A low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city.
hemorrhage control
prehospital care
simulator
tourniquet
trauma
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
25 Mar 2024
25 Mar 2024
Historique:
received:
23
10
2023
accepted:
10
03
2024
medline:
25
3
2024
pubmed:
25
3
2024
entrez:
25
3
2024
Statut:
aheadofprint
Résumé
Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components. The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement. Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups. This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.
Sections du résumé
BACKGROUND
BACKGROUND
Hemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components.
METHODS
METHODS
The training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement.
RESULTS
RESULTS
Our findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups.
CONCLUSION
CONCLUSIONS
This study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Global Surgical Training Challenge
Informations de copyright
© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).
Références
Jacobs, Lenworth M., David S. Wade, Norman E. McSwain, Frank K. Butler, William P. Fabbri, Alexander L. Eastman, Michael Rotondo, John Sinclair, and Karyl J. Burns. 2013. “The Hartford Consensus: THREAT, a Medical Disaster Preparedness Concept.” Journal of the American College of Surgeons 217(5): 947–953. https://doi.org/10.1016/j.jamcollsurg.2013.07.002
Eilertsen, Kenneth A., Morten Winberg, Elisabeth Jeppesen, Gyri Hval, and Torben Wisborg. 2021. “Prehospital Tourniquets in Civilians: A Systematic Review.” Prehospital and Disaster Medicine 36(1): 86–94. https://doi.org/10.1017/S1049023X20001284
Sidwell, Richard A., Sarah K. Spilman, Richard S. Huntsman, and Carlos A. Pelaez. 2018. “Efficient Hemorrhage Control Skills Training for Healthcare Employees.” Journal of the American College of Surgeons 226(2): 160–164. https://doi.org/10.1016/j.jamcollsurg.2017.11.003
Bulger, Eileen M., David Snyder, Karen Schoelles, Cathy Gotschall, Drew Dawson, Eddy Lang, Nels D. Sanddal, et al. 2014. “An Evidence‐Based Prehospital Guideline for External Hemorrhage Control: American College of Surgeons Committee on Trauma.” Prehospital Emergency Care 18(2): 163–173. https://doi.org/10.3109/10903127.2014.896962
American College of Surgeons. Stop the Bleed. Stop the Bleed. https://www.stopthebleed.org/. Accessed September 11, 2023.
World Bank. World Bank Open Data: Guatemala. World Bank Open Data. https://data.worldbank.org. Accessed September 11, 2023.
Baruch, Erez N., Avi Benov, Avi Shina, Amy L. Berg, Amir Shlaifer, Elon Glassberg, James K. Aden, Tarif Bader, John F. Kragh, and Avraham Yitzhak. 2016. “Does Practice Make Perfect? Prospectively Comparing Effects of 2 Amounts of Practice on Tourniquet Use Performance.” The American Journal of Emergency Medicine 34(12): 2356–2361. https://doi.org/10.1016/j.ajem.2016.08.048
Dennis, Andrew, Francesco Bajani, Victoria Schlanser, Leah C. Tatebe, Ann Impens, Katarina Ivkovic, Anqi Li, et al. 2019. “Missing Expectations: Windlass Tourniquet Use without Formal Training Yields Poor Results.” Journal of Trauma and Acute Care Surgery 87(5): 1096–1103. https://doi.org/10.1097/TA.0000000000002431
Landman, Annemarie, Peter van Oorschot, M. M. R. van Paassen, Eric L. Groen, Adelbert W. Bronkhorst, and Max Mulder. 2018. “Training Pilots for Unexpected Events: A Simulator Study on the Advantage of Unpredictable and Variable Scenarios.” Human Factors 60(6): 793–805. https://doi.org/10.1177/0018720818779928
Issenberg, S. B., W. C. McGaghie, I. R. Hart, et al. 1999. “Simulation Technology for Health Care Professional Skills Training and Assessment.” JAMA 282(9): 861–866. https://doi.org/10.1001/jama.282.9.861
Dean, A. G., T. G. Arner, G. G. Sunki, R. Friedman, M. Lantinga, S. Sangam, J. C. Zubieta, et al. 2020. Epi Info 7TM, a Database and Statistics Program for Public Health Professionals: Published online.
Parham, Groesbeck, Eric G. Bing, Anthony Cuevas, Boris Fisher, Jonathan Skinner, Mulindi Mwanahamuntu, and Richard Sullivan. 2019. “Creating a Low‐Cost Virtual Reality Surgical Simulation to Increase Surgical Oncology Capacity and Capability.” Ecancermedicalscience 13: 910. https://doi.org/10.3332/ecancer.2019.910
Pelly, T., N. Shanmugathas, H. Bowyer, A. Wali, and R. Pankhania. 2020. “Low‐cost Simulation Models in Urology: a Systematic Review of the Literature.” Central European Journal of Urology 73(3): 373–380. https://doi.org/10.5173/ceju.2020.0122
Bing, Eric G., Groesbeck P. Parham, Anthony Cuevas, Boris Fisher, Jonathan Skinner, Mulindi Mwanahamuntu, and Richard Sullivan. 2019. “Using Low‐Cost Virtual Reality Simulation to Build Surgical Capacity for Cervical Cancer Treatment.” Journal of Global Oncology 5: 1–7. https://doi.org/10.1200/JGO.18.00263
Cleary, Timothy J., Steven J. Durning, and Anthony R. Artino. 2016. “Microanalytic Assessment of Self‐Regulated Learning during Clinical Reasoning Tasks: Recent Developments and Next Steps.” Academic Medicine 91(11): 1516–1521. https://doi.org/10.1097/ACM.0000000000001228
Forsberg, Elenita, Kristina Ziegert, Håkan Hult, and Uno Fors. 2016. “Assessing Progression of Clinical Reasoning through Virtual Patients: An Exploratory Study.” Nurse Education in Practice 16(1): 97–103. https://doi.org/10.1016/j.nepr.2015.09.006
Tan, Swee Chin, Nicholas Marlow, John Field, Meryl Altree, Wendy Babidge, Peter Hewett, and Guy J. Maddern. 2012. “A Randomized Crossover Trial Examining Low‐versus High‐Fidelity Simulation in Basic Laparoscopic Skills Training.” Surgical Endoscopy 26(11): 3207–3214. https://doi.org/10.1007/s00464‐012‐2326‐0
Munshi, Fadi, Hani Lababidi, and Sawsan Alyousef. 2015. “Low‐versus High‐Fidelity Simulations in Teaching and Assessing Clinical Skills.” Journal of Taibah University Medical Sciences 10(1): 12–15. https://doi.org/10.1016/j.jtumed.2015.01.008