B-CON Course: Skills Acquired at Training in Bleeding Control Techniques for the Prevention of Exsanguinating Hemorrhage

INTRODUCTION

Bleeding is among the main causes of deaths due to trauma. In Argentina and across Latin America, interpersonal violence and the growing number of road traffic injuries led to many preventable deaths reaching epidemic proportions, and at enormous cost to the entire health systems. It is known that training the general population on techniques to control bleeding is virtually non-existent and the tools necessary to perform them are rarely available, even inside hospitals and military institutions where many are at risk of dying from bleeding. Faced with these challenges, the American College of Surgeons (ACS) proposed mass training using the “Stop the Bleed” course and campaign, to educate non-medical personnel on the basic maneuvers to control hemorrhage in emergency and trauma situations. The course has been broadly accepted. Furthermore, it has trained a large number of professionals that may function as instructors and thus extending the reach to an even larger number of people.

The objective of the present study was to analyze skills and knowledge acquisition by nonmedical military personnel from the Argentina Armed Forces after taking the B-CON Stop the Bleeding course.

MATERIALS AND METHODS

This is a prospective, observational study. Training on bleeding control principles was taught to nonmedical military personnel, members of the Argentina Armed and Security Forces and Medical students. The training consisted of the “Stop the Bleeding” B-CON Course of the ACS followed by a written examination and questionnaire evaluations, to measure knowledge and opinions of the course.

RESULTS

A total of 412 nonmedical people took the course and performed the surveys. It included 320 students, 27 operating room surgical assistants, 35 nursing assistants, and 30 members of the armed forces (Figs 1 to 4). The results indicated that 92.7% (382) had no previous knowledge of the basic maneuvers of bleeding control. 73.3% (302) had some familiarity with tourniquets but only 6.55% (27) knew how to apply it properly and effectively. Notably, 100% of the participants reported having no access to the tools necessary to carry out bleeding control maneuvers at their daily places of living, working, and studying.

The post-course evaluation revealed done immediately after completing the course, that 401 (92.3%) were able to correctly place the tourniquet on others while 223 (54.1%) could correctly self-apply the tourniquet (Fig. 5).

The control of exsanguinating hemorrhages by direct wound compression was correctly done by all participants (100%). Wound compression was the most acknowledged maneuver by all participants, which reported it to be easy to perform and reproduce. Regarding course contents and teaching methodology, 341 (82.7%) reported feeling empowered by the course, and 71 (17.2%) requested to repeat it to further solidify the learning (Fig. 6). One hundred of the respondents recognized that the knowledge acquired was beneficial.

DISCUSSION

The likelihood of dying due to traumatic exsanguinating injuries is inversely proportional to the wealth and human development of the country, resulting in urgency to train the communities of Latin America, including civilians, military, and non-health citizens, on how to control bleeding.^1–4

It has been shown that primary maneuvers to control hemorrhage are easily taught and training can be done using established programs such as the “Stop de Bleed” B-CON course of the ACS. This course has hands-on activities, simulation, and repetitive sessions teaching technical maneuvers such as wound packing and the use of tourniquets for extremities.^3,5–7 Considering the simplicity of the skills, the course can be taught in virtually any educational institutions and too much of the general population, similar to the existing cardiopulmonary resuscitation (CPR) courses and the availability of DEA in schools, gyms, airports, sports institutions, etc.^4,7–9

Different studies have shown that the use of teaching strategies on control maneuvers of exsanguinating hemorrhage can be taught in school-age people with broad acceptance while for those with higher education (health professionals), teaching can use cadaveric models for simulation, which allows for greater realism for military personnel and security forces who must act as first responders in disaster situations and conflicts.^2,6,7,10,11 Indeed, the international literature suggests that educating the greatest number of people would reduce mortality caused by hemorrhage, requiring for this purpose, the permanent commitment of the institutions and health authorities to disseminate, finance, and provide the necessary tools for the maneuvers to be correctly applied.^2,4,5

CONCLUSION

The authors believe that training nonmedical personnel as well as the general population could prove essential in preventing complications, including death, caused by hemorrhage. Educational programs should be implemented in all levels of society using community organizations as well as making the necessary tools such as tourniquets, widely available.

The active participation of the medical community and constant interaction through prevention measures are fundamental pieces to reduce deaths caused by trauma.

REFERENCES

1. American College of Surgeons. Bleeding Control Basic (BCon) Course v. 1.0.- BleedingControl.org. 2018. Fecha de consulta: 16 de enero de 2017. Disponible en: https://www.bleedingcontrol.org/private/materials.

2. Berwick D, Downey A, Cornett E, ed., A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: National Academies Press; 2016.

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11. Kragh JF, Walters TJ, Baer DG, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma 2008;64 (Supplement):S38–S50. DOI: 10.1097/TA.0b013e31816086b1.