Initial Steps in Training the Public about Bleeding Control: Surgeon Participation and Evaluation.

BACKGROUND: With increasing active shooter and intentional mass casualty events, as well as everyday injuries resulting in severe bleeding, there have been calls for the public to learn bleeding control techniques. The aims of this project were to offer bleeding control training to surgeons attending the Clinical Congress of the American College of Surgeons (ACS), to determine if the trained surgeons believe that teaching bleeding control to the public should be a priority of the ACS, and to assess the surgeon trainees' perceptions regarding the appropriateness of the course for a public audience. STUDY DESIGN: This was an educational program with a post-course evaluation to determine if the bleeding control course is appropriate for a public audience. RESULTS: Three hundred forty-one surgeons were trained. All were trained and successfully performed a return demonstration. Regarding perceptions of the participating surgeons that teaching bleeding control to the public should be a priority of the ACS, 93.79% of the 322 surgeons responding indicated agreement with this proposition. Regarding whether or not the training was at an appropriate level of difficulty for the public, 93.13% of the 320 respondents to this item agreed that it was appropriate. CONCLUSIONS: The surgeons who were trained were very much in favor of making training the public a priority of the ACS. With additional training of surgeons and other health care professionals as trainers, and the engagement of the public, the goal of having a citizenry prepared to stop bleeding can be achieved.

Use of a Tourniquet by LIFE STAR Air Medical Crew: A Case Report.

For many years tourniquets were perceived as dangerous due to the belief that they led to loss of limb because of ischemia. Their use in civilian and military environments was discouraged. Emergency medical responders were not taught about tourniquets and commercial tourniquets were not available. However, research by the United States military during the wars in Iraq and Afghanistan has demonstrated that tourniquets are safe life-saving devices. As a consequence, they have been widely deployed in combat situations and there are now calls for the use of tourniquets in the civilian prehospital setting. This article presents a report of the successful application of a tourniquet by the LIFE STAR crew to control bleeding that local emergency medical services (EMS) personnel could not control with direct pressure. Tourniquets should be readily available in public places and carried by all EMS.

The use of simulation procedural training to improve self-efficacy, knowledge, and skill to perform cricothyroidotomy.

The pre-eminent requirement for surgical education is that it is effective and efficient. We sought to determine if the addition of low-fidelity simulation to our standard method of teaching cricothyroidotomy improves Postgraduate Year 1 residents' self-efficacy, knowledge, and skill to perform cricothyroidotomy. The teaching methods were standard education using a lecture and video compared with standard education plus low-fidelity simulation instruction and practice on a mannequin. The methods were randomly assigned. After the assigned teaching in the morning and completion of pre- and posttests of self-efficacy and knowledge, the residents were evaluated on performance of cricothyroidotomy during the afternoon on euthanized swine. Time to complete the procedure and complications were recorded. Nineteen residents participated. Time to complete cricothyroidotomy was significantly less (P = 0.047) and performance scores were significantly higher (P = 0.01) in the simulation group. This group had four (36.4%) complications and the no simulation group had one (12.5%) complication (P = 0.34). Both groups improved on self-efficacy from pre- to posteducation (P < 0.05). Low-fidelity simulation can improve time and skill to perform cricothyroidotomy.

The Hartford Consensus to improve survivability in mass casualty events: Process to policy.

OBJECTIVE: The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events was formed to make recommendations to improve survival from intentional mass casualty incidents. This article describes the development of the Hartford Consensus and the process used to disseminate and implement its findings. MAIN OUTCOME: Members of the Committee included individuals from select public safety organizations. The first meeting of the Committee was held on April 2, 2013, and a second meeting was held on July 11, 2013. Attendance at the second meeting was enlarged and included representatives from the Federal Emergency Management Agency and the National Security Staff of the Office of the President. The results of these meetings became known as the Hartford Consensus. RESULTS: The ideas generated at the meetings produced two documents, one from each meeting. These are referred to as Hartford Consensus I and II. Hartford Consensus I is a concept document and Hartford Consensus II is a call to action that no one should die from uncontrolled bleeding. The recommendations are being incorporated into training programs and have been endorsed by many organizations whose members are involved in the response to mass casualty incidents. CONCLUSION: The Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events was successful in stimulating policy to bring about change. Training and resources including tourniquets and hemostatic dressing are being directed to help ameliorate the unfortunate reality of intentional mass injury.

