American Red Cross Research Articles

2024 American Heart Association and American Red Cross Guidelines for First Aid.

Codeveloped by the American Heart Association and the American Red Cross, these guidelines represent the first comprehensive update of first aid treatment recommendations since 2010. Incorporating the results of structured evidence reviews from the International Liaison Committee on Resuscitation, these guidelines cover first aid treatment for critical and common medical, traumatic, environmental, and toxicological conditions. This update emphasizes the continuous evolution of evidence evaluation and the necessity of adapting educational strategies to local needs and diverse community demographics. Existing guidelines remain relevant unless specifically updated in this publication. Key topics that are new, are substantially revised, or have significant new literature include opioid overdose, bleeding control, open chest wounds, spinal motion restriction, hypothermia, frostbite, presyncope, anaphylaxis, snakebite, oxygen administration, and the use of pulse oximetry in first aid, with the inclusion of pediatric-specific guidance as warranted.

Occupational and industry prevalence of new long-term symptoms within American Red Cross blood donors with and without history of SARS-CoV-2 infection.

Limited information is known about the burden of Long COVID by occupation and industry. This study compares the occurrence of self-reported new long-term symptoms lasting 4 weeks or longer among blood donors with and without prior SARS-CoV-2 infection by occupation and industry. The American Red Cross invited blood donors 18 years and older who donated during May 4-December 31, 2021 to participate in online surveys. New long-term symptoms lasting 4 weeks or longer were assessed by self-reported occurrence of any of 35 symptoms since March 2020. SARS-CoV-2 infection status was determined by serological testing and self-report. We describe the prevalence of new long-term symptoms by SARS-CoV-2 infection status. We calculate the difference in reported new long-term symptoms by SARS-CoV-2 infection status within occupation and industry categories. Data were collected from 27,907 employed adults - 9763 were previously infected and 18,234 were never infected with SARS-CoV-2. New long-term symptoms were more prevalent among those previously infected compared to the never-infected respondents (45% vs 24%, p < 0.05). Among all respondents, new long-term symptoms by occupation ranged from 26% (installation, maintenance, and repair) to 41% (healthcare support) and by industry ranged from 26% (mining) to 55% (accommodation and food services). New long-term neurological and other symptoms were commonly reported by those previously infected with SARS-CoV-2. New long-term symptoms are more prevalent among certain occupation and industry groups, which likely reflects differential exposure to SARS-CoV-2. These findings highlight potential need for workplace accommodations in a variety of occupational settings to address new long-term symptoms.

CPR Memory and Skill Degradation Among Non-Allied Healthcare Professionals

Cardiopulmonary Resuscitation is defined by the Mayo Clinic as a lifesaving technique that is useful in many emergencies, such as a heart attack, stroke, choking, or drowning, in which someone’s breathing and heartbeat have stopped.Under the guidelines put forth by the International Liaison Committee on Resuscitation (ILCOR) and the Emergency Cardiovascular Care Organization (ECC), the American Red Cross and American Heart Association currently require that an individual’s CPR certification be renewed every two years. However, data has suggested that non-allied healthcare providers, such as school-based personnel, may require more regular training to maintain required CPR proficiency levels. Four hundred non-allied healthcare professionals from a school district in central Georgia were CPR-certified under the American Heart Association (AHA) Heart-Saver curriculum. Participants included 153 males and 247 females from elementary, middle, and high school settings. Participants included administrators, teachers, coaches, and staff. Two tenured college professors from the School of Health and Human Performance were responsible for teaching and certifying study participants. Each of these professors possessed a minimum of five years of CPR certification experience with the American Heart Association. Course sizes were limited to 12-15 participants. All CPR certification courses were implemented under standardized, controlled circumstances. Following the initial certification, twenty-five percent of participants were randomly selected to be reassessed at either three, six, nine, or twelve months, respectively, to determine memory and skill degradation rates and patterns. Degradation of declarative and procedural knowledge was observed during subsequent retest sessions at each of the three-, six-, nine-, and twelve-month marks. Scores depreciated approximately 10% each three-month retesting period, to 88%, 79%, 69%, and 57%, respectively. Data suggest that after six months, participants failed to meet the AHA standards for demonstrating acceptable declarative and procedural knowledge related to CPR implementation. Due to the observed degradation in both declarative and procedural knowledge, it is apparent that a more periodic training and recertification process in CPR is required for school-based personnel. A more consistent and periodic approach to preparing school-based first responders may prove beneficial in maintaining CPR proficiency rates, which very well could save lives.

