Implementing

Stop the Bleed

in Schools
 By: Tonya Bright, MSN, RN
 Faculty Chair: Dr. Jennifer Frank
 Preceptors: Dr. Laura Junkin and Hubbard Harvey, JD
 July 15, 2021
 • An anonymous survey was administered to school
nurses.
• A majority of nurses requested additional information
in emergency preparedness for mass casualty events.

• The American College of Surgeons (ACS) developed a

standardized curriculum to teach Stop the Bleed (StB) to
Needs laypersons.

Assessment • Nurses will be certified as StB instructors to

disseminate training to the faculty and staff at their
schools.
• The more people trained in StB increases the survival
rate in a mass casualty event.
  To instruct and practice manual compression, wound
packing, and tourniquet application

Learning  To improve knowledge, confidence, preparation, and skill

Outcomes of school nurses in recognizing and treating bleeding
emergencies
  Does implementing the StB educational
intervention, as compared to no training,
PICO Question increase the knowledge, confidence,
preparation, and skill to respond to bleeding
emergencies?
 Theoretical Framework
The Protective Action Decision Model (PADM) is a decision-making process involving information
from environmental and social sources which impact the reception and comprehension of
information determining possible threats and actions (Lindell & Perry, 2012).

The Theory of Reasoned Action is the foundation for PADM and is a conceptual framework
considering various attitudes, beliefs, and norms which affect behavioral change (Heath et al.,
2019).

StB campaigns aim to inform the public of potential disaster or emergency scenarios and
encourage planning and preparation to reduce their impact (Health & Abel, 1996).

PADM wields predictive validity in managing the public’s response to environmental hazards and
explains why people take preventive action (Lindell & Perry, 2012; Heath et al., 2018).
  Natural disasters, traumatic events, or other
emergencies can occur at any time (Russell, 2019).

Review of  It is important to establish priorities to act quickly

and effectively in response to disasters (CDC,
Literature 2018) .

Introduction  The first five minutes before emergency personnel

arrive are vital in improving outcomes and
emergency preparedness (Kress, Conlin, & Jackson,
2019).
 Review of literature
Background

Global threats (Al Sabah et al., 2018; Schroll et al., 2019; Schroll et al., 2020;
Sonneborne et al., 2018; Usher et al., 2015b; Veenema et al., 2016; Yan et al.,
2015)
• September 11, 2001 bombings
• Boston Marathon Bombing
• Flight 357 crash

National Shootings (Clark, Bass, & Boiteaux, 2019; Ciraulo et al., 2020; Goolsby et
al., 2020; Liu et al., 2019; Lu & Spain, 2020; Nanassy et al., 2019; Zwislewski et al.,
2019)
• Columbine High School
• Sandy Hook Elementary
• Las Vegas Harvest Festival
  In 2015, the American College of Surgeons (ACS) reported
uncontrolled hemorrhage was one of the leading causes of
preventable deaths due to trauma.

 Tourniquets save lives (Ciraulo et al., 2020).

Review of
literature  StB techniques decrease complications, morbidity, mortality,
(continued) and transfusions due to hemorrhage (Villegas et al., 2020).

 Average response time for emergency personnel to arrive on

scene is between 7.7 – 14.5 minutes (Al Sabah et al., 2018;
Andrade et al., 2020; Goralnick et al., 2018; Jones et al., 2019).
  Lowndes et al. (2019) explain 40% of trauma mortality is related to
bleeding.

 Fifty-seven percent of hemorrhagic deaths could be prevented (Lei

et al., 2019).

Review of  A six-fold reduction in hospital mortality rates exists when

Literature laypersons apply tourniquet in a prehospital setting (Texeira et al.,

2018).

Statistics  Tourniquet application improved from 16.9% without training (Ross

et al., 2018) to 88% after training (Goralnick et al., 2018).

 Eighty-five percent of nurses failed the knowledge test regarding

disaster preparedness (Jiang et al., 2015).
 Review of Literature
Outcomes

Improved confidence (Andrade et al., 2020; Lei et al., 2019;

Nanassy et al., 2019; Schroll et al., 2020; Villegas et al., 2020)
Improved self-efficacy and school preparedness (Nanassy et
al., 2019)
Improved knowledge (Andrade et al., 2020; Lei et al. 2019)

Improved skill demonstration and knowledge (Schroll et al.,

2019)
  Nurses are a majority of frontline responders (Usher et
al., 2015a; Yan et al., 2015).

 Nurses require education and training to improve

Review of outcomes of disasters (Ugalde et al., 2018; Veenema et
al., 2016; Yan et al., 2015).
Literature
School Nurses  With knowledge and skills, nurses prove to be
indispensable medical professionals in the school
setting (Alim, Kawabata, & Nakazawa, 2015; Jiang et al.,
2015).
PRACTICE INTERVENTION QUASI-EXPERIMENTAL MIXED-METHOD ANONYMOUS SURVEYS ANONYMOUS SKILLS
TO IMPROVE QUALITY DESIGN TO MEASURE APPROACH OF GIVEN BEFORE AND EVALUATIONS
PERFORMANCE KNOWLEDGE, QUALITATIVE AFTER TRAINING PERFORMED BEFORE AND
CONFIDENCE, AND SKILL DEMOGRAPHIC DATA AND AFTER TRAINING
QUANTITATIVE DATA

Design Method
 Purposal
Evaluation and Institutional Review
Needs assessment
Review Committee Board approval
approval

Project Site approval

Voluntary consent
from participants
Surveys and skills
evaluation
Implementation
StB course
Surveys and skills
instruction and Statistical analysis
evaluation
practice
 • Knowledge improved in 80% of participants.

• Tourniquet application improved in 89.6% of

participants.

• Wound packing improved in 86% of participants.

Outcomes/Analysis
• Confidence increased from 55% to 70% after training.

• School preparedness increased from 75.8% to 100%

after training.
 Training school nurses as Stop the Bleed instructors can
impact the number of school personnel trained.

Stop the Bleed training is feasible and beneficial.

Conclusion/
Stop the Bleed techniques save lives.
Implications for
Practice A one-hour class increases the knowledge, confidence,
preparation, and skill to respond to bleeding
emergencies.

As with CPR and AED training, the more people trained

increases the survival rate in a mass casualty event.
 Certify Establish Record Post Provide
Certify all Establish Record voice- Post Provide
school nurses Guidelines for over for presentation practice kits
as StB annual PowerPoint on school and
instructors. training. presentation. website for instructional
easy access. materials for
skills
Sustainability of demonstration.

Project
 Acknowledgments

Dr. Jennifer Frank, Faculty Chair

Dr. Fuller, APA Editor
Dr. Laura Junkin, Preceptor
Hubbard Harvey, JD, Preceptor
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d7
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