From the Albert Einstein College of Medicine (F.N.J.), New York City; Department of Emergency Medicine (F.N.J.), White Plains Hospital (F.N.J., N.B.D., S.R.S., F.Q., E.A.L., B.A., J.R.), White Plains; NYIT College Of Osteopathic Medicine (K.F.), Old Westbury, NY; Rutgers Robert Wood Johnson Medical School (N.B.D.), New Brunswick, NJ; MGH Institute of Health Professions (A.K.), Boston, MA; Albert Einstein School of Medicine (E.A.L.), New York City; and Departments of Emergency Medicine (D.M.) and Critical Care (K.E.), White Plains Hospital, White Plains, NY.
Simul Healthc. 2021 Dec 1;16(6):e159-e167. doi: 10.1097/SIH.0000000000000546.
The Stop the Bleed (STB) program trains the general public on identifying and treating life-threatening bleeding. Data on efficacy and retention of skills taught through this program are limited, with the role of high-technology modalities to augment the program, such as simulation and feedback devices, untested.
A convenience sample of 66 school personnel participated in an open-label observational study from January to August 2019. The control group received the standard bleeding control course, while the intervention group received the bleeding control course with addition of a simulation and a feedback device for wound packing. Assessment was performed by STB instructors using performance metrics from prior studies as well as a feedback device. Retention testing was performed 2 to 8 months after intervention. The study was approved by the hospital's institutional review board.
The intervention group performed better than the control group on correct tourniquet application [90.3% vs. 71.0%; odds ratio (OR) = 11.28; P = 0.015; 95% confidence interval (CI) = 1.86 to 104.67] wound packing scores (59.5% vs. 29.6%; OR = 0.33; P = 0.007; 95% CI = 9.36 to 56.00) and were more likely to assess their safety (OR = 5.49; P = 0.034; 95% CI = 1.28 to 27.66), and reported higher comfort scores on stepping into an emergency scenario (OR = 11.19; P = 0.004; 95% CI = 2.51 to 63.11), wound packing (OR = 5.16; P = 0.025; 95% CI = 1.35 to 22.46), and using a tourniquet (OR = 11.41; P = 0.003; 95% CI = 2.57 to 67.59). Thirty-one participants (46.9%) were assessed again at retention 2 to 8 months later where scores for tourniquet placement and wound packing were not significantly different in the two groups.
Augmenting STB with simulation and feedback improved both self-reported comfort level and skill set of participants, but the retention of skills was poor in both groups.
止血培训(STB)项目培训公众识别和治疗危及生命的出血。通过该项目教授的技能的有效性和保留数据有限,高技能模式(如模拟和反馈设备)的作用尚未经过测试。
2019 年 1 月至 8 月,66 名学校人员参加了一项开放性观察研究。对照组接受标准止血课程,而干预组则在止血课程中增加了模拟和反馈设备进行伤口包扎。评估由 STB 讲师使用先前研究的绩效指标以及反馈设备进行。干预后 2 至 8 个月进行保留测试。该研究获得了医院机构审查委员会的批准。
干预组在正确应用止血带方面的表现优于对照组[90.3%对 71.0%;优势比(OR)=11.28;P=0.015;95%置信区间(CI)=1.86 至 104.67];伤口包扎评分[59.5%对 29.6%;OR=0.33;P=0.007;95%CI=9.36 至 56.00],更有可能评估其安全性[OR=5.49;P=0.034;95%CI=1.28 至 27.66],并报告在紧急情况下进入时更高的舒适度评分[OR=11.19;P=0.004;95%CI=2.51 至 63.11],伤口包扎[OR=5.16;P=0.025;95%CI=1.35 至 22.46]和使用止血带[OR=11.41;P=0.003;95%CI=2.57 至 67.59]。31 名参与者(46.9%)在 2 至 8 个月后的保留测试中再次进行了评估,两组的止血带放置和伤口包扎评分没有显著差异。
通过模拟和反馈增强 STB 提高了参与者的自我报告舒适度和技能水平,但两组的技能保留都很差。