‘Allenby, O’ Allenby’: John Huston Finley’s Internationalist Case for a British Mandate in Palestine

ABSTRACT As the First World War drew to a close, the head of the American Red Cross’s Commission to Palestine, John Huston Finley, stepped into ongoing debates over the future of the Holy Land when he called for an international trusteeship in Palestine. Supporters and opponents of the Zionist movement – as well as the few scholars that have since engaged with Finley’s views – primarily understood Finley’s proposal as anti-Zionist. While Finley certainly presented his plan as an alternative to a Jewish state in Palestine, this article demonstrates that Finley’s proposal was much more directly a case for a British mandate that was rooted in Finley’s experiences working with the British – as well as his personal fascination with General Edmund Allenby. Finley believed and argued that Allenby’s person, character, and conduct demonstrated that the interests of ‘civilization’ could best be secured in Palestine by a British trusteeship. In his 1919 A Pilgrim in Palestine, published amidst the post-war debates over mandate assignments, Finley presented Allenby as a symbol of trusteeship’s possibilities in making an American case for British rule.

Evolution and Contribution of a Global Partnership against Measles and Rubella, 2001-2023.

This article describes the arc of global measles and rubella elimination since 2000 from the perspective of the founding partners of the Measles Initiative. The Measles Initiative was formed in 2001 as a partnership among the American Red Cross, the Centers for Disease Control and Prevention, UNICEF, the United Nations Foundation, and the World Health Organization with the aim to reduce measles deaths in low-income countries. Recognizing rubella as the leading infectious disease cause of congenital abnormalities globally and achievement of measles and rubella elimination in the region of the Americas, the partnership was renamed the Measles and Rubella Initiative (MRI) in 2012. The goals of the MRI were at least a 95% reduction in global measles mortality and elimination of measles and rubella in at least five of the six WHO regions. In January 2023, the membership of the partnership was expanded to include the Bill and Melinda Gates Foundation (BMGF) and Gavi the Vaccine Alliance, and its name changed to the IA2030 Measles and Rubella Partnership. We describe the role the partnership has had in measles partner effectiveness and its impact on measles and rubella disease burden, including how the partnership has strategically adapted to the evolving immunization landscape. We conclude with lessons learned regarding the role global partnerships can play in furthering the impact of disease control programs within the current global immunization environment.

Breaking a Century of Silence: A Historiography of the Tulsa Race Riot

The events of May 31 through June 1, 1921 had been obscured by a lack of official records and a culture of silence for the better part of a half-century. Thanks to the diligent work of amateur journalists and historians like Mary E. Jones Parrish, and civil servants like Maurice Willows of the American Red Cross, we have a historical record to work with. Writers like Ed Wheeler and Scott Ellsworth pioneered investigation into the riot, conducting Interviews and collating their findings into some of the first works dedicated to the act. Thanks to the efforts of Don Ross and the other members of the Oklahoma Commission to Study the Tulsa Race Riot of 1921, the prevailing narrative preserved by Parrish and Willows persisted into acceptance as the official story. Historians working during the commission drafted three distinct histories, built upon past work on the subject and serving different purposes: either to humanize the victims and perpetrators of the riot, make the case for reparations, or examine the context surrounding the riot's remembrance in the city.

