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 St. Louis doctors came up with some ingenious adaptations to lower
the price of training kits used to teach people how to stop severe
bleeding that can cost a life, and describe their inner-city focused
training program and tools in JAMA Surgery.
"We just ran into a wall after getting funding to teach the class,"
said the report's lead author, Dr. Erin Andrade, a research fellow
at Washington University. "The commercially available trainer kit
costs about $1,000. We had to figure out a way to do it
inexpensively.
Instead of the expensive limb model included in the commercial kits,
Andrade and her colleagues constructed one out of foam rollers, in
which they made cuts that were painted red to simulate wounds, to
which trainees could practice applying a tourniquet.
"We used pool noodles to teach people how to apply pressure,"
Andrade said. "If you apply it correctly the hole in the center
completely closes."
The trainers also taught participants to put together the bandages
and other materials needed to stop bleeding themselves, so they
could carry supplies with them.
Each training kit, including limb model, gauze, gloves and other
supplies costs about $25, Andrade and her colleagues write in their
report.
The payoff can be huge. "The average ambulance response time is 7.7
minutes in urban areas in the United States, which is longer than
the time it takes to bleed out from an arterial injury," the
researchers note. "Tourniquet use is associated with a 90 percent
survival rate when placed before the onset of shock but only 20
percent when placed after shock's onset."
Andrade's efforts are part of the "Stop the Bleed" campaign launched
by the American College of Surgeons in 2015 to teach laypersons
bleeding control techniques. Just as teaching members of the public
to use portable defibrillators and CPR lets bystanders help someone
in cardiac arrest until an ambulance arrives, the idea is that
bystanders can also learn to stop severe bleeding before it's too
late.
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A subset of the campaign, the Acute Bleeding Control program,
focuses on training groups most at risk for experiencing gun
violence, the authors note.
Andrade and her colleagues focused on inner city residents who are
at risk for gun violence. "By learning how to react after a violent
incident they can take over the situation and be empowered to change
the narrative about violence," she said.
As an illustration, Andrade points to the story of a girl who took
the course while in juvenile detention. "Her brother was injured
after she left - stabbed in the thigh," Andrade said. "She was able
to use the tourniquet she received and saved his life."
Stop the Bleed training is "the CPR of the 21st century," Andrade
said. "It's trauma first aid. It's everything you need to know to
stop life-threatening bleeding. With it, anyone can save a life."
"They have used a novel approach and I think it's a great adaptation
of the current program," said Dr. Raquel Forsythe, an assistant
professor of surgery and critical care medicine and associate
medical director of trauma surgery at the University of Pittsburgh
Medical Center in Pennsylvania.
Forsythe applauded the development of an inexpensive training kit as
well as a low-cost kit that trainees learned to put together on
their own. "We're talking about the people who are most at risk, but
may not have the funds to purchase a kit," Forsythe said. "A
lower-cost easy-to-assemble option is a great innovation."
SOURCE: https://bit.ly/2XNvf3L JAMA Surgery, online April 24, 2019.
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