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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
1Emergency Department, Billings Clinic, Billings, MT, USA.
Purpose:
Simulation-based education plays a pivotal role in preparing healthcare providers for rare, high-acuity emergencies such as hemorrhagic extremity trauma. Advances in simulation fidelity, including hemorrhagic pumping systems (HPS), may enhance realism, urgency, and clinical decision-making. However, evidence on how such enhancements affect provider performance remains limited.
Patients And Methods:
In this randomized case-control study at a rural Level I trauma center simulation learning laboratory, emergency care providers (n = 146) managed a simulated extremity trauma scenario using either standard moulage (Group A; No HPS) or an active HPS (Group B). Participants were stratified by profession/licensure prior to recruitment. Within each professional stratum participants were randomized to ensure balanced representation, into the two groups and the timed endpoints included (i) First Intervention, (ii) Tourniquet-only Application, and (iii) Scenario Completion. Subgroup analyses were conducted by healthcare license (Emergency Medical Technician (EMT), Registered Nurse (RN), Others (neither EMT or RN licensure)) and years of licensure (<5 vs ≥5 years).
Results:
Participants using the HPS performed the first intervention significantly faster (mean = 54.9s) than those with No HPS (mean = 71.9s; p=0.002). EMTs and "Others" showed significant time improvements with HPS use, while RN performance did not differ. Tourniquet-only and Scenario Completion times were unaffected by HPS presence. Among RNs, those with <5 years of experience performed significantly faster in the first intervention than their more experienced peers (p=0.039); no other timing differences reached statistical significance based on licensure length.
Conclusion:
Enhanced realism within simulation-based education incorporating dynamic bleeding systems improves response time in initial trauma interventions, particularly among EMTs and less-experienced providers. While total scenario times and tourniquet application did not differ, early engagement appears positively influenced by simulation fidelity. Integrating high-fidelity elements like HPS into trauma training may strengthen learner urgency, decision-making, and improve real-world provider readiness.