Long-Term Symptoms Associated With SARS-CoV-2 Infection Among Blood Donors

Long-term symptoms, lasting more than 4 consecutive weeks after acute COVID-19 disease, are an important consequence of SARS-CoV-2 infection. Many prior studies have lacked a non-SARS-CoV-2-infected control population to distinguish background prevalence of symptoms from the direct impact of COVID-19 disease. To examine the prevalence of long-term physical and mental health symptoms associated with SARS-CoV-2 infection in a large population of blood donors based on self-report and serologic test results. This cross-sectional study included American Red Cross blood donors (aged ≥18 years) who were surveyed between February 22 and April 21, 2022, about new long-term symptoms arising after March 2020 and their SARS-CoV-2 infection status. All participants underwent at least 1 serologic test for antinucleocapsid antibodies between June 15, 2020, and December 31, 2021. SARS-CoV-2 infection as defined by a self-reported, confirmed acute infection or antinucleocapsid antibody positivity. New long-term symptoms since March 2020, including 5 symptom categories (neurologic, gastrointestinal, respiratory and cardiac, mental health, and other). Among 818 361 individuals who received the survey, 272 965 (33.4%) responded, with 238 828 meeting the inclusion criteria (138 576 [58.0%] female; median [IQR] age, 59.0 [47.0-67.0] years). Of the 83 015 individuals with a history of SARS-CoV-2 infection, 43.3% reported new long-term symptoms compared with 22.1% of those without a history of SARS-CoV-2 infection. After controlling for age, sex, race and ethnicity, and number of underlying conditions, those with a history of SARS-CoV-2 infection had an increased odds of new long-term symptoms compared with those without (adjusted odds ratio [AOR], 2.55; 95% CI, 2.51-2.61). Female sex and a history of chronic conditions were associated with new long-term symptoms. Long-term symptoms in the other category (AOR, 4.14; 95% CI, 4.03-4.25), which included changes in taste or smell, and the respiratory and cardiac symptom categories (AOR, 3.21; 95% CI, 3.12-3.31) were most associated with prior SARS-CoV-2 infection. Mental health long-term symptoms were also associated with prior SARS-CoV-2 infection (AOR, 1.05; 95%, CI, 1.02-1.08). This study's findings suggest that long-term symptoms lasting more than 4 weeks are common in the adult population, but there is a significantly higher prevalence among those with SARS-CoV-2 infection. Continued efforts to define and track long-term sequelae of SARS-CoV-2 using a control group without infection and serologic information to include those who had asymptomatic or unidentified infections are needed.

Social Impacts of the American Red Cross (ARC) Disaster Interventions: A Scoping Review.

The American Red Cross (ARC) self-reports post-disaster efforts annually, potentially biased for public image. The lack of formal reviews of ARC interventions' social impacts further exacerbates the issue. This scoping review aims to address both issues by summarizing and evaluating the social impact of ARC's national disaster interventions. As a secondary objective, this review will also provide important information to guide ARC and other organizations in truly fulfilling their missions. The inclusion criteria involve participants of all age groups, marginalized communities, displaced individuals, and ARC disaster responders. Opinionated statements, except for anecdotes, were excluded. This review involves all United States (US) areas that have been affected by disasters and required assistance from ARC. With no search limits, all evidence was searched on PubMed from July to August 2023. Two stages of screening were conducted by two independent reviewers: title/abstract screening and full-text screening. During each stage, each paper underwent a quality assessment. Disagreements in each stage were resolved before proceeding to the next stage. Through 22 academic papers, the review outlines key themes in ARC comprehensive interventions on disaster preparedness and on-site disaster interventions. However, research gaps were found in ARC recovery interventions, especially their impact on evacuees. This investigation found that ARC makes general efforts to address the needs of communities they assist before, during, and after disasters. Because the results suggest that ARC is moving in the correct direction in reducing the nationwide harm disasters cause, ARC's social impact on studied populations is mostly positive.

