Teaching how to stop the bleed: does it work? A prospective evaluation of tourniquet application in law enforcement officers and private security personnel.

INTRODUCTION: Stop the Bleed (STB) program was launched by the White House, for the use of bleeding control techniques at the scene of traumatic injury. The purpose of this study was to conduct an STB course in private security and law enforcement personnel. METHODS: Pre- and post-questionnaire using the Likert scale was shared with participants on their knowledge and comfort level with the use of tourniquets. Participants were also observed while placing tourniquets and the time for placement recorded. The didactic portion and practical session of the STB was then taught and participants were again observed placing tourniquets and a questionnaire distributed. Fisher's exact tests or Wilcoxon matched-pairs signed-ranks tests were used to compare pre-post measurements. RESULTS: A total of 151 subjects were enrolled over the course of seven sessions. The tourniquet was applied correctly by 17.2% (26/151) and 92.7% (140/151) at the pre- and post-instruction assessments, respectively (p < 0.001). Mean times to apply the tourniquet were 29.8 ± 18.5 and 18.7 ± 6.7 s, respectively (p < 0.001). Subjects reported their level of comfort with the tourniquet to be 5.1 ± 3.3 and 8.8 ± 2.2, respectively (p < 0.001), and their familiarity with anatomy and bleeding control to be 5.2 ± 3.1 and 8.2 ± 2.4, respectively (p < 0.001). At the end of the course, the mean score in response to a question about the extent to which the explanation had helped was 9.0 ± 1.9 (95% CI 8.7-9.4) and to a question about the extent to which teaching would make them feel more secure and safe was 9.2 ± 1.9 (95% CI 8.9-9.5). CONCLUSIONS: STB course improved correct tourniquet placement, demonstrated dramatic improvements in application time, and increased levels of comfort. These findings validate the need for ongoing teaching and education.

Acquired Hemophilia A: A Case Report.

Hemophilia A, also known as factor VIII deficiency, is a rare disorder caused by an insufficient level of factor VIII, an essential clotting protein. Hemophilia A can be inherited or acquired. Inherited hemophilia A is caused by a mutation to the factor VIII gene on the X chromosome, which is commonly passed down from parents to children. However, in about one-third of cases, the cause is a spontaneous mutation in that gene. Acquired hemophilia A is due to an autoantibody to factor VIII, which is termed an inhibitor. This rare disorder can cause life-threatening bleeding complications. Management relies on a rapid and accurate diagnosis, control of bleeding episodes, and eradication of the inhibitor by immunosuppression therapy. Most treatment strategies are centered around anecdotal reports or small case series. This case report summarizes the successful treatment of a patient with acquired hemophilia A and major bleeding following a surgical procedure, with the use of desmopressin, recombinant factor VIIa, repeated doses of recombinant factor VIII, rituximab, and prednisone.

Pre-peritoneal pelvic packing for the management of life-threatening pelvic fractures.

BACKGROUND: Pre-peritoneal pelvic packing (PPP) is a technique used for treating pelvic hemorrhage in patients with pelvic fractures and hemodynamic instability after a high-energy trauma representing a life-threatening situation. The aim of this study was to perform a comprehensive review of the literature. METHODS: A review of the medical literature was performed, based on the following inclusion criteria: patients sustaining pelvic fractures with hemodynamic instability and the inclusion of PPP as a tool for hemorrhage control. Articles not involving human patients, review articles, surveys, pediatric patients, hemodynamic stability, case reports, and not directly related publications; such as angiography with or without embolization, and REBOA use for hemorrhage control as a primary outcome evaluation were excluded from this search. RESULTS: Eleven articles out of seventy-seven identified publications between 2008 and 2018 met the inclusion criteria and were included in this review. CONCLUSIONS: PPP is a surgical approach used in life-threatening situations due to pelvic fracture with high risk of death for exsanguination. Performed expediently, good results can be obtained with a decrease in the need for blood products, improved systolic blood pressure, and a decrease in mortality rates overall. This makes PPP an important life-saving tool.

Novel simulation for training trauma surgeons.

BACKGROUND: Clinical training in operative technique is important to boost self-confidence in residents in all surgical fields but particularly in trauma surgery. The fully trained trauma surgeon must be able to provide operative intervention for any injury encountered in practice. In this report, we describe a novel training model using a human cadaver in which circulation in the major vessels can be simulated to mimic traumatic injuries seen in clinical practice. METHODS: Fourteen human cadavers were used for simulating various life-threatening traumatic injuries. The carotid and femoral arteries and the jugular and femoral vein were cannulated and connected to perfusate reservoirs. The arterial reservoir was connected to an intra-aortic balloon pump, which adds pulsatile flow through the heart and major arteries. Fully trained trauma surgeons evaluated the utility of this model for repairing various injuries in the thoracic and abdominal cavity involving the heart, lungs, liver, and major vessels while maintaining emergent airway control. RESULTS: Surgeons reported that this perfused cadaver model allowed simulation of the critical challenges faced during operative trauma while familiarizing the student with the operative techniques and skills necessary to gain access and control of hemorrhage associated with major vascular injuries. CONCLUSION: In this report, we describe a novel training model that simulates the life-threatening injuries that confront trauma surgeons. An alternative to living laboratory animals, this inexpensive and readily available model offers good educational value for the acquisition and refinement of surgical skills that are specific to trauma surgery.