Page data
Part of Crash Savers Trauma
Type Medical skill
Keywords trauma, surgery
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors CrashSavers
Published 2021
License CC-BY-SA-4.0
Affiliations Global Surgical Training Challenge
Language English (en)
Impact Number of views to this page. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 127

The learning experience and accompanying self-assessment are embedded in an environment using gamification to engage users to complete theoretical and practical activities, the results of which are immediate feedback for self-assessment. To ensure that users are practicing appropriate skills, the software-based simulation provides didactic and video-based instruction of the specific skills to be learned.

Tests are built into the software simulator as 'games' that provide feedback on the selection of appropriate hemorrhage control techniques. If a user selects an inappropriate technique for a scenario presented, the user will fail the scenario and be given specific feedback on why other hemorrhage control techniques are more appropriate. If a user does not complete all steps of a technique/skill to demonstrate understanding and adequate performance (for example, does not continue to crank tourniquet until the cessation of bleeding) the simulator will give corresponding feedback. Furthermore, once a user demonstrates competency and moves on to the physical model, they will have real-time feedback with visual cessation of bleeding that shows the adequate technique. If the user does not meet goal parameters, they will receive preset feedback. Ultimately, successful completion of both the app-based simulator and physical model determine competency for each skill.

Case 1[edit | edit source]

Identifying Data: 32-year-old man

History: the patient is the driver of a light vehicle involved in a head-on collision traveling at 120 km/hr. The passenger of the vehicle has died.

Vital Signs:

  1. HR 142 bpm
  2. BP 70/30
  3. RR 34
  4. GCS 10 (3EV2M5)
  5. Shock Index 2.02

Physical Exam:

  • Head: Laceration to the left parietal-temporal scalp with copious active bleeding. Bilateral palpebral edema and hematoma with anisocoric, hyporeactive pupils
  • Neck: no signs of trauma
  • Torso: Excoriated lesion in the left hemithorax from the 2nd to the 7th costal arches. Crepitus is present upon palpation with subcutaneous emphysema. Decreased respiratory sounds in the left hemithorax. Abdomen non-tender. Hematoma present in the let lumbo-sacral region.
  • Extremities: Left upper extremity with expanding hematoma and deformity. Supracondylar traumatic amputation of the left lower extremity without active bleeding.

Analysis of the information

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Case 2[edit | edit source]

Identifying Data: 21-year-old man

History: Firearm injury to the right inguinal region

Vital Signs:

  1. HR 115 bpm
  2. BP 100/70
  3. RR 26
  4. GCS 13 (4EV4M5)
  5. Shock Index 1.15

Physical Exam Focused on Bleeding:

  • Head/Neck/Thorax/Abdomen/Pelvis: No signs of trauma
  • Extremities: Single 1cm diameter hole in the inner third of the right inguinal region with pulsatile active bleeding. Distal right extremity is cool with diminished pulses and capillary refill greater than 3 seconds. No motor or sensory defects.
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Case 3[edit | edit source]

Identifying Data: 38-year-old woman

History: Victim of domestic violence who presents with multiple blunt traumatic injuries as well as a stab injury (from a broken bottle) to the left axillary region

Vital Signs:

  1. HR 135 bpm
  2. BP 130/90
  3. RR 32
  4. GCS 15
  5. Shock Index 1.03

Physical Exam Focused on Bleeding:

  • Head: Palpebral hematoma on the left, swelling and deformity of the nasal pyramid, no active bleeding
  • Neck: no evidence of injury
  • Thorax: Right scapular hematoma. Normal chest expansion, no crepitus or subcutaneous emphysema
  • Abdomen/Pelvis: No signs of trauma
  • Extremities: Irregular wound with loss of soft tissues in the left axillary region, approximately 11cm in diameter with non-pulsatile active bleeding. Distal pulses are symmetric, capillary refill <3 seconds, no motor or sensory defects

Analysis of the information

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Case 4[edit | edit source]

Identifying Data: 21-year-old man

History: Patient found on a public street after multiple firearm injuries

Vital Signs:

  1. HR 123 bpm
  2. BP 96/53
  3. RR 28
  4. GCS 15
  5. Shock Index 1.28

Physical Exam:

  • Head: no injuries
  • Neck: 0.5cm orifice in zone 2 of the left neck with active pulsatile bleeding
  • Thorax: Symmetric ventilation. There is a 0.5 cm hole in the right infraclavicular region in the middle third of the clavicle, with a perilesional expanding hematoma.
  • Abdomen/pelvis: no injuries
  • Extremities: Left forearm with excoriation and projectile burn lesion, 10x2cm, with minimal active bleeding. Distal pulses palpable and symmetric, capillary refill <3 seconds, intact distal motor and sensory function.

Analysis of the information

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Measurement of skills[edit | edit source]

The self-assessment in our model is based on real clinical cases in a mobile app that uses gamification. An algorithm of possible action options is presented. In the said algorithm, options framed in red are incorrect; thus, if the student chooses this option the clinical case will stop and the student will not be able to advance in the case. They will receive immediate feedback explaining why their chosen option is incorrect. On the other hand, the correct options will be framed in blue. If the student chooses this option, the clinical case will continue to advance to the next question until the case is complete.

The measurement of the acquisition of skills is carried out through training on the physical simulator built by the learner. Once the exercises are completed, the learner evaluates themselves using a checklist and measure the time of placement of the tourniquet using a checklist adapted from Weiman, S (2019). Retention of Tourniquet Application Skills Following Participation in a Bleeding Control Course, Journal of Emergency Nursing, Volume 46, Issue 2, 2020, Pages 154-162 which is embedded within the mobile application[1]

Fig 1. Checklist to measure proper tourniquet application technique.
Fig 2 and 3. Checklist embedded in the mobile application.

As part of the self assessment protocol, we created a web environment to check the performance and data of the users who completed the cases and to measure the learning curves of the procedure.

Number of Users that Completed all the Cases.png
Tourniquet Learning Curve.png

References[edit | edit source]

  1. Weinman, S. (2020). Retention of tourniquet application skills following participation in a bleeding control course. Journal of Emergency Nursing, 46(2), 154-162.