Are Political and Charitable Giving Substitutes? Evidence from the United States

Using microdata from the American Red Cross (ARC) and the Federal Election Commission (FEC) in two natural experiments, we provide evidence that political giving and charitable giving are substitutes. In the first natural experiment, we estimate the effects of a positive shock to charitable donations to the ARC: foreign natural disaster events. We find that although charitable donations to ARC increase by 34.9% in the six weeks following a disaster, political donations decline by 18.8% in the same period. Put differently, each 1% increase in the charitable giving to ARC is accompanied by a 0.53% drop in political donations. At the average county-week–level donations, the implied effect of a $1 increase in charitable giving is a $0.42 decline in political donations. In the second natural experiment, we estimate the effects of a positive shock to political giving: advertisements for political campaigns. Exploiting geographic discontinuities in advertising markets, we find that political advertisements increase political giving, whereas they decrease charitable donations to ARC. Our estimates imply that each 1% increase in the political giving is accompanied by a 0.59% drop in charitable donations to ARC. At the average county-week–level donations, the implied effect of a $1 increase in political giving is a $0.33 decline in charitable donations. The crowding-out elasticities suggest that political giving and charitable giving are relatively close substitutes. We provide a number of robustness checks, and we discuss potential causal mechanisms. This paper was accepted by Eric Anderson, marketing. Funding: P. Yildirim thanks the Dean’s Research Fund and the Mack Institute at the Wharton School as well as the Wharton Behavioral Laboratory for their financial support. M. Petrova thanks financial support from the Severo Ochoa Programme for Centres of Excellence in R&amp;D (Barcelona School of Economics CEX2019-000915-S), funded by MCIN/AEI/10.13039/501100011033. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.00845 .

Nature-based Solution for Local Watershed and Coastal Flood Mitigation in Indonesia

This study evaluates the effectiveness of program implementation that combines Integrated Community-based Risk Reduction (ICBRR) with Nature-based Solution (NbS) in Manggarai Regency, East Nusa Tenggara and Tanggamus, Regency of Lampung Province. The method used is qualitative measurement using indicators of NbS achievement by the United Nations Office for Disaster Risk Reduction (UNDRR), the International Union for Conservation and Nature (IUCN), and the International Federation of the Red Cross and Red Crescent Societies (IFRC). Data were collected from quarterly evaluation reports by program implementers: the Indonesian Red Cross (PMI) and American Red Cross (Amcross) and interviews with program implementers. The results showed that the broad concept of NbS is difficult to apply and measure in short-duration programs because it takes a longer time to see significant and balanced changes in each variable, especially in the variables of net gain biodiversity, livelihood improvement, and regional policy integration. However, the program that has been implemented has been able to initiate an implementation framework that is easily understood at the local level and brings NbS to the context of community needs and capabilities.

A Case Study of American Red Cross Mental and Psychosocial Health in South Asia from 2000-2010

A Case Study of American Red Cross Mental and Psychosocial Health in South Asia from 2000-2010

The operational and financial impact of adding anaerobic screening of platelets.

We evaluated the operational and safety impact of implementing anaerobic culture screening of apheresis and pooled platelets at the American Red Cross on the already established use of the aerobic culture screening of each donation performed no sooner than 24 h following collection. Platelets were screened for bacterial contamination with the BACT/ALERT 3D® (bioMérieux, Durham, NC) microbial detection testing system. The addition of anaerobic culture to the already existing aerobic culture resulted in sampling an additional 8-10 mL from each donation. Implementation of anaerobic testing resulted in an approximate 3.5-fold increased rate of False Positive BACT/ALERT alarms. There was a modest increase in the rate of True Positive alarms of 1.4-fold with increased detection of Klebsiella and Propionibacterium species, including Cutibacterium acnes. In addition, there was an approximate 3.5-fold increase rate of False Positives and a 13.5-fold increase rate of Indeterminates, the majority (~57%) were due to Cutibacterium acnes. The combined costs and lost revenue associated with adding anaerobic screening increased by ~$1,000,000/year due to testing cost and product discards. The addition of anaerobic culture to aerobic culture to the original donation (without the introduction of sampling delay) resulted in a significant increase in the rate of alerts. The 40% increased rate of True Positive alarms may have modestly improved platelet safety. However, there was a disproportionate increase in the rate of False Positive and Indeterminate bacterial culture alarms, which added substantial cost and overall loss of platelet products.

Armenians in 1920s Greece: Turkey’s Unwanted Minority, the League of Nations’ Burden, Greece’s “Other” Refugees

Abstract This article sheds light upon the history of an underresearched group of refugees who settled in Greece in the 1920s. It focuses on Armenians from Anatolia who fled to Greece in 1921–22, during and after the Greek-Turkish War of 1919–22. The article examines how the Greek government and international humanitarian organizations (Near East Relief, American Red Cross, etc.) approached the Armenian refugees, including orphans. The study further highlights practices such as transfers of Armenians within Greece, repatriation programs supported by Greece to send the Armenian refugees to Soviet Armenia, and citizenship policies regarding them.

