Assessment of Prehospital Hemorrhage and Airway Care Using a Simulation Model

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Abstract

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

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