Trauma Outreach In The Prehospital Setting: Pre And Post Training Confidence With Hemorrhage Control

Abstract

Hemorrhage control is essential for prehospital providers and has been recently highlighted in the Stop the Bleed® campaign. Our large, urban, Level I trauma center performs outreach with EMS providers to provide additional education on hemorrhage control. This study aimed to examine confidence with hemorrhage control techniques before and after training. Prehospital providers were administered surveys to evaluate their confidence in the management of severe hemorrhage with wound packing, tourniquet placement, and use of advanced hemostatics. Responses were measured on a five-level Likert scale. The participants were instructed by ACS surgeons with lecture and simulation training, after which the providers were reassessed using an identical survey. A total of 48 providers were trained. Provider confidence in hemorrhage control improved with training for all categories. Pre-training confidence varied, with greatest confidence noted for tourniquet use (93%), hemorrhage management (81%), indications for wound packing (70%), and performance of wound packing (69%), all of which increased to 100% post-training. Using the Likert scale, the greatest impact of training was in advanced hemostatics which improved from a pre-training score of 3.2 to 4.3 after instruction. Substantial improvements were noted in placement of wound packing (3.8 pre training, 4.6 post training) and knowing indications for wound packing (3.89 pre training, 4.5 post training). Prehospital providers described increased confidence with hemorrhage control after lecture and simulation-based instruction by ACS surgeons. Advanced hemostatics and indications for wound packing placement were areas of greatest initial concern and greatest improvement after training. Other centers may consider similar outreach education programs.