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Part of Crash Savers Trauma
Subskill of Foley Crashsavers Simulator

We recommend that learners study this module’s content first, then complete the Readiness Test. Additionally, it is highly recommended that learners are familiar with the educational content prior to proceeding to Module 3 “Skills Practice”. All of the educational content in this module can also be found in the CrashSavers smartphone app.

Dangers of Hemorrhage[edit | edit source]

Bleeding is the leading cause of preventable death after trauma with up to 40% of deaths in traumatically injured patients.[1][2] According to the Centers for Disease Control and Prevention (CDC), 62% of people who died from traumatic injuries and 75% from gunshot wounds perished outside the hospital setting.[3] Steward et al found that 53% of traumatic deaths occurred in the first 12 hours, and of these, 37% were caused by uncontrolled bleeding.[4] As it only takes minutes for an individual to bleed to death, it is critical that decisions surrounding hemorrhage control are made within seconds.

In high-income countries, first responders (i.e. paramedics, police officers, firefighters) are trained and skilled in hemorrhage control techniques.[5][6] However, this is not the case for those in Guatemala where a formal EMS system is lacking. Guatemalan firefighters are involved with all types of emergencies; however, the medical training they receive is basic, and only 1 of the 3 organizations provides the option for a non-mandatory formal EMT course. Furthermore, many traumas occur in rural areas with minimal to no trauma centers, scarce blood bank capabilities, and dramatically variable–and often excessive–hospital transport time. Guatemala does not have a centralized blood bank system to provide transfusions to patients in need. There are only 3 public blood banks in Guatemala City, a city with a population of over 3 million people.[7] Given the inadequate means for blood transfusion in the country, the ability to control traumatic bleeding in individuals is of utmost importance.

Importance of Learning Hemorrhage Control[edit | edit source]

We chose to present a series of hemorrhage control techniques in our simulation model, as these skills are often taught merely by observation and without substantial feedback on how to appropriately apply pressure to stop bleeding. Inadequate training can lead to poor technique in hemorrhage control and ultimately, ongoing bleeding and death that could have been preventable. Studies have shown that practice in hemorrhage control techniques, particularly advanced maneuvers such as tourniquet application, is shown to be effective. Thus, formalized training and hands-on practice are essential.

Overall, there are few formal programs to train healthcare providers in how to stop bleeding. One of the most well-known programs, Stop the Bleed, is a grassroots campaign launched by the American College of Surgeons as a way to teach bystanders how to save the lives of injured people with uncontrolled, life-threatening bleeding.[8] Over 1.5 million people across 119 countries have been trained in the Stop the Bleed campaign, though poor accessibility remains in many low- and middle-income countries.

As a way to address this, we have designed a low-cost, portable simulator and assessment tool for hemorrhage control techniques with the potential to markedly advance the efficacy of care for trauma patients. Our novel, hands-on training model to teach hemorrhage control techniques has broad implications in considerably reducing prehospital morbidity and mortality from traumatic hemorrhage. The CrashSavers Simulator will empower first responders and healthcare providers in Guatemala and other countries with the competence and confidence in applying different hemorrhage control techniques as part of the initial trauma triage performed in the prehospital setting.

Self-assessment[edit | edit source]

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  • Self-assessment: Here.
  • Work in progress

References[edit | edit source]

  1. Curry N, Hopewell S, Dorée C, Hyde C, Brohi K, Stanworth S. The acute management of  trauma hemorrhage: a systematic review of randomized controlled trials. Crit Care.  2011;15(2):R92. doi:10.1186/cc10096
  2. Rhee P, Joseph B, Pandit V, et al. . Increasing trauma deaths in the United States. Ann Surg.  2014;260(1):13-21.
  3. CDC. Quickstats: Percentage of Injury Deaths for Which Death↵↵was Pronounced Outside the Hospital. Morb Mortal Wkly Rep↵↵2008;57:1130.
  4. Stewart RM, Myers JG, Dent DL, et al. Seven hundred fifty-three↵↵consecutive deaths in a level I trauma center: the argument for↵↵injury prevention. J Trauma 2003;54:66-70 discussion −1.
  5. American College of Surgeons BleedingControl.org—about us.  http://www.bleedingcontrol.org/about-bc.
  6. Bulger EM, Snyder D, Schoelles K, Gotschall C, Dawson D, Lang E, Sanddal ND, Butler FK,  Fallat M, Taillac P, White L, Salomone JP, Seifarth W, Betzner MJ, Johannigman J, McSwain N  Jr. An evidence-based prehospital guideline for external hemorrhage control: American  College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014 Apr-Jun;18(2):163- 73. doi: 10.3109/10903127.2014.896962. PMID: 24641269.
  7. https://www.censopoblacion.gt/explo/TabA5.xlsx
  8. https://www.stopthebleed.org/
FA info icon.svgAngle down icon.svgPage data
Part of Crash Savers Trauma
Keywords emt
SDG SDG03 Good health and well-being
Authors CrashSavers
License CC-BY-SA-4.0
Organizations Global Surgical Training Challenge
Language English (en)
Related 0 subpages, 12 pages link here
Impact 572 page views
Created July 24, 2021 by CrashSavers
Modified January 29, 2024 by StandardWikitext bot

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