Evaluation of Stop the Bleed Training Among High School Personnel: A Qualitative Study.

BACKGROUND: Uncontrolled hemorrhage is the primary preventable cause of death following trauma. Stop the Bleed training exists to promote identification and basic treatment of life-threatening bleeding in the prehospital or community setting. Limited qualitative research is available on participant evaluation of hemorrhage control training for laypersons. OBJECTIVE: To evaluate the experience and satisfaction with Stop the Bleed training among lay community members in an urban public school setting. METHODS: Three group interviews were conducted with public high school personnel (faculty and staff) who received Stop the Bleed training. Personnel were asked to evaluate the training and provide suggestions for improvement. Responses were digitally recorded and transcribed verbatim. Content analysis for common themes was performed using NVivo. RESULTS: A total of eight participants were interviewed. Participants expressed satisfaction with hands-on training and dissatisfaction with crowded and rushed training conditions. Major themes included: (1) skill acquisition, retention, and decay, (2) training format and setting, and (3) use of simulation. CONCLUSIONS: Current Stop the Bleed training is considered satisfactory among public school educators. Suggestions for improvement include annual retraining programs and simulation-enhanced training opportunities.

Evaluation of "Stop the Bleed" training among K-12 faculty and staff in Alabama.

OBJECTIVES: To evaluate "Stop the Bleed" (STB) training among/K12 personnel in an Alabama school system, and to assess participants' perceived readiness to train peers in STB methods. DESIGN AND SAMPLE: We performed a cross-sectional observational study with a convenience, nonprobability sample of 466 full-time personnel who received STB training. Data were collected using an anonymous online survey. MEASUREMENTS: We asked participants to recall feelings related to STB both prior to and after completing training using a 5-point Likert scale (5 = "Strongly Disagree", 1 = "Strongly Agree"). We used logistic regression to evaluate the association among posttraining feelings and perceived preparedness to train others in STB. RESULTS: Participants were primarily female (78%), aged 41 ± 10 years, who held faculty positions (94%). Results revealed increased knowledge of (4 [IQR 2-4] vs. 2 [1-2], p < .001) and comfort with (4 [2-5] vs. 2 [1-2], p < .001) STB skills. Participants felt more empowered to organize STB training (4 [3-5] vs. 3 [2-4], p < .001); those who felt empowered to organize STB training were eight times more likely to feel capable of teaching STB. CONCLUSIONS: After STB training, K-12 personnel felt empowered to organize additional STB trainings and capable of teaching STB methods to others.

Aspirin for primary prevention of stroke in traumatic cerebrovascular injury: association with increased risk of transfusion.

OBJECTIVEBlunt traumatic extracranial carotid or vertebral artery injury (i.e., traumatic cerebrovascular injury [TCVI]) occurs in 1%-2% of all blunt trauma admissions, carries a 10% risk of thromboembolic ischemic stroke, and accounts for up to 9600 strokes annually in the US. Screening CT angiograms (CTAs) of patients with trauma has become ubiquitous in recent years, and patients with initially asymptomatic TCVI are commonly treated with antiplatelet agents to prevent stroke. Prophylaxis with antiplatelets is thought to be safer than anticoagulation, which carries a significant risk of hemorrhage in patients with trauma. However, the risk of hemorrhagic complications due to antiplatelets has not been assessed in this population.METHODSThis is a retrospective cohort study of patients in whom a screening CTA was obtained after admission for blunt trauma at a Level 1 trauma center. Patients with CTAs indicating TCVI were treated routinely with 325 mg aspirin daily. The risk of transfusion > 24 hours after admission was compared according to CTA findings (CTA+ or CTA- for positive or negative findings, respectively) and aspirin treatment (ASA+ or ASA- for treatment or no treatment, respectively).RESULTSThe mean overall transfusion amount (number of units of packed red blood cells [PRBCs]) was 0.9 ± 2.1 for CTA+/ASA+ patients (n = 196) and 0.3 ± 1.60 for CTA-/ASA- patients (n = 2290) (p < 0.0001). In adjusted models, the overall relative risk (RR) of PRBC transfusion was 1.70 (1.32-2.20) for CTA+/ASA+ patients compared with CTA-/ASA- patients. Among age groups, participants whose ages were 50-69 years had the greatest significantly elevated RR (1.71, 95% CI 1.08-2.72) for CTA+/ASA+ patients compared with CTA-/ASA- patients.CONCLUSIONSTreatment with aspirin for the prevention of stroke in patients with initially asymptomatic TCVI carries a significantly increased risk of PRBC transfusion. Future studies are needed to determine if this risk is offset by a reduced risk of ischemic stroke.