Assessment of Prehospital Hemorrhage and Airway Care Using a Simulation Model

ABSTRACTBackgroundThe quality of prehospital care impacts patient outcomes. Military efforts have focused on training revision and the creation of high fidelity simulation models to address potentially survivable injuries. We sought to investigate the applicability of models emphasizing hemorrhage control and airway management to a civilian population.MethodsPrehospital healthcare providers (PHPs) undergoing their annual training were enrolled. A trauma scenario was simulated with two modules: hemorrhage control and airway management. Experienced raters used a validated tool to assess performance. Pearson correlation, logistic regression, and chi-square tests were used for analysis.ResultsNinety-five PHPs participated with a mean experience of 15.9 ± 8.3 years, and 7.4% reported past military training. The PHPs’ overall execution rate of the six hemorrhage control measures varied from 38.9% to 88.4%. The median blood loss was 1700 mL (IQR, 1043-2000), and the mean global rater score (GRS) was 25.0 ± 7.4 (scale 5-40). There was a significant relationship between PHP profession and past military experience to their consideration of blood transfusion and tranexemic acid. An inverse relationship between blood loss and GRS was found (r = -0.59, n = 88, p = 1.93 x 10-9). After simulated direct laryngoscope (DL) failure in the airway module, 58% of PHPs selected video laryngoscopy (VL) over placement of a supraglottic airway (SGA). Eighty-six percent of participants achieved bilateral chest rise in the manikin regardless of management method. Participants reported improved comfort with skills after simulation.ConclusionsOur data reveal marginal performance in hemorrhage control regardless of the PHP’s prior experience. The majority of PHPs were able to secure an advanced airway if DL was unavailable with a predisposition for VL over SGA. Our findings support the need for continued training for PHPs highlighting hemorrhage control maneuvers and increased familiarity with airway management options. Improved participant confidence post-training gives credence to simulation training.Level of EvidenceIII, prognostic/epidemiological Background The quality of prehospital care impacts patient outcomes. Military efforts have focused on training revision and the creation of high fidelity simulation models to address potentially survivable injuries. We sought to investigate the applicability of models emphasizing hemorrhage control and airway management to a civilian population. Methods Prehospital healthcare providers (PHPs) undergoing their annual training were enrolled. A trauma scenario was simulated with two modules: hemorrhage control and airway management. Experienced raters used a validated tool to assess performance. Pearson correlation, logistic regression, and chi-square tests were used for analysis. Results Ninety-five PHPs participated with a mean experience of 15.9 ± 8.3 years, and 7.4% reported past military training. The PHPs’ overall execution rate of the six hemorrhage control measures varied from 38.9% to 88.4%. The median blood loss was 1700 mL (IQR, 1043-2000), and the mean global rater score (GRS) was 25.0 ± 7.4 (scale 5-40). There was a significant relationship between PHP profession and past military experience to their consideration of blood transfusion and tranexemic acid. An inverse relationship between blood loss and GRS was found (r = -0.59, n = 88, p = 1.93 x 10-9). After simulated direct laryngoscope (DL) failure in the airway module, 58% of PHPs selected video laryngoscopy (VL) over placement of a supraglottic airway (SGA). Eighty-six percent of participants achieved bilateral chest rise in the manikin regardless of management method. Participants reported improved comfort with skills after simulation. Conclusions Our data reveal marginal performance in hemorrhage control regardless of the PHP’s prior experience. The majority of PHPs were able to secure an advanced airway if DL was unavailable with a predisposition for VL over SGA. Our findings support the need for continued training for PHPs highlighting hemorrhage control maneuvers and increased familiarity with airway management options. Improved participant confidence post-training gives credence to simulation training. Level of Evidence III, prognostic/epidemiological Corresponding Author: Mariya Skube, MD, Mailing Address: 420 Delaware St SE; MMC 195; Minneapolis, MN 55455, Telephone Number: 612-624-3940, Fax Number: 612-625-3675. Email Address: hache005@umn.edu Conflicts of Interest and Source of Funding: No conflicts declared. No relevant source of funding. Meetings: 1. Minnesota Surgical Society/Minnesota Committee on Trauma Resident Paper Competition (Winner), October 2016, Brainerd, MN 2. Region 5 American College of Surgeons’ Committee on Trauma Resident Paper Competition, November 2016, Detroit, MI 3. Military Health System Research Symposium, August 2017, Kissimmee, FL © 2018 Lippincott Williams & Wilkins, Inc.

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