Management of major blunt liver injury at Hartford Hospital: a ten-year review.

The purpose of this study was to describe the management of patients at Hartford Hospital with major blunt liver injuries. The medical records of patients admitted to Hartford Hospital between January 1, 2000 through January 31, 2010 with blunt trauma that resulted in a laceration with significant hepatic disruption were reviewed. One hundred forty-eight patients were identified from the Trauma Registry. Of those, 133 patient records were examined. Twenty-one patients (15.8%) died in the emergency department and three were transferred to other facilities. Of the 109 patients treated at Hartford Hospital, most (60.2%) had agrade IV or V liver injury; 19 had an operation and 90 were managed nonoperatively. Those managed with an operation were more severely injured and had higher mortality, P < .05. Most patients requiring an operation were identified and operated upon in a timely manner.

Evaluation of leadership skills during the simulation education course for the initial management of blunt trauma.

Leadership skills of senior residents, trauma fellows, and a nurse practitioner were assessed during simulation training for the initial management of blunt trauma. This was a pilot, observational study, that in addition to skill development and assessment also sought to determine the need for a dedicated leadership training course for surgical residents. The study evaluated the leadership skills and adherence to Advance Trauma Life Support (ATLS) guidelines of the team leaders during simulation training. The team leaders' performances on criteria regarding prearrival planning, critical actions based on ATLS, injury identification, patient management, and communication were evaluated for each of five blunt-trauma scenarios. Although there was a statistically significant increase in leadership skills for performing ATLS critical actions, P < 0.05, there were 10 adverse events. A structured simulation program dedicated to developing skills for team leadership willbe a worthwhile endeavor at our institution.

Nurse and physician preferences for end-of-life care for trauma patients.

BACKGROUND: End-of-life care for trauma patients requires unique practice guidelines because it is fraught with difficulties not encountered in end-of-life care for terminally ill patients. The purpose of this project was to analyze survey information from nurses and physicians regarding preferences for end-of-life care in trauma that would inform best-practice guidelines. METHODS: A survey was sent via the US Postal Service to a convenience sample of trauma professionals, including physicians, nurses, and emergency medical technicians. Questions were designed to provide information on difficult issues related to death and dying from trauma. The general public was also surveyed, and all results were used to develop a best-practice model for end-of-life care. RESULTS: Seven hundred seventy-four trauma professionals returned the survey for a response rate of 51%. This included 460 nurses and 181 physicians. Some salient findings include: (1) If a loved one required resuscitation in the emergency department, more nurses (78.4%) than physicians (38.7%) prefer to be in the treatment room rather than in the waiting room; (2) similar percentages of nurses (97.7%) and physicians (99.4%) agree that life-sustaining treatment should be withdrawn in cases in whom there is no hope of recovery; and (3) a larger percentage of nurses (58.8%) than physicians (20.6%) believe that patients have the right to demand care that physicians think is medically futile. CONCLUSIONS: Nurses and physicians agree on some issues about end-of-life care in trauma but disagree on others. Education and discourse among trauma professionals are needed to bring understanding to the issues.

A simulation education course for the initial management of blunt trauma.

A simulation education course was developed at Hartford Hospital to teach members of the trauma team the initial management of blunt trauma. Five educational scenarios were created using Sim-Man (Laerdal) with injuries to the 1. head, 2. chest, 3. abdomen, 4. extremities, and 5. multiple injuries. Students were assessed on self-efficacy and knowledge before and after participation in the scenarios, debriefing, and PowerPoint lectures. Self-efficacy increased significantly from pre- to posttesting for each of the five scenarios. Knowledge increased significantly from pre- to post-testing for the head, chest and extremities scenarios. The Simulation Education Course for Blunt Trauma is a worthwhile educational program. As with all educational efforts, attention must be given to course content, delivery, and evaluation.