Red Blood Cell Aliquoting: Improving O Negative Red Blood Cell Utilization in Neonate and Pediatric Inpatients at UC Davis Medical Center

Abstract Introduction/Objective UC Davis Medical Center (UCDMC) is the Sacramento region’s only level 1 adult and pediatric trauma center. It serves a 65,000 square mile area that includes 6 million residents from 33 counties across Northern and Central California. Nearly 7000 patients are transfused annually at UCDMC. Blood supply restrictions, especially on group O negative red blood cells (RBCs), escalated by the COVID-19 pandemic, posed significant patient safety risk. We sought to mitigate this risk by employing restrictive O negative RBC transfusions as recommended by AABB Choosing Wisely, through ABO matched small volume transfusions in neonate and pediatric patients. Methods/Case Report We conducted monthly audits starting in January 2021 to identify trends in O negative RBC use at UCDMC. We partnered with our blood supplier, American Red Cross (ARC), to modify hospital blood inventory. In 2022, we implemented the RBC aliquoting procedure using AS-3 RBCs to facilitate ABO matched small volume transfusions in neonates and children to conserve O negative blood supply. We reviewed regulatory standards, developed standard operating procedures, performed extensive technical validations, and worked with IT to enhance laboratory information system for product manufacturing, labeling, and traceability. We developed education documents for physicians, other providers, nurses, and transfusion services staff including sustainable competency and training. We conducted audits post implementation to measure goal performance in Q4 of FY22, compared to pre- implementation baseline data from Q1 of FY22. Results (if a Case Study enter NA) N/A Conclusion We achieved 57% reduction in O negative RBC utilization post implementation of the RBC aliquoting procedure in Q4 of FY22. Overall O negative RBC use trend at UCDMC improved with a 58% reduction between January 2021 to December 2022. Subsequent reduction of orders was achieved.We conclude that ABO matched RBC aliquot transfusion in neonates and pediatrics is an effective laboratory practice to reduce O negative RBC usage.

Blood Shortage Monitoring: Comparison of the Supply Situation During the Omicron Surge and at the Tail End of the COVID-19 Pandemic this Year

Abstract Introduction/Objective The COVID-19 pandemic was marked by the first-ever declaration of a severe blood crisis by the American Red Cross in 2022. During this blood crisis, the, there were significant shortages of blood products that required precise monitoring of the current stock for communication and collaboration with the clinical team to ensure uninterrupted patient care. The blood supply gradually improved since 2022’s blood crisis, particularly as the public health emergency related to COVID-19 ended on May 11th, 2023. However, published literature on the comparison of the blood supply in the last calendar months of the public health emergency versus during the blood shortage is sparse. Methods/Case Report From January 28th, 2022, to February 28th, 2022, the amount of red blood cell (RBC) inventory was noted along with the percentage reduction from usual pre-crisis inventory level. This inventory information was communicated with the clinical services to coordinate clinical care during the blood supply crisis. Additionally, a separate inventory comparison to cover the last 5 calendar months (including May) until the end of the Public Health Emergency on May 11th, 2023, was performed from January 1st, 2023, to May 11th, 2023. Results (if a Case Study enter NA) During the crisis from January 28th, 2022, to February 28th, 2022, there were significant reductions in red blood cell inventory (up to 67% reduction in O+ units and 75% for A+ units). Collaboration with the clinical team and efforts to procure and conserve blood products enabled continuity of clinical care. On the other hand, there was documented improvement in the blood inventory at the tail end of the pandemic (January 1st, 2023, to May 11th, 2023) with average inventory reductions of only 19% in O+ units and 43% in A+ units. Conclusion There was a significant blood shortage during the Omicron surge of 2022 that required inventory monitoring, collaboration with the clinical team, and efforts to procure and conserve blood products to ensure continued successful clinical care. As the pandemic’s public health emergency neared its end, the blood supply situation has been improving substantially.

Self-Sustainability with Therapeutic Phlebotomy, a Solution to the National Blood Crisis?

