Starosolski Michal, Kalemba Alicja, Kaplan Cezary, Majewska Karolina, Ulbrich Krzysztof
Emergency Medicine Department, Medical University of Silesia, 40-055 Katowice, Poland.
Student Scientific Society at the Department of Emergency Medicine, Medical University of Silesia, 40-055 Katowice, Poland.
Healthcare (Basel). 2024 Nov 26;12(23):2370. doi: 10.3390/healthcare12232370.
In a pre-hospital setting, uncontrolled hemorrhages in patients are undoubtedly a highly stressful situation for the rescuing medic, demanding prompt intervention. The effective stopping of a hemorrhage significantly reduces the risk of death for victims. The purpose of this study is to evaluate the students' chosen methods and the effectiveness of their actions during a simulated hemorrhage situation. In addition, the students' behavior and their cognitive overload classified using the NASA scale were also analyzed.
The study enrolled 101 medical students, who were randomized and assigned sequentially to a study group ( = 49) and a control group ( = 52). The research group participated in a training course. Both groups then proceeded to a simulated hemorrhage scenario in a patient in a pre-hospital setting. Finally, the students assessed their cognitive overload using the NASA scale.
After the training, more students have achieved effective bleeding control (36/49, 73.5% vs. 22/52, 42.3%, = 0.002). The prevalent method of bleeding control in both groups was using a tourniquet (97/101, 96%) with or without additional gauze and bandages. A significant improvement in the technique of the tourniquet application was observed-in the control group, 23/52 students (47.9%) applied it properly, while in the study group, it was 36/49 (73.5%). This resulted in a shorter time to achieve effective bleeding control and lower blood loss in the study group ( = 0.013 and = 0.034, respectively). The median blood loss was 32 mL (IQR = 24, range 11-65 mL) in the study group compared to 53 mL (IQR = 26, range 10-117 mL) in the control group.
The education program for young medics needs changes, including an increased emphasis on learning procedures and improving practical skills.
在院前环境中，患者出现无法控制的出血情况无疑会给救援医护人员带来极大压力，需要迅速采取干预措施。有效止血可显著降低受害者的死亡风险。本研究的目的是评估学生在模拟出血情况下所选择的方法及其行动的有效性。此外，还分析了学生的行为以及使用NASA量表分类的认知负荷情况。
该研究招募了101名医学生，他们被随机且依次分配到研究组（n = 49）和对照组（n = 52）。研究组参加了一个培训课程。然后两组学生都进入院前环境中对一名患者进行模拟出血场景的操作。最后，学生使用NASA量表评估他们的认知负荷。
培训后，更多学生实现了有效止血控制（36/49，73.5% 对比 22/52，42.3%，P = 0.002）。两组中最常用的止血方法是使用止血带（97/101，96%），可搭配或不搭配额外的纱布和绷带。观察到止血带应用技术有显著改进——对照组中，23/52名学生（47.9%）正确应用，而研究组中为36/49（73.5%）。这使得研究组实现有效止血控制的时间更短且失血量更低（分别为P = 0.013和P = 0.034）。研究组的中位失血量为32 mL（IQR = 24，范围11 - 65 mL），而对照组为53 mL（IQR = 26，范围10 - 117 mL）。
针对年轻医护人员的教育计划需要改进，包括更加强调学习操作流程和提高实践技能。
