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    Consensus Statement
    Emergency Medicine
    July 6, 2020

    Defining a Research Agenda for Layperson Prehospital Hemorrhage Control: A Consensus Statement

    Author Affiliations
    • 1Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
    • 2Center for Surgery and Public Health, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
    • 3Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    • 4Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland
    • 5National Center for Disaster Medicine and Public Health, Rockville, Maryland
    • 6National Health Care Preparedness Program, Department of Health and Human Services, Washington, DC
    • 7Office of the Dean, Medical School, Aga Khan University, Karachi, Pakistan
    • 8Department of Surgery, Hartford Hospital, Hartford, Connecticut
    JAMA Netw Open. 2020;3(7):e209393. doi:10.1001/jamanetworkopen.2020.9393
    Key Points español 中文 (chinese)

    Question  What are the key areas and questions on which future research of prehospital hemorrhage control by laypersons should be focused?

    Findings  In this consensus statement, a cohort of 45 subject matter experts, professional society leaders, and funding agency representatives conducted a 3-round modified Delphi consensus process to identify and prioritize key research gaps in prehospital hemorrhage control by laypersons. Participants identified 113 high-priority questions in the themes of epidemiology and effectiveness, materials, education, global health, and health policy, with the top 24 questions constituting the prioritized national research agenda.

    Meaning  The National Stop the Bleed Research Consensus Conference identified and prioritized a research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage.

    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 priori–defined 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.

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