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Invited Commentary
September 2018

Optimizing Bleeding Control Training for the Public: A National Imperative

Author Affiliations
  • 1University of Washington, Seattle
  • 2University of Rochester, Rochester, New York
  • 3University of Connecticut, Hartford
JAMA Surg. 2018;153(9):799. doi:10.1001/jamasurg.2018.1100

The Stop-the-Bleed Program, launched by the White House in 2015, seeks to inform, educate, and empower civilians to serve as immediate responders to save lives by control of hemorrhage at the scene of injury. In response to this initiative, the American College of Surgeons Committee on Trauma partnered with the National Association of National Association of Emergency Medical Technicians to develop the Bleeding Control course, which is targeted at the lay public. This course has been widely adopted, with more than 16 000 registered instructors and estimates of 100 000 to 150 000 citizens trained in the first year.1 Understanding the optimal educational approach to maximize mastery and retention of these skills is critical as we continue to promote and evolve this program. We therefore applaud Goralnick et al2 for this excellent assessment of 3 training options for the skill of tourniquet placement. This is a well-designed randomized clinical trial with appropriate statistical analyses. The results overwhelmingly favor in-person training with the bleeding control course vs point-of-care instructions, either visual or audio. The educational level of the training cohorts does not reflect the country because 2017 US census data suggest 38% of adults have high school or less as their highest level of education, compared with only 21.7% in this study.3 However, education level was not associated with skill retention in this study.

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