M. Narayan1, M. Chandramouli1, A. Gupta1, A. L. Jones3, M. Dominguez1, D. Zappetti2, R. J. Winchell1, P. S. Barie1 1Weill Cornell Medical College,Trauma, Burns, Critical And Acute Care,New York, NY, USA 2Weill Cornell Medical College,New York, NY, USA 3Stony Brook University Medical Center,Stony Brook, NY, USA
Introduction: Uncontrolled bleeding is the leading cause of preventable death in trauma. Immediate bystanders, equipped with basic knowledge of bleeding control, can potentially save lives. The Stop the Bleed (StB) course, taught globally, empowers lay persons to control hemorrhage. StB is typically taught over 1 hour, including a 30-min didactic program followed by a skills session (using mannequin limbs) for techniques of direct pressure (DP), wound packing (WP), and tourniquet application (TA). Ideal instructor-to-trainee ratio is 1:8. While StB is offered free of charge, it is time-consuming and costly, as each training kit is USD950. We hypothesize that traditional StB training can be imparted solely through an instructional video (InV), with the potential for expanded access and reduced cost.
Methods: Test population (first-year medical students (MS) on day one of orientation), selected to represent lay persons with minimal prior medical training, viewed a 40-min didactic video (DdV), using the approved StB PowerPoint deck. A pre- and post-DdV survey was given. MS then watched a technical video (TeV), demonstrating proper techniques for DP, WP, and TA. Skills examination (SE) and a post-test survey were then given. Option for repeat viewing of TeV was provided. Instruction-related questions were identical for all three surveys. Statistical analysis: descriptive statistics, composite analyses, Mann-Whitney U and Kruskal-Wallis H tests, a=0.05.
Results: Of 106 MS, 52% were female. 13.2% had taken a course on bleeding control and 12.3% were trained emergency medical technicians. 79.2% never responded to an emergency medical situation. 88.7% and 91.5% had never performed TA or WP, respectively. 29%, 8% and 13% reported confidence in DP, WP and TA pre-InV, increasing to 92%, 79%, and 76% respectively after DdV, to 100%, 96%, and 100%, respectively, after TeV and SE, (p<0.001). Only 3 MS watched TeV more than once. During the SE, StB instructors noted 96%, 99%, and 89%, respectively, could perform DP, WP, and TA without any prompting. More than 94% of MS opined DdV and TeV were effective, and they would be comfortable teaching their new skills to others. Interestingly, 61% still reported preferring live didactic lecture whereas only 48% preferred a live instructor to TeV. Prior experience did not correlate with increased performance evaluation but did correlate with greater initial pre-InV confidence (p<0.001). Greater increases in confidence was seen in those with no prior training (p<0.001).
Conclusion: To our knowledge, this is the first study which establishes that lay persons can acquire comparable knowledge, skills, and confidence to achieve bleeding control by only watching InV, as compared to the traditional in-person course. The implications are far-reaching. StB could potentially be disseminated more widely and taught in settings where in-person training may be constrained (e.g., low-income countries, remote settings).