A. Gupta1, J. Rosenberg1, C. Villegas1, J. S. Curren1, R. Winchell1, M. Narayan1 1Weill Cornell Medical College,The Division Of Trauma, Burns, Critical And Acute Care Surgery,New York, NY, USA
Introduction:
As active shootings and other mass casualty incidents have become more prevalent, courses designed to teach basic hemorrhage control to laypersons have proliferated. In the current StB course, participants undergo hands-on training using a synthetic limb mannequin. In a prior survey of 302 participants there was overwhelming sentiment that the mannequin was limited by its inability to demonstrate cessation of bleeding when hemorrhage control techniques were applied. We hypothesized that enhanced flow characteristics (pulsatile flow and flow at variable pressure) that can be stanched by StB techniques would improve the mannequin, and hence the experience and confidence of trainees.
Methods:
The mannequin was redesigned as a self-contained circulation model that could mimic both arterial and venous bleeding. Different synthetic soft tissues were assessed for texture, thickness, compressibility, and durability. Vessel material, construction, and placement were evaluated on their ability to mimic pulsatile blood flow and durability to repeated pressure, packing, and tourniquet applications. Multiple mechanisms of simulating blood flow (gravity, pump) were also trialed. An 85 ml synthetic rubber capacity bulb with a 7.4 mm inner diameter tubing were used resulting in a stroke volume of 16 cc per hand stroke and pressure of 20-25 kPa or 150-187 mmHg. Finally, material cost was considered to facilitate low-cost, global distribution. The final mannequin resulted in an inexpensive, novel synthetic cadaver limb model that is equipped with vessels which mimic blood flow and provide a realistic wound on which to practice the hemostatic techniques of direct pressure, wound packing and tourniquet application taught in StB.
Results:
Nurse and physician educators conducted beta testing of the perfused mannequin. One-on-one interviews revealed positive feedback regarding both realism of the perfused mannequin and participants’ ability to obtain bleeding control using StB techniques. In addition, participants who trialed the mannequin reported an increased awareness of the rate of blood flow out of a wound, which in turn increased their sense of urgency in applying hemorrhage control techniques.
Conclusion:
Several training modalities are available to teach hemorrhage control techniques, varying from high-fidelity simulators, to animal models, to synthetic mannequins. In an effort to address shortcomings noted by participants in the current StB mannequin, we developed a novel perfused-bleeding mannequin that mimics both arterial and venous bleeding, responds appropriately to various hemorrhage cessation techniques, and is both inexpensive
