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

BACKGROUND: 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 instructors but limits the potential workforce for sharing life-saving knowledge and skills. Other Stop the Bleed courses, 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. METHODS: 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 FAST program. RESULTS: 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 older and had 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. IMPLICATIONS: Lay instructors and EMS-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.

Intention to vaccinate against COVID-19 and potential outreach strategies for a residential research university in Northeastern Ohio.

INTRODUCTION: A university's understanding of student, faculty, and staff members' intention to vaccinate against COVID-19 has been vital in returning safely to in-person education, research, and engagement with communities and professions. We employed a novel survey to describe intentions across subpopulations of one campus and consider key issues in their rationales for intentions and hesitancies. MATERIALS AND METHODS: 1,077 surveys based on Theory of Planned Behavior were completed from randomly selected pools of undergraduate students, graduate students, part-time faculty, full-time faculty, and staff. Chi-Squared Automated Interaction Detection algorithm analysis provided paths for evaluation. RESULTS AND DISCUSSION: 83 percent of respondents said they would receive the vaccine at their first opportunity, while 5 percent said they would never get the vaccine; the remaining 12 percent wanted more evidence before getting the vaccine. Findings included negative health perceptions of the vaccine, misinformation on the process, as well as negative rhetorical responses differentiated between political partisanship and membership within the campus community, eg, faculty, staff, or student. IMPLICATIONS: Universities seeking to raise campus vaccination rates should concentrate limited resources on the largest populations with the most opportunity to vaccinate. In this study, newer students, with conservative political views, represented a population of opportunity. Their formative beliefs may be influenced by messaging and in collaboration with students' personal physician and/or friend groups. A theory-based approach leads to focused efforts for safer campuses and resumption/continuation of face-to-face interactions for students, faculty, and staff.

The Value of Songs for Teaching and Learning Cardiopulmonary Resuscitation (CPR) Competencies: A Systematic Review.

We sought to summarize, in a systematic review, the effectiveness of songs to support learning, performance, and recall of quality characteristics of cardiopulmonary resuscitation (CPR) compression rate, and depth. We systematically reviewed the literature from eight academic indexes from the fields of medicine, nursing, allied health, and education, from 2014 to 2020 to identify studies that evaluated an intervention of song use during CPR training against control and reported outcomes of compression rate and depth. There were 185 studies initially identified for review, eight met criteria for inclusion and analysis. For the critical outcome of compression depth, a pooled song group (n=446) when compared to a non-song group (n=443) demonstrated higher odds of being in the recommended range (OR 3.47). All studies, however, performed an average compression depth shallower than recommended guidelines in each arm. The available literature, we found, utilized heterogenous methodology and was at high risk of bias. When pooled, there were trends towards improved CPR metric performance in groups who were exposed to songs during treatment, though this only reached significance when groups were tested at >30 days from initial exposure. Findings of lower compression rates in the song groups suggest that song selection should favor beats per minute closer to the midpoint of the 100-120 ideal range to allow for variation when used as mental metronomes.

First Aid Education for Opioid Overdose Poisoning: Scoping Review.

Effective health education needs ongoing evidence to support policy development and action in a public health crisis, like the opioid epidemic in the United States. Opioid Education and Naloxone Distribution (OEND) programs work to change behaviors through information, education, and resources to empower people to prevent and respond to opioid overdose poisonings. In this review, we sought to identify the first aid educational components of OEND to address opioid overdose poisoning, identify gaps in the existing literature, and support the development of future studies that could then be systematically reviewed. From a systematic review that identified 2057 peer-reviewed manuscripts, 59 studies demonstrated that the educational literature is sparse, of low quality, lacks quality measures and effective methodologies, and suffers from self-reported and highly inconsistent endpoints, making outcome comparisons challenging, if not impossible. The reviewed OEND programs generally used a public health/health education approach focusing on people who inject opioids, their family and friends, first responders, and rarely the general public. Depending on the learners, interventions were broken down to those <15, 16-90, and >90 minutes, which categorically showed differences in knowledge and first aid response actions. Only eight studies used comparison groups which provide a slightly higher level of evidence. Reports of survival appeared to positively correlate with naloxone kit distribution. Opportunity exists to develop policies and plans that support individual and community efforts through evidence-based guidelines, particularly to the domains of first aid education, so that educators and organizations can deliver efficacious programming that meets the needs of their learners.

The FAST VIP (First Aid for Severe Trauma "Virtual" in-Person) Educational Study.

