Assessing the effect of “Stop the Bleed” training on external hemorrhage management by the lay first responders in prehospital settings in Kakamega County, Kenya

Dinnah Akosa Okwiri; Tecla Sum

doi:10.51867/ajernet.7.2.77

Auteurs

Dinnah Akosa Okwiri Texila American University, South America https://orcid.org/0000-0001-5522-2186
Tecla Sum Masinde Muliro University of Science and Technology, Kenya https://orcid.org/0000-0001-7345-4714

DOI :

https://doi.org/10.51867/ajernet.7.2.77

Mots-clés :

External Hemorrhage, Lay First Responders, Pre Hospital Care, Stop the Bleed

Résumé

Trauma remains a major public health concern worldwide and contributes substantially to mortality and disability. Globally, an estimated 5–8 million deaths occur annually as a result of traumatic injuries. Among these, uncontrolled hemorrhage is a leading contributor to preventable trauma-related deaths. Early recognition and effective control of bleeding are critical in preventing complications and death following traumatic injury. In many low- and middle-income countries, bystanders and community members often serve as the first individuals to respond to emergencies before professional medical teams arrive. Their level of preparedness and practical skills in hemorrhage control, therefore, plays an important role in patient survival. The objective of this study was to assess the effect of “Stop the Bleed” training on external hemorrhage management by lay first responders in prehospital settings in Kakamega County, Kenya. The study was guided by the Health Belief Model and employed a quantitative approach using a quasi-experimental design. Sub-counties were selected using a census approach, while participants were recruited through simple random sampling. A total of 208 lay first responders participated in the baseline assessment prior to training. Baseline data was collected using structured questionnaires, simulated trauma scenarios, and observation checklists. Data analysis was conducted using SPSS version 28. The findings revealed considerable gaps in hemorrhage control practices among participants. 70.1% of the participants approached accident scenes without first assessing scene safety. Only 40% correctly applied direct pressure to control bleeding. The average time from injury to control of bleeding is approximately 24 minutes. An intervention was carried out by training them on external hemorrhage control skills. After training them on hemorrhage control using the “Stop the Bleed" package, post-training data was collected using similar tools used during the pre-training test. There was marked improvement in their practice. Factorial ANOVA showed post-training skills significantly influenced time to bleeding control (F = 5.18, p = 0.024), while age, education, and their interaction were not significant. The study concludes that although bystanders are often. The first to reach trauma scenes in resource-limited settings, many lack adequate skills in basic hemorrhage control. The “Stop the Bleed” training is effective in improving their skills. Therefore, the ministry of health and other stakeholders should implement the training widely in order to enhance community hemorrhage control during emergency trauma response in the county.

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Références

Abdelrahman, H., Mekkodathil, A., El-Menyar, A., Consunji, R., Rizoli, S., & Al-Thani, H. (2025