Abdelrahman Husham, Mekkodathil Ahammed, El-Menyar Ayman, Consunji Rafael, Rizoli Sandro, Al-Thani Hassan
Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar.
Department of Surgery, Clinical Research, Trauma & Vascular Surgery, Hamad Medical Corporation, Doha, Qatar.
Eur J Trauma Emerg Surg. 2025 Jul 14;51(1):252. doi: 10.1007/s00068-025-02917-4.
Exsanguinating hemorrhage is the most common cause of preventable trauma death at the injury scene, and it is often due to the inability to control bleeding immediately. Training layperson first responders (LFR) in trauma care, particularly hemorrhage control, has been recommended to address this trauma care gap. We conducted a systematic review (SR) to analyze the effect of hemorrhage control training courses for LFRs on knowledge, skill, and attitude to intervene in trauma patients.
PubMed and Google Scholar databases were used to identify relevant peer-reviewed research articles describing evaluations of hemorrhage control courses for LFR between 2013 and 2024. Studies examined whether the training course was implemented in low- and middle-income countries (LMICS); trainees were LFR and had outcome measures, including knowledge, skills, attitudes (confidence gained, willingness, comfort, and likelihood to intervene) toward care utilization for trauma patients, as well as outcomes.
The SR included 12 articles. The quality of the selected studies was generally high. Five studies (42%) reported improved willingness, confidence, comfort, and the likelihood of responding safely to trauma. Nine studies (75%) used pre-and post-tests to document knowledge acquired, and five studies (42%) used knowledge retention evaluation at different intervals and reported substantial knowledge and skill reductions after a few months (1-3 months, 3-6 months, or both 6 and 9 months or up to 3 years). A few studies followed incident reports to document the utilization of knowledge and skills acquired during training. None reported patient outcomes.
Bleeding control training courses for layperson first responders in LMICS significantly improve knowledge, skill, confidence, and willingness to intervene to apply bleeding control techniques to trauma patients. Evaluating clinically relevant outcomes is needed to strengthen the evidence.
失血性出血是创伤现场可预防的创伤死亡的最常见原因，通常是由于无法立即控制出血。建议培训非专业急救人员（LFR）进行创伤护理，特别是出血控制，以弥补这一创伤护理差距。我们进行了一项系统评价（SR），以分析针对LFR的出血控制培训课程对干预创伤患者的知识、技能和态度的影响。
使用PubMed和谷歌学术数据库来识别2013年至2024年间描述对LFR出血控制课程评估的相关同行评审研究文章。研究考察培训课程是否在低收入和中等收入国家（LMICs）实施；培训对象为LFR，并有结果指标，包括对创伤患者护理利用的知识、技能、态度（获得的信心、意愿、舒适度和干预可能性）以及结果。
该系统评价纳入了12篇文章。所选研究的质量总体较高。五项研究（42%）报告了意愿、信心、舒适度以及安全应对创伤可能性的改善。九项研究（75%）使用前后测试来记录获得的知识，五项研究（42%）在不同时间段进行知识保留评估，并报告几个月后（1至3个月、3至6个月，或6个月和9个月或长达3年）知识和技能大幅下降。一些研究跟踪事件报告以记录培训期间获得的知识和技能的应用情况。没有研究报告患者结局。
低收入和中等收入国家针对非专业急救人员的出血控制培训课程显著提高了应用出血控制技术干预创伤患者的知识、技能、信心和意愿。需要评估临床相关结局以加强证据。