INTRODUCTION: Trauma is the leading cause of death for young Americans. Increased school violence, combined with an emphasis on early hemorrhage control, has boosted demand to treat injuries in schools. Meanwhile, coronavirus disease 2019 (COVID-19) has made educating the public about trauma more difficult. A federally funded high school education program in development, called First Aid for Severe Trauma™ (FAST™), will teach students to aid the severely injured. The program will be offered in instructor-led, web-based, and blended formats. We created a program to prepare high school teachers to become FAST instructors via "virtual" in-person (VIP) instruction. We used a webinar followed by VIP skills practice, using supplies shipped to participants' homes. To our knowledge, no prior studies have evaluated this type of mass, widely distributed, VIP education. METHODS: This study is a prospective, single-arm, educational cohort study. We enrolled a convenience sample of all high school teachers attending FAST sessions at the Health Occupations Students of America-Future Health Professionals International Leadership Conference. Half of the participants were randomized to complete the Stop the Bleed Education Assessment Tool (SBEAT) prior to the webinar, and the other completed it afterward; SBEAT is a validated tool to measure learning of bleeding competencies. We then performed 76 VIP video-training sessions from June-August 2020. The FAST instructors assessed each participant's ability to apply a tourniquet and direct pressure individually, then provided interactive group skills training, and finally re-evaluated each participant's performance post-training. RESULTS: A total of 190 (96%) participants successfully applied a tourniquet after VIP training, compared to 136 (68%) prior to training (P < 0.001). Participants significantly improved their ability to apply direct pressure: 116 (56%) pre-assessment vs 204 (100%) post-assessment (P < 0.001). The mean score for the SBEAT increased significantly from pre-training to post-training: 2.09 with a standard deviation (SD) of 0.97 to 2.55 post-training with a SD of 0.72 (P < 0.001). CONCLUSION: This study suggests that a webinar combined with VIP training is effective for teaching tourniquet and direct-pressure application skills, as well as life-threatening bleeding knowledge. VIP education may be useful for creating resuscitative medicine instructors from distributed locations, and to reach learners who cannot attend classroom-based instruction.

Diagnosis of out-of-hospital cardiac arrest by emergency medical dispatch: A diagnostic systematic review.

INTRODUCTION: Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest. METHODS: We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to "emergency medical dispatcher", "cardiac arrest", and "diagnosis", among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation. RESULTS: We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers. CONCLUSION: The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilization.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

"Stop the Bleed" Education Assessment Tool (SBEAT): Development and Validation.

As part of the national Stop the Bleed campaign in the United States, more than a million people have received bleeding control training through the work of many organizations. These public and professional educational experiences are ideally grounded in health sciences, clinical, and educational evidence to be most effective. However, there is currently no standard tool for evaluating the educational quality of these programs. We developed and validated the Stop the Bleed Education Assessment Tool (SBEAT) to provide a standard measure of life-threatening bleeding educational programs knowledge learning outcomes to aid in evaluation and development of this public health program. The SBEAT development included medical, clinical, and educational experts to derive and validate learning outcomes. Specific item writing incorporated focus groups for input on language and then pilot testing before a full community pilot test established a data set, for which a Rasch methodology was applied. The resulting tool used 34 items embedded in 19 survey questions, with item separation statistic of 5.56 (0.97 reliability) and person separation statistic of 2.09 (0.81 reliability) for 171 persons. Overall, the Cronbach Alpha (KR-20) person score "test reliability" equaled 0.85 (SEM = 2.24). The SBEAT project establishes a standardized assessment tool to evaluate the cognitive aspects of first aid for life threatening bleeding. Comparison of outcomes from different teaching styles and methods will allow for the development of best practices for future bleeding control education and help organizations demonstrate value to learners, funders, and policy makers, and advance health sciences education. SBEAT offers a measure for which educational efficiency and efficacy can be judged within a larger effort to prepare people for personal emergencies or large-scale disasters.

Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.

2019 American Heart Association and American Red Cross Focused Update for First Aid: Presyncope: An Update to the American Heart Association and American Red Cross Guidelines for First Aid.

This 2019 focused update to the American Heart Association and American Red Cross first aid guidelines follows the completion of a systematic review of treatments for presyncope of vasovagal or orthostatic origin. This review was commissioned by the International Liaison Committee on Resuscitation and resulted in the development of an international summary statement of the International Liaison Committee on Resuscitation First Aid Task Force Consensus on Science With Treatment Recommendations. This focused update highlights the evidence supporting specific interventions for presyncope of orthostatic or vasovagal origin and recommends the use of physical counterpressure maneuvers. These maneuvers include the contraction of muscles of the body such as the legs, arms, abdomen, or neck, with the goal of elevating blood pressure and alleviating symptoms. Although lower-body counterpressure maneuvers are favored over upper-body counterpressure maneuvers, multiple methods can be beneficial, depending on the situation.

Two-thumb-encircling advantageous for lay responder infant CPR: a randomised manikin study.

