair.…”

Section: Discussionmentioning

confidence: 99%

Potentially survivable fatal vascular access hemorrhage with tourniquet use: A post‐mortem analysis

et al. 2020

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Background: The US military has prioritized battlefield hemorrhage control. Researchers credit tourniquet use, and a novel trauma care training program, with saving 1000-2000 lives in Iraq and Afghanistan. The Stop the Bleed campaign translates these lessons learned to the public. This is the first analysis of the potential impact of this newfound knowledge about tourniquet use for extremity fatal vascular access hemorrhage in a civilian population. Fatal vascular access hemorrhage includes bleeding from arteriovenous fistulas and grafts used for hemodialysis and central venous catheters. Methods: This is a retrospective study of decedent records. We selected Maryland death records from 2002-2017 using the following search terms: "graft," "shunt," "fistula," "dialysis," and "central venous catheter." The records were analyzed for potential survivability with a checklist of military criteria modified for a civilian population. Suicides were excluded. Two reviewers independently classified the deaths as either potentially survivable or non-survivable, and a third reviewer broke ties. Results: There were 111 deaths included in the final analysis. Ninety-two of the 111 decedents had potentially survivable extremity fatal vascular access hemorrhage. The remaining 19 records were excluded, because they did not have extremity hemorrhage. Zero decedents had hemorrhage deemed to be non-survivable with prompt tourniquet application. Conclusion: This study identified 92 Maryland extremity fatal vascular access hemorrhage decedents who potentially could have survived with tourniquet use-an average of 6 per year. These results suggest the need for further epidemiology investigation, as well as exploration of the risks and benefits of teaching and equipping vascular access patients and their caregivers to use tourniquets for life-threatening bleeding.

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Section: Discussionmentioning

confidence: 99%

Potentially survivable fatal vascular access hemorrhage with tourniquet use: A post‐mortem analysis

et al. 2020

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“…The principles used here can be extrapolated to other procedures and educational initiatives. Just-in-Time interventions have been effective for diverse fields, 9,10 with web-based interventions successful as well. 9 Emulating our principles of cost-efficiency can therefore be beneficial to many different specialties striving for procedural competence.…”

Section: Discussionmentioning

confidence: 99%

Cost-Efficient Medical Education: An Innovative Approach to Creating Educational Products

Kaplovitch

Otremba

Morgan

et al. 2019

Journal of Graduate Medical Education

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Background Cost is a barrier to creating educational resources, and new educational initiatives are often limited in distribution. Medical training programs must develop strategies to create and implement cost-effective educational programming. Objective We developed high-quality medical programming in procedural instruction with efficient economics, reaching the most trainees at the lowest cost. Methods The Just-In-Time online procedural program was developed at the University of Toronto in Canada, aiming to teach thoracentesis, paracentesis, and lumbar puncture skills to internal medicine trainees. Commercial vendors quoted between CAD $50,000 and $100,000 to create 3 comprehensive e-learning procedural modules—a cost that was prohibitive. Modules were therefore developed internally, utilizing 4 principles aimed at decreasing costs while creating efficiencies: targeting talent, finding value abroad, open source expansion, and extrapolating efficiency. Results Procedural modules for thoracentesis, paracentesis, and lumbar puncture were created for a total cost of CAD $1,200, less than 3% of the anticipated cost in utilizing traditional commercial vendors. From November 2016 until October 2018, 1800 online instructional sessions have occurred, with over 3600 pageviews of content utilized. While half of the instructional sessions occurred within the city of Toronto, utilization was documented in 10 other cities across Canada. Conclusions The Just-in-Time online instructional program successfully created 3 procedural modules at a fraction of the anticipated cost and appeared acceptable to residents based on website utilization.

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“…When those laypeople watched a brief web-based video, however, success rates increased to 75%. 31,33 A recent trial 30 found that skill degradation over time is significant and laypeople could correctly apply a tourniquet only 55% of the time 3 to 9 months after the Bleeding Control Basic course. Multiple entities have implemented either independent or modified versions of these programs, but limited evaluation beyond subjective participant or instructor feedback is available.…”

Section: Theme 3: Educationmentioning

confidence: 99%

Defining a Research Agenda for Layperson Prehospital Hemorrhage Control

Goralnick¹,

Ezeibe²,

Chaudhary³

et al. 2020

JAMA Netw Open

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IMPORTANCE Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military's medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector. OBJECTIVE To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons. EVIDENCE REVIEW The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda. FINDINGS Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a prioridefined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy. CONCLUSIONS AND RELEVANCE The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.

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Brief, Web‐based Education Improves Lay Rescuer Application of a Tourniquet to Control Life‐threatening Bleeding

Abstract: Brief, Web-based training, combined with JiT education, may help as many as 75% of laypeople properly apply a tourniquet. These findings suggest that this approach may help teach the public to Stop the Bleed.

Cited by 37 publications

References 20 publications

Potentially survivable fatal vascular access hemorrhage with tourniquet use: A post‐mortem analysis

Potentially survivable fatal vascular access hemorrhage with tourniquet use: A post‐mortem analysis

Cost-Efficient Medical Education: An Innovative Approach to Creating Educational Products

Defining a Research Agenda for Layperson Prehospital Hemorrhage Control

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