Supporting Laypeople Addressing Prehospital Hemorrhage Study
Condition: Hemorrhage; Laceration
MeSH terms: Hemorrhage; Lacerations
Study type: Interventional

Summary: 
      It is unknown if bystanders equipped with point-of-care (POC) instruction are as effective as
      bystanders with in-person training for bleeding control. Therefore, POC instructional
      interventions were developed during this study in response to the scalability challenges
      associated with in-person training to measure the comparative effectiveness and skill
      retention of POC instructions vs in-person training using a randomized clinical trial design.
    

Detailed description: 
      Road traffic injuries (RTIs) are the largest contributor to the global trauma burden, which
      disproportionately affects low- and middle-income countries (LMICs). With a lack of robust
      emergency medical services (EMS), there has been increasing reliance on layperson bystanders
      to respond to RTIs in LMICs, called lay first responders (LFRs). In prospective studies of
      LFR activity across three sub-Saharan African countries comprising 2,039 total patient
      encounters, LFRs most frequently provided hemorrhage control in 61% of patient encounters.
      Rapid hemorrhage control for compressible extremity hemorrhage by bystander LFRs has the
      potential to mitigate exsanguination, reducing mortality secondary to RTIs. Rapid hemorrhage
      control also has applicability to high-income country settings like the United States that
      sustain high rates of penetrating trauma due to gun violence. Rapid hemorrhage control using
      tourniquets for compressible extremity hemorrhage in patients not yet in shock is strongly
      associated with saved lives demonstrated in battlefield studies, decreasing preventable
      deaths by more than 50%. Bystanders may be trained in-person or point-of-care (POC)
      instruction may be provided, as exists with automated external defibrillators. However, it is
      unknown if bystanders equipped with POC instruction are as effective as bystanders with
      in-person training for tourniquet application. Therefore, the investigators developed POC
      instructional interventions in response to the scalability challenges associated with
      in-person training to measure comparative effectiveness and skill retention using a
      randomized controlled trial design.
    

Intervention name(s): Audio kit; Instructional flashcard; In-person training
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): MP3 audio files for each of 6 steps and instructional flashcard with pictures corresponding to each of the 6 steps of tourniquet application; Single page (instructional flashcard) with pictures corresponding to each of the 6 steps of tourniquet application; Stop the Bleed bleeding control (B-Con) course is used for instruction for tourniquet application attempt
Allocation: Randomized
Intervention model: Factorial Assignment
Intervention model description: Participants are randomized to 1 of 4 educational interventions. Once the initial instructional intervention is completed, participants subsequently present for a 6-month follow-up.
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment