Evaluating Interventions Supporting Laypeople Addressing Prehospital Hemorrhage Study (SLAPS): A Parallel, 4-Arm Randomized Controlled Trial.
Journal of the American College of Surgeons · 2025-08-08 · Randomised trial
Abstract
BACKGROUND: Hemorrhage is a significant source of preventable death in the United States. Bystander hemorrhage control training is crucial, yet resource-intensive to scale and suffers longitudinal knowledge decay. Efficacy of point-of-care (POC) instructional modalities to address these challenges was compared versus in-person training for tourniquet application by laypeople longitudinally. STUDY DESIGN: Parallel randomized controlled trial evaluating tourniquet application on limb hemorrhage simulators by direct-observation checklist and simulated hemorrhage arrest using undergraduate students. Four arms included:POC audiovisual (Group 1, n=36), POC flashcard (Group 2, n=48), in-person training (Group 3, n=33), and control without POC instructions/training (Group 4, n=41). POC materials were available at follow-up given the inherent nature of POC instructional material integration with devices, while in-person training had no re-training at follow-up to assess skill decay using per protocol analysis with Wilcoxon rank-sum tests. Secondary outcomes included participant confidence, failure reason, and completion time. RESULTS: 217 participants recruited, 204 enrolled (38 excluded for prior/interval hemorrhage control training), 8 lost-to-follow-up (5.06%) for 158 trial participants. At 6-month follow-up, there was no difference in performance between POC and in-person training by checklist, with in-person training demonstrating 48.5% (95CI:31.2%,66.1%) versus POC audiovisual=63.9% (95CI:46.2%,78.7%) (p=0.203), or by simulated hemorrhage arrest; in-person training=72.7% (95CI:54.2%,86.1%) versus POC audiovisual=77.8% (95CI:60.4%,89.3%) (p=0.635). At follow-up, both POC arm confidence levels exceeded in-person training (p=0.02), despite longer completion time (p<0.001). CONCLUSIONS: Point-of-care instruction may be as effective as in-person training for tourniquet application by laypeople longitudinally, suggesting a potential alternative to disseminate hemorrhage control devices, addressing in-person training scalability challenges.
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