D. El-Gabri1, A. D. McDow1, S. A. Sullivan3, H. Jung2, K. L. Long1 3University Of Wisconsin,Department Of Surgery/ University Of Wisconsin School Of Medicine And Public Health,Madison, WI, USA 1University Of Wisconsin,Division Of Endocrine Surgery/ Division Of General Surgery/ Department Of Surgery/ University Of Wisconsin School Of Medicine And Public Health,Madison, WI, USA 2University Of Wisconsin,Division Of Trauma, Acute Care Surgery, Burn And Surgical Critical Care/ Division Of General Surgery/ Department Of Surgery/ University Of Wisconsin School Of Medicine And Public Health,Madison, WI, USA
Introduction:
The American College of Surgeons Committee on Trauma developed the Stop the Bleed (STB) program in 2015 as a mechanism to prepare the public for response to life-threatening bleeding or mass casualty incidents. Assessments of STB in the United States (US) have shown the training’s effectiveness in improving comfort and skill in aiding a trauma victim. While the program continues to spread throughout the US, to the best of our knowledge, it has not been conducted and evaluated in low or middle-income countries. Kenya has a high burden of injuries and violence accounting for 88.4 deaths per 100,000 people. Addressing this burden is a healthcare priority in the country. STB training represents a potential intervention that could reduce trauma morbidity and mortality in a country with limited healthcare resources. The purpose of this study was to assess the effectiveness and retention of STB training in Kenya as compared to implementation in the US, the population for which it was originally designed.
Methods:
This quasi-experimental study assessed differences between a STB intervention post-test conducted in the US and in Kenya. The two samples consisted of volunteer participants with no medical background. The STB training was advertised, and any willing participants were recruited into the study. The population of interest was recruited in Migori Kenya (n=19), the comparison population in Wisconsin, United States (n=12). Each group received the same STB training course in July 2018 by physicians trained to give STB instruction from the same US institution. After completing the course, each group received the same 5-question post-test, designed to assess effectiveness and comprehension of the material. The quizzes were anonymous and taken voluntarily. The quiz scores between each group were compared using the Mann-Whitney U Test.
Results:
There is a statistically significant (p=0.04) difference in the quiz scores between the US (n=12) and Kenya samples (n=18). The Kenyan and US mean scores were 3.9 and 4.7 out of a possible 5, respectively. If one quiz question is excluded from analysis, there is no significant difference between the two group’s quiz scores (p=0.41). The individual question that significantly lowered the mean score in the Kenyan sample was: “What is the first step when approaching an injured, bleeding person?”, which may identify a difference in interpretation of the material.
Conclusion:
In general, both samples studied demonstrated good comprehension of the STB core concepts. In detailed review of the post-test scores, only one question was significantly different in answers among the Kenya and US participants. Additional studies to assess long-term retention of these concepts will be necessary in both populations. Understanding the discrepancies between the assessments in differing populations may contribute to the validation and utility of this STB post-intervention evaluation.