Assessing Baseline Proficiency of National Guard Combat Medics Due for Recertification: A Pilot Study

ABSTRACT Introduction Combat medics, or 68W Healthcare Specialists in the Army, are an early part of a combat casualty’s chain of survival. Their job requires a high degree of competency in emergency medical guidelines established by the Committee of Tactical Combat Casualty Care (CoTCCC) as well as basic bleeding control skills. The American Warfighting Experience for the last two decades highlights just how important these skills are in preventing death on the battlefield. A recent Government Office of Accountability suggests sustainment for critical wartime skills is lacking. This is especially concerning for National Guard Soldiers who must juggle their military obligations with their civilian ones. It is unknown how well-prepared National Guard combat medics are in fulfilling their most critical combat care responsibilities. The current study attempts to address this gap in knowledge by assessing National Guard Soldiers due for their annual recertification. Materials and Methods Nine medics due for their annual recertification were recruited for the study. First, they were given a questionnaire intended to gather basic demographic information about their experience and a six-question quiz on current CoTCCC guidelines. The medics were then evaluated on their ability to place a Combat Application Tourniquet on a live person, which was verified by a Doppler microphone. The medics were finally evaluated on their ability to pack a wound with a hemostatic dressing. Statistical analysis was used to determine if experience or frequency of practice over the previous year could predict success. Results Medics, on average, were only able to answer an average of 2.2 questions on the quiz correctly. The overall success rate for tourniquet application was 44.4%, and the overall success rate for wound packing was 22.2%. Statistical analysis showed that experience or frequency of practice could not adequately explain the success rates. Conclusions A soldier’s experience alone could not predict if the soldier will be successful in performing bleeding control tasks or if they will demonstrate higher levels of casualty care knowledge. Future research is needed in this area to better define recertification and refresher training issues.

Hemoglobin Precipitation: An Index of In Vitro Vasoconstrictive Activities of Methanol Leaf Extracts of Croton megalocarpus Hutch and Lantana camara Linn

The function of innate hemostasis aids the body in bleeding control, preventing the loss of excessive amounts of blood following low-degree injuries. However, injuries of a higher degree may require extrinsic intervention to stop life-threatening blood loss. Astringent agents’ actions result in mechanical constriction of small blood vessels and shrinkage of body tissues, thereby stopping blood loss. This enhances the primary phase of hemostasis, where vasoconstriction is the main mechanism at play during the initial response to injury. The effects of plant extracts on protein precipitation have been linked to blood vessel vasoconstriction. Traditionally, the leaves of Croton megalocarpus Hutch and Lantana camara Linn plants are used by communities living in Makueni County, Kenya, for peripheral bleeding control. However, the effects of extracts of both plants on hemoglobin precipitation have not been evaluated scientifically. In the current study, the activities of methanol extracts of C. megalocarpus (H.) and L. camara (L.) on blood protein precipitation were investigated. The leaves were harvested, cleaned, air-dried, milled, and extracted in absolute methanol before being concentrated into dry powders. A qualitative phytochemical screen revealed the presence of terpenoids, steroids, tannins, phenols, flavonoids, reducing sugars, cardiac glycosides, and carbohydrates in the methanol extract of C. megalocarpus (H.). The methanol extracts of L. camara (L.) contained cardiac glycosides, saponins, tannins, phenols, terpenoids, reducing sugars, and carbohydrates. The hemoglobin precipitation ability of various concentrations of extracts using mice samples was presented as relative astringency following the tannic acid external standard method. Methanol extracts C. megalocarpus (H.) and L. camara (L.) had significantly higher relative astringency compared with the normal control, indicating a protein precipitating activity. The relative astringency observed in both plant extracts is linked to the activity of tannins, phenols, flavonoids, and saponins detected during preliminary phytochemical screening.

Damage control in abdominal vascular trauma

Abdominal vascular trauma occurs in a small proportion of patients admitted in trauma centers. However, up to a quarter or a third of the patients who require a laparotomy will have a vascular injury. Preoperative identification is impossible in most cases, therefore, surgeons must be prepared for its early intraoperative recognition to allow appropriate management. This include temporary bleeding control techniques, identification of the probable injured vessel and the specific approach and management. Often, recognition of exsanguinating intra-abdominal hemorrhage will lead to immediate surgical indication, with activation of damage control protocols and consideration of early aortic occlusion.This paper illustrates the applications of damage control in the management of patients with abdominal vascular trauma.

Student Perspectives on Implementing Stop the Bleed Training into Medical School Curriculum

Background Following the Hartford Consensus guidelines and recommendations, third-year medical students from a single institution were offered an optional Stop the Bleed (STB) training course in August 2018. The aim of this study was to assess medical students’ confidence in performing bleeding control techniques and teaching others after completing the STB course. The secondary goal was to assess student perception on integrating mandatory STB training into the medical school curriculum. Materials and Methods A 24-question survey using a 4-point Likert scale was administered to all medical students who completed STB training. Students were anonymously asked to self-report their confidence in performing bleeding control techniques, training others after STB training, and their perception on integrating STB training into medical school curriculum. Results After completing the STB course, 95% of students were comfortable applying a tourniquet, 92% of students were confident in packing wounds, and 99% of students could apply direct pressure to wounds to stop bleeding. Overall, 94% of students reported that STB training would be helpful for their clinical rotations. Conclusion These results demonstrate that medical students are positively impacted by Stop the Bleed courses and validate that the implementation of mandatory STB courses into medical school curriculum will improve medical students’ knowledge and skills for hemorrhage control.

Have Students Used Techniques to Stop the Bleed?

Introduction The Stop the Bleed course was initiated in response to the Hartford Consensus and over 1 million people have been taught basic bleeding control techniques. Our study sought to determine the extent to which this training has been utilized. Methods Surveys were sent by email to students that had taken the Stop the Bleed course through our institution in 2017 or 2018. Data were collected utilizing the REDCap system and statistical calculations were performed. Results 2505 surveys were sent with 445 (18%) responses. The mean age of respondents was 48 years of age, 343 (77%) were female, and 230 (52%) were in the medical field. There were 17 respondents (3.8%) that stated they had utilized the techniques taught in the course; 16 out of 17 put pressure on a wound, 7 packed a wound, and 6 used a tourniquet. Patients had been injured by a variety of mechanisms including gunshot wound, stabbing, accidental laceration, and motor vehicle collision. Patients had good outcomes with 3 out of 17 surviving to emergency medical services arrival without known final outcome and the remaining 14 were known to do well. Conclusion The Stop the Bleed course is important to enable bystanders to provide hemorrhage control. Our study shows that the techniques have been utilized with 17 treated patients having a good outcome and while a utilization rate of 3.8% may appear low, it is similar to the utilization rate of cardiopulmonary resuscitation instruction of 2%.