Defining a Research Agenda for Layperson Prehospital Hemorrhage Control

Abstract

IMPORTANCE Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military's medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector. OBJECTIVE To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons. EVIDENCE REVIEW The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda. FINDINGS Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a prioridefined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy. CONCLUSIONS AND RELEVANCE The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.

Developing a National Trauma Research Action Plan: Results from the prehospital and mass casualty research Delphi survey

“…Prioritizing key topics and specific research questions is an important aspect of building the evidence base. Several forums led by public and private organizations, including the National Institutes of Health and the Centers for Disease Control and Prevention, have convened over the last two decades to prioritize civilian trauma research 11–17 . Despite these efforts, there remains a critical need for a coordinated, national strategic plan for trauma research to guide stakeholders, funders, health care providers, researchers, advocacy groups, and the public.…”

Comparison of two teaching methods for stopping the bleed: a randomized controlled trial

“…Unintentional injury is the leading cause of death among people aged 1–45 years old, resulting in more than 160,000 deaths each year in the United States and showing a gradually increasing trend [ 1 ]. Studies show that nearly 60% of potentially survivable deaths are caused by haemorrhaging, which means that controlling bleeding in a timely and effective manner is the key to preventing death in injury patients [ 2 , 3 ]. The US military was the first to make a breakthrough in the study of traumatic haemostasis and has reduced battlefield mortality by 44.2% over the 16 years of war in Iraq and Afghanistan due to its medical advancements in the field of prehospital haemorrhage control [ 4 ].…”

Comparing Blood Loss Estimates by Medical Laypeople in Online and In-person Formats using SABLE

“…Bystanders who act during medical emergencies, socalled immediate responders, are being increasingly recognized as an important link in the trauma chain of survival (Bakke & Wisborg, 2017;Goralnick et al, 2020). This is particularly the case for trauma emergencies with severe hemorrhages (Goralnick et al, 2020;Goolsby et al, 2018). Such traumas can be fatal within minutes (Tjardes & Luecking, 2018) and thus may require first aid before first responders arrive at the scene.…”