Page 59 - JSOM Fall 2018

Implementation and Evaluation of a First-Responder
Bleeding-Control Training Program in a Rural Police Department

James R. Reed, DNP, CRNA, RN *; Margaret J. Carman, DNP, ENP-BC, RN ;
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Frank J. Titch, DNP, CRNA, RN ; Russ S. Kotwal, MD, MPH 4
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ABSTRACT
Background: In the prehospital environment, nonmedical first and potentially survivable injuries. Evidence­based practice
3,4
responders are often the first to arrive on the scene of a trau­ guidelines and performance improvement programs that re­
matic event and must be prepared to provide initial care at duce preventable death in the military, such as Tactical Com­
the point of injury. In civilian communities, these nonmedical bat Casualty Care (TCCC) and the Ranger First Responder
first responders often include law enforcement officers. Hem­ program, have been translated and can also reduce mortality
orrhage is a major cause of death in trauma, and many of within civilian communities. 1,5­7
these deaths occur in the prehospital environment; therefore,
prehospital training efforts should be directed accordingly Traumatic mass casualty events in civilian communities are in­
toward bleeding control. Methods: A bleeding control train­ creasing in incidence as are reports of them in media headlines.
ing program was implemented and evaluated in a rural po­ These events, whether natural or manmade, are often challeng­
lice department in Pinehurst, North Carolina, from February ing to those who respond. Common among these events are
8,9
to April 2017. A repeated measures observational study was mass shootings and terrorist activities directed against large
conducted to evaluate the training program. Measured were numbers of citizens assembling in open and public places. Re­
self­efficacy (pre­ and post­test), knowledge (pretest, post­test sponding and caring for the wounded during these incidents
1 [immediate], post­test 2 [at 4 weeks]), and limb­tourniquet can prove difficult. Contingency planning, coordination, re­
application time (classroom, simulation exercise). Results: The hearsals, and resourcing for such events impose a major bur­
study population was composed of 28 police officers (92.9% den on local, state, and national medical systems.
male) whose median age was 37 (interquartile range, 22–55)
years. Mean self­efficacy scores, equating to user confidence According to data from the National Center for Injury Pre­
and the decision to intervene, increased from pre­ to post­train­ vention and Control, highlighted by the landmark 2016 Na­
ing (34.54 [standard deviation (SD) 4.16] versus 35.62 [SD tional Academy of Sciences, Engineering, and Medicine report
4.17]; p = .042). In addition, mean knowledge test scores on trauma, approximately 30,000 preventable deaths occur
1
increased from pre­ to immediately post­training (75.00 [SD annually from trauma in the United States. Similar to com­
16.94] versus 85.83 [SD 11.00]; p = .006), as well as from pre­ bat, hemorrhage was a major cause of death in many civilian
to 4 weeks post­training (75.00 [SD 16.94] versus 84.17 [SD trauma events. 1,10 In the civilian community, traumatic hem­
11.77]; p = .018). Lower limb–tourniquet application times orrhage also poses a challenge to those who reside or conduct
were more rapid in the classroom than during the simulation activities in rural or wilderness environments. 11
exercise (23.06 seconds [SD 7.68] versus 31.91 seconds [SD
9.81]; p = .005). Conclusion: First­responder bleeding­control After the Sandy Hook Elementary School shooting, and in sup­
programs should be initiated and integrated at the local level port of a Presidential Policy Directive for national prepared­
throughout the Nation. Implementation and sustainment of ness, the White House initiated the “Stop the Bleed” program.
such programs in police departments can save lives and en­ National trauma experts also formed the Hartford Consensus
hance existing law enforcement efforts to protect and serve to make recommendations to improve casualty response to
communities. mass casualty events, particularly through empowerment of
bystanders. The Hartford Consensus, in conjunction with the
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Keywords: bleeding control; first responder; hemorrhage; National Tactical Officers Association (NTOA), recommended
limb tourniquet; prehospital; trauma that law enforcement personnel should adopt, train, and main­
tain core competency first­responder and bleeding­control
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skills similar to that of the military. Nonmedical first respond­
Introduction ers usually arrive first on the scene; thus, widespread use by law
enforcement of tourniquets for bleeding control has potential
The US military continues to achieve lower case fatality rates to reduce morbidity and mortality from trauma. 13­17
1,2
despite advancements in enemy tactics and modern weap­
onry. Although prehospital and hospital progress has been The purpose of this study was to implement and evaluate a
made, frontiers in battlefield medicine still exist and have been first­responder bleeding­control program in a rural police de­
identified through comprehensive study of preventable death partment as recommended by the Hartford Consensus and
*Correspondence to Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710; or james.r.reed@duke.edu
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1 Dr Reed, Dr Carman, and Dr Titch are at Duke University School of Nursing, Durham, NC. Dr Kotwal is at the Department of Defense Joint
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Trauma System, Joint Base San Antonio–Fort Sam Houston, TX.
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