OBJECTIVE: Paediatric health providers and educators influence infant mortality through advocacy and training within families and communities. This research sought to establish the efficacy and training of two-finger versus two-thumb-encircling techniques for lone responder infant chest compressions with ventilations in initially trained infant caregivers. DESIGN: This is a randomised, cross-over educational intervention assessed on instrumented manikins using the 2015 guideline measures of quality infant cardiopulmonary resuscitation (CPR). Additional subjective data on the experience were collected through self-reporting. SETTING: Non-healthcare community organisations and secondary school classrooms. PARTICIPANTS: Fourteen years or older, fluent in English and had not taken infant CPR in the last 5 years. INTERVENTIONS: Groups of eight participants were randomised to learn one technique, practised and then tested for 8 min. After a 30 min rest, the group repeated the process using the other technique. MAIN OUTCOME MEASURES: Mean chest compression depth and rate, compression fraction, and correct hand position; tiredness and pain as reported by the caregiver. RESULTS: The two-thumb-encircling technique achieved a deeper mean compression depth over the 8 min period (2.0 mm, p<0.01), closer to the minimum recommendation of 40 mm; the two-finger technique achieved higher percentages of compression fraction and complete recoil. Caregivers preferred the two-thumb technique (64%), and of these 70% had long fingernails. CONCLUSIONS: The two-thumb-encircling technique improved compression depth, over an 8 min scenario, and was preferred by caregivers. This adds to the existing literature on the advantages of two-thumb-encircling as a technique for lone and team infant CPR, which counters current guidelines.

Measuring Intent to Aid of Lay Responders: Survey Development and Validation.

BACKGROUND: Increasing lay responder cardiopulmonary resuscitation and automated external defibrillator use during sudden cardiac arrest depends on an individual's choice. Investigators designed and piloted an instrument to measure the affective domain of helping behaviors by applying the theory of planned behavior (TPB) to better understand lay responders' intent to use lifesaving skills. METHOD: Questionnaire items were compiled into 10 behavioral domains informed by the TPB constructs followed by refinement via piloting and expert review. Two samples from an American Red Cross-trained lay-responder population ( N = 4,979) provided data for an exploratory (EFA, n = 235) and confirmatory (CFA, n = 198) factor analyses. EFA derived interitem relationships into factors and affective subscales. CFA yielded statistical validation of factors and subscales. RESULTS: The EFA identified four factors, aligned with the TPB constructs of attitudes, norms, confidence, and intention to act to explain 57% of interitem variance. The internal consistency of factor-derived subscales ranged between 0.71 and 0.91. Reduction of instrument items went from 47 to 32 (32%). The CFA yielded good model fit with the switching of the legal ramification item from the social norm to intention construct. CONCLUSION: The Intent to Aid (I2A) survey derived from this investigation aligned with the constructs of the TPB yielding four subscales. The I2A allows health education researchers to differentiate modalities and content impact on learner intention to act in a first aid (FA) emergency. I2A compliments cognitive and psychomotor measurements of learning outcomes. The experimental instrument aims to allow curricula developers and program evaluators a means of assessing the affective domain of human learning regarding intention-to-act in an FA emergency. In combination of with assessment of functional knowledge and essential skills, this instrument may provide curricula developers and health educators an avenue to better describe intention to act in an FA emergency.

Assessing American Red Cross First Aid mobile app user trends: Implications for resilience.

OBJECTIVE: Disasters have devastated communities, impacted the economy, and resulted in a significant increase in injuries. As the use of mobile technology increasingly becomes a common aspect of everyday life, it is important to understand how it can be used as a resource. The authors examined the use of American Red Cross mobile apps and aimed to characterize user trends to better understand how mobile apps can help bolster individual and community preparedness, resilience, and response efforts. DESIGN/MAIN OUTCOME MEASURES: Tornado data were obtained from the National Oceanic and Atmospheric Administration and the National Weather Service. Data for the mobile apps were provided by the American Red Cross. All data were reviewed for 2013, 2014, and three specific tornado events. Data were organized in Microsoft Excel spreadsheets and then graphed or mapped using ArcMap 10.2(™). RESULTS: Between 2013 and 2014, 1,068 tornado watches and 3,682 tornado warnings were issued. Additionally, 37,957,560 Tornado app users and 1,289,676 First Aid app users were active from 2013 to 2014. Overall, there was an increase in the use of American Red Cross mobile apps during tornado occurrences. Yet the increase does not show a consistent correlation with the number of watches and warnings issued. CONCLUSIONS: Mobile apps can be a resourceful tool. This study shows that mobile app use increases during a disaster. The findings indicate that there is potential to use mobile apps for building resilience as the apps provide information to support individuals and communities in helping before, during, and after disasters.