Pilot Simulation Task Trainer for Prehospital Management of Neck Hemorrhage

Traumatic injuries are the leading cause of death in the U.S. of persons < 45 years of age, with 5-10% of all traumas caused by penetrating neck injuries (PNI). The neck contains several large blood vessels that supply the brain; thus, exsanguination is the leading cause of fatality in PNI. Vascular neck trauma is common in assaults, motor vehicle accidents, battlefields, and sporting events, particularly in ice hockey. There is a general lack of guidance on prehospital management of these injuries, and educating first responders, medics, and sports trainers on how to manage these complex injuries is challenging due to high costs, limited availability, and ethical considerations regarding use of cadavers or live animals. Here, we describe the development of a prehospital PNI-hemorrhage curriculum paired with a novel hands-on simulator and its pilot implementation with a group of professional hockey athletic trainers.

We conducted a literature review to understand previously proposed algorithms for PNI, traumatic life support, combat trauma, and massive hemorrhage. Concepts from each of these algorithms were considered when determining the key steps of managing a PNI and how these should differ from previously proposed algorithms. We developed a synthetic medical simulator and training curriculum in conjunction with the National Hockey League (NHL) to create a training program for athletic trainers and team physicians to improve rapid response. The simulator was designed using computed tomography of a human neck and was fabricated to mimic the material properties of human tissue.

The algorithm for prehospital management of PNI was developed in three fundamental steps: 1) identify venous vs arterial bleeding patterns; 2) control the hemorrhage; and 3) transfer the patient to a trauma center. The synthetic medical simulator allowed for the simulation of arterial and venous bleeding and was used to train 180 NHL athletic trainers and physicians at their annual meeting in 2024. Voluntary quantitative and qualitative post-training feedback obtained from 46% of trainers who participated was very positive (overall rating 4.7/5).

Penetrating neck injuries are high-risk events that first responders are generally undertrained to manage due to their rarity. Simulation is effective to potentially improve the outcomes of these scenarios, and the use of synthetic medical simulators is cost effective. We developed a novel algorithm, medical simulator, and training curriculum for the management of PNI in conjunction with the NHL for training athletic trainers and physicians.