105.06 Stop The Bleed: Effective Training In Need Of Improvement

Posted on January 31, 2019

C. Villegas1, S. Liu1, J. Rosenberg1, R. Winchell1, M. Narayan1  1Weill Cornell Medical College,The Division Of Trauma, Burns, Critical And Acute Care Surgery,New York, NY, USA

Introduction:
The “Stop the Bleed” (StB) campaign was instituted to educate laypersons on how to perform bleeding control techniques in the event of mass casualty events that result in life-threatening hemorrhage.  Participants currently undergo a 90-min instructional and practice session, the latter incorporating a mannequin on which participants practice. We hypothesized participants would 1) increase content knowledge after StB participation: and 2) find that the training could be improved by a more life-like modification of the mannequin.

Methods:
From July 2017 to January 2018, hospital and community members from a major metropolitan area participated in StB training.  Participants provided demographic data regarding prior emergency training and experience and were asked pre- and post-test questions (5-point Likert scale) regarding likelihood of and confidence in responding to hemorrhage.  Individuals also evaluated the mannequin on whether it would improve their education if it were more life-like.  Scores were reported as medians with interquartile ranges (IQR).  Wilcoxon paired and unpaired tests were used as appropriate to evaluate differences with α=0.05 and subset analysis stratified by experience.

Results:
Of 402 participants, 310 had complete data on demographic and outcome data of interest.  On a composite, pre-test self-assessment of willingness and confidence to respond to hemorrhage in emergency situations, participants had a median score of 24 out of 30 points (IQR 19-27).  Post-testing demonstrated a statistically significant increase with a median score of 29 (IQR 26-30, p < 0.05).  Participants’ composite score on mannequin realism assessing compression, packing, and tourniquet application was 13 out of 15 (IQR 12-15), yet the participants reported that more realistic model would increase their confidence in technique (median 15, IQR 12-15).  Subset analysis of those individuals without prior training or experience in emergency response or hemorrhage control (n=117) demonstrated that they had the largest gains in pre- and post-test differentiation (median difference 8.5, IQR 4.3-12.0) compared to those with prior experience (n=193, median difference of 3.0, IQR 0.0-6.0, p <0.05).  Both subgroups reported that training would be enhanced if the mannequins were more realistic (median 15, IQR 12-15 for both groups).

Conclusion:
StB is an effective education program resulting in improved confidence in wound compression, packing, and tourniquet application. Those without prior experience or training in hemorrhage cessation demonstrated the most improvement.  Regardless of background, participants overwhelmingly reported that the training would be more effective if it were more realistic. Future work to design and develop cost-effective mannequins demonstrating cessation of hemorrhage is required to enable learners to actually “Stop the Bleed”. 
 

04.19 Stop The Bleed (Stb): Development Of A Perfused Synthetic Cadaver Model

Posted on January 31, 2019

A. Gupta1, J. Rosenberg1, C. Villegas1, J. S. Curren1, R. Winchell1, M. Narayan1  1Weill Cornell Medical College,The Division Of Trauma, Burns, Critical And Acute Care Surgery,New York, NY, USA

Introduction:
As active shootings and other mass casualty incidents have become more prevalent, courses designed to teach basic hemorrhage control to laypersons have proliferated. In the current StB course, participants undergo hands-on training using a synthetic limb mannequin.  In a prior survey of 302 participants there was overwhelming sentiment that the mannequin was limited by its inability to demonstrate cessation of bleeding when hemorrhage control techniques were applied. We hypothesized that enhanced flow characteristics (pulsatile flow and flow at variable pressure) that can be stanched by StB techniques would improve the mannequin, and hence the experience and confidence of trainees.

Methods:
The mannequin was redesigned as a self-contained circulation model that could mimic both arterial and venous bleeding.  Different synthetic soft tissues were assessed for texture, thickness, compressibility, and durability.  Vessel material, construction, and placement were evaluated on their ability to mimic pulsatile blood flow and durability to repeated pressure, packing, and tourniquet applications.  Multiple mechanisms of simulating blood flow (gravity, pump) were also trialed. An 85 ml synthetic rubber capacity bulb with a 7.4 mm inner diameter tubing were used resulting in a stroke volume of 16 cc per hand stroke and pressure of 20-25 kPa or 150-187 mmHg. Finally, material cost was considered to facilitate low-cost, global distribution. The final mannequin resulted in an inexpensive, novel synthetic cadaver limb model that is equipped with vessels which mimic blood flow and provide a realistic wound on which to practice the hemostatic techniques of direct pressure, wound packing and tourniquet application taught in StB.

Results:
Nurse and physician educators conducted beta testing of the perfused mannequin. One-on-one interviews revealed positive feedback regarding both realism of the perfused mannequin and participants’ ability to obtain bleeding control using StB techniques. In addition, participants who trialed the mannequin reported an increased awareness of the rate of blood flow out of a wound, which in turn increased their sense of urgency in applying hemorrhage control techniques.

Conclusion:
Several training modalities are available to teach hemorrhage control techniques, varying from high-fidelity simulators, to animal models, to synthetic mannequins. In an effort to address shortcomings noted by participants in the current StB mannequin, we developed a novel perfused-bleeding mannequin that mimics both arterial and venous bleeding, responds appropriately to various hemorrhage cessation techniques, and is both inexpensive