CONCLUSION Hereditary hemochromatosis (HH) is a genetic condition associated with iron overload in the human body. The mainstay of treatment remains therapeutic phlebotomy. On August 1st, 2022, the American Red Cross approved using blood obtained from therapeutic phlebotomy for transfusion. While normal individuals can donate blood only as often as once in 56 days, individuals with HH can have phlebotomy as often as once weekly. Utilizing the blood collected from these patients could be a significant resource to mitigate the shortage of blood needed for transfusion. We aimed to quantify the number of units of blood removed by therapeutic phlebotomy from individuals with HH and assess its potential contribution to total units of blood required in a community hospital for two years (2021 and 2022). We retrospectively reviewed electronic medical records of adult individuals who underwent therapeutic phlebotomy at Saint Vincent Hospital between January 1, 2021, and December 31, 2022. Patients with hereditary hemochromatosis were identified based on a positive genetic test for HFE gene mutations. We collected data including gender, race, age at diagnosis, and the number of units of blood removed from patients during the study period. The total number of units transfused in the in-patient care services and operating room was obtained. A descriptive statistic was performed using R version 4.2.2 statistics software. A total of 112 patients received therapeutic phlebotomy over two years (2021 and 2022) of whom 65% (N=73) had a diagnosis of HH. A majority of the patients were males (60%, 44/73) and were non-Hispanic/Latino (85%, 62/73). The mean age at diagnosis of HH was 62 [standard deviation (SD): 17] years. The median number of units of blood removed by phlebotomy per patient with HH was 3 (2-5), the annual distribution is as displayed in Table 1. A total of 504 units of whole blood was removed through therapeutic phlebotomy from 73 patients during the study period. The total requirement for blood transfusion across all the departments in the hospital was 6065 units (2,733 units in 2021 and 3,332 units in 2022). The total number of units removed through therapeutic phlebotomy in HH patients represented 8.31% (504/6065 Units) and 82.49% (504/611 Units) of total units of blood requirement for the entire hospital and operating room respectively (Table 2). The units of blood removed through therapeutic phlebotomy of patients with HH, could potentially help sustain 8.31% of total blood requirement of the hospital. Primarily, over 82% of the demand from the operating room could be fulfilled if the entirety of the blood from therapeutic phlebotomy were to be transfused. Overcoming technical challenges in utilizing the blood from therapeutic phlebotomy for transfusion in routine clinical practice could help mitigate the national blood crisis and aid in self-sustainability of blood products at a community level. Our study highlights the need for broader efforts to create awareness and incentivizing re-utilization of blood obtained from therapeutic phlebotomy.

Digital Humanitarian Mapping and the Limits of Imagination in International Law

Humanitarian maps assembled using digital technology are indicative of transformations underway in how the world is made knowable, sensible, and actionable, including for international legal purposes. These transformations are exemplified by the Missing Maps Project (MMP), an initiative of the Humanitarian OpenStreetMap Team, a U.S.-registered non-profit, and three other non-governmental organisations operating internationally: American Red Cross; British Red Cross; and Médecins Sans Frontières. Projects such as the MMP make it harder for international lawyers to lay claim to, and seek to imaginatively reorient, shared repositories of common sense. Meanwhile, international legal scholars continue to propagate ideas that the world may be reimagined with their help, largely without regard to such transformations. In lieu of imagination’s standard evocation to the end of enhancing critical agency in international legal writing, this article contends that the idiosyncratic notion of imagination advanced in the writings of Walter Benjamin may be better attuned to ongoing shifts in sense-making apparent in international humanitarian mapping. Walter Benjamin’s atypical rendering of imagination as a ‘purely receptive, uncreative’ force in a field of technological reproduction offers international legal scholars another way of thinking about agency and prospects for re-forming their field in the face of its burgeoning digitalisation.

Learner's Stop the Bleed Outcomes Between Lay Instructor and Emergency Medical Services (EMS)-Trained Instructor Groups.

One of the most utilized Stop the Bleed courses, the "Bleeding Control Basic (BCon) course v. 1.0," requires instructors to have a specific healthcare license or pre-hospital credential (e.g., physician or paramedic) or specific emergency medical services (EMS) instructor certification and have completed the BCon provider course. This requirement provides a level of expertise in instructorsbutlimits the potential workforce for sharing life-saving knowledge and skills. Other Stop the Bleedcourses, such as the American Red Cross First Aid for Severe Trauma (FAST) course, do not have this requirement. This raises questions pertaining to the learners' outcomes between those facilitated by instructors with and without healthcare licenses or credentials. Learners' outcomes for applying a tourniquet (skill), knowledge (cognitive), and Intention to Aid (attitude for behavior) were compared between those taught by lay instructors and EMS-trained (emergency medical technician or paramedic) instructors. All were trained as new instructors in the FASTprogram. For the study's primary outcome, all of the learners (n=135) properly applied a tourniquet to a simulated leg injury at the end of the training based on video evidence (skill). Learners in the EMS-trained instructor groups (n=84, mean age 25.5 years, 68% female), who were olderandhad more education, scored significantly higher on knowledge of tourniquet use on the Stop the Bleed Educational Assessment Tool (SBEAT) (mean=90.0 vs. 83.9 on a scale of 0-100, p=0.001) with a small effect size than the lay instructor group (n=51, mean age 16.6 years, 88% female).There was no statistical difference in attitude toward helping behaviors in a bleeding emergency between the two groups on the Intention to Aid (I2A) survey. Lay instructors andEMS-trained instructors performed comparably in facilitating a widely available Red Cross Stop the Bleed course. Lay experience with tourniquets should not disqualify individuals from being a Stop the Bleed instructor. Using a standard curriculum with instructor development offers a way for people with and without an EMS background to teach life-saving competencies effectively.

At (Red) cross purposes: American Red Cross humanitarian ‘arrogance’ and France’s Great War relief and reconstruction, 1917–20

ABSTRACT Directors of American Red Cross (ARC) 1917–20 French civilian relief electively addressed and ignored France’s First World War-triggered needs. ARC leaders’ programmes during the organization’s three-year period of active French service voluntarily embraced and discarded Francophile policies endorsed by their subordinates, their colleagues and their superiors. ARC wartime assistance allotments increasingly, and sometimes perplexingly, favoured US servicemen over French non-combatants. Post-War ARC aid allocations deliberately advanced embryonic Eastern European activity over enduring and extensive known and indefinite French privations. ARC executives even periodically proposed and imposed orders that made France and its people unwitting underwriters of the American Red Cross’ focus on Eastern Europe, even as that process expressly reduced French civilian aid. Their self-confident, repeated and arbitrary conduct vis-à-vis Great War-afflicted French non-combatants advanced ARC purposes at Frenchmen’s expense. It thus meets current definitions of ‘arrogant’ humanitarianism.

The activity and influence of the American Red Cross in Italy during and after World War one (1917–1919)

ABSTRACT During the First World War, the Italian people became familiar with the American khaki uniform not from the presence of combat units, which hardly appeared in Italy, but rather from the American Red Cross (ARC) workers, who arrived immediately after the disastrous rout of Caporetto (October/November 1917). Throughout Italy, they were the most visible representatives of mythical America, its munificence, effectiveness and concern for the common man. Relief for wounded and sick soldiers was but a small part of ARC activity: more than two thirds of its total expenditure was upon civilians. In fact, its greatest mission was to put new heart into all components of Italian society. It was there not only to heal combatants’ wounds, but also to minister to the ‘wounds of the spirit’ of the population, in terms of demoralization, unrest and attraction towards revolutionary violence. Accordingly, it extended its activity over the entire country, from the Alps to the islands, dividing it into 16 districts, each under a Red Cross delegate. At the end of the war, the organization’s staff numbered 949 US employees, along with approximately 1000 Italian workers. In all, more than 7000 cities, towns and villages were reached by Red Cross representatives. Its substantial donations of material aid went to soldiers, hospitals, refugees, orphans and needy families. The Italian campaign was second only to the French in terms of budget and range. Besides emergency work, it comprised long-term projects, such as the construction of a village for refugees near Pisa, nursing schools and strategies for the prevention of tuberculosis, which in effect became pilot projects for European reconstruction and civilian aid in general in peacetime.