Comparative Effectiveness of Telesimulation Versus In-Person Training for Teaching Tourniquet Application for Life-Threatening Hemorrhage: A Prospective Randomized Controlled Study.

Abstract

Introduction: Hemorrhage continues to be the leading cause of preventable death in trauma, and tourniquet application has been associated with survival. The purpose of our study was to evaluate the efficacy of telesimulation (TeleSIM) versus in-person training (SIM) for teaching tourniquet application for life-threatening hemorrhage control.

Methods: We performed a prospective randomized study of participants enrolled in a Stop The Bleed course at a university medical school. The TeleSIM group completed the course with an instructor streaming live from an off-site location. The SIM group completed the course in the standard fashion with a live instructor present. The primary endpoint was the successful application of a combat application tourniquet to a bleeding extremity in a simulation scenario. We also evaluated the time for successful tourniquet application according to training modality. Participants' thoughts, feelings, and attitudes pertaining to their experience in the course were obtained via a postcourse survey.

Results: Ninety-four of 97 (96.9%) eligible subjects participated in the study. There was no difference in the proportion of participants in each group who successfully applied a combat application tourniquet during their simulation scenario: TeleSIM group, 100% (95% CI, 92.5-100.0); SIM group, 100% (95% CI, 92.7-100.0). We also observed no significant difference in the mean time it took the participants to apply a tourniquet regardless of their training modality. Both groups reported their learning modality as an effective way to learn hemorrhage control.

Conclusion: A telesimulation-based instructional delivery design is an effective way to teach tourniquet application for hemorrhage control.