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BLEED TIME Simulation Study - Bleeding Limb, Effectiveness and Efficiency in Determining Time to Intervene on Mangled

Timothy J Bikman1,2, William F Selde1, William B Belk3

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High-fidelity simulation with active bleeding systems improves emergency response times for rare trauma scenarios. This enhanced realism benefits Emergency Medical Technicians and less-experienced providers, boosting readiness for critical events.

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clinical decision-makingdynamic bleeding modelsemergency medical serviceshigh fidelity simulation trainingmedical simulation trainingtrauma education

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Area of Science:

  • Medical Simulation
  • Trauma Care Education
  • Emergency Medicine Training

Background:

  • Simulation-based education is crucial for preparing healthcare providers for high-acuity emergencies like severe extremity trauma.
  • Advances in simulation technology, such as hemorrhagic pumping systems (HPS), aim to increase realism and improve clinical decision-making.
  • Limited evidence exists on the impact of enhanced simulation fidelity on provider performance in critical scenarios.

Purpose of the Study:

  • To evaluate the effect of an active hemorrhagic pumping system (HPS) on emergency care provider performance in a simulated extremity trauma scenario.
  • To compare response times for initial interventions, tourniquet application, and overall scenario completion between standard moulage and HPS-enhanced simulation.
  • To analyze performance differences based on provider profession (EMT, RN, Other) and years of licensure.

Main Methods:

  • A randomized case-control study was conducted with 146 emergency care providers at a Level I trauma center's simulation lab.
  • Participants were randomized into two groups: standard moulage (No HPS) and active HPS.
  • Timed endpoints included First Intervention, Tourniquet-only Application, and Scenario Completion, with subgroup analyses by licensure and experience.

Main Results:

  • Providers using HPS achieved the first intervention significantly faster (mean 54.9s) than those without HPS (mean 71.9s; p=0.002).
  • Emergency Medical Technicians (EMTs) and 'Others' showed significant time improvements with HPS; Registered Nurse (RN) performance was unaffected.
  • No significant differences were observed in tourniquet-only or scenario completion times; less-experienced RNs (<5 years) performed faster on the first intervention (p=0.039).

Conclusions:

  • Enhanced simulation realism with dynamic bleeding systems improves initial trauma intervention response times, especially for EMTs and less-experienced providers.
  • While overall scenario completion and tourniquet application times were not affected, early engagement in critical interventions is positively influenced by simulation fidelity.
  • Integrating high-fidelity elements like HPS in trauma training can enhance learner urgency, decision-making, and ultimately improve real-world provider readiness for emergencies.