Goralnick E, et al. - Researchers determined the effectiveness of different instructional point-of-care interventions and in-person training for hemorrhage control compared with no intervention and assessed skill retention 3 to 9 months after hemorrhage control training. Currently, the in-person hemorrhage control training for laypersons was recognized to be the most efficacious means of enabling bystanders to act to control hemorrhage. After undergoing a 1-hour course, laypersons can successfully perform tourniquet application. However, there were only 54.5% who retained this skill after 3 to 9 months. This suggests the significance of investigating refresher training or improved point-of-care instructions.

Methods

• Researchers performed a randomized clinical trial of 465 laypersons at a professional sports stadium in Massachusetts with capacity for 66,000 people and assessed correct tourniquet application by using different point-of-care interventions (audio kits and flashcards) and a Bleeding Control Basic (B-Con) course.
• After initial testing (conducted from April 2017 to August 2017), non-B-Con arms received B-Con training.
• They performed retesting for 303 participants (65%) 3 to 9 months after training (October 2017 to January 2018) to assess B-Con retention.
• For retention testing, they performed a logistic regression for demographic associations.
• They randomized the participants into 4 arms: instructional flashcards, audio kits with embedded flashcards, B-Con, and control.
• All participants received B-Con training to later assess retention.
• Correct tourniquet application in a simulated scenario was assessed as the main outcome measure.

Results

• This study included 465 participants.
• Of those participants, 189 (40.7%) were women and the mean (SD) age was 46.3 (16.1) years.
• For correct tourniquet application, B-Con (88% correct application [n = 122]; P < .001) was noted to be better in controlling (n = 104 [16%]) while instructional flashcards (n = 117 [19.6%]) and audio kit (n = 122 [23%]) groups were not.
• In point-of-care arms, more than half of participants did not use the educational prompts as intended.
• Researchers assessed 303 participants (65%) 3 to 9 months after undergoing B-Con training; among these,165 (54.5%) could correctly apply a tourniquet.
• They noted no further skill decay in the adjusted model that treated time as either linear over this period (odds ratio [OR], 0.98; 95% CI, 0.95-1.03) or quadratic (OR, 1.00; 95% CI, 1.00-1.00).
• Age was recognized to be the only demographic that was associated with correct application at retention; adults aged 18 to 35 years (n = 58; OR, 2.39; 95% CI, 1.21-4.72) and aged 35 to 55 years (n = 107; OR, 1.77; 95% CI, 1.04-3.02) were more likely to be efficacious than those older than 55 years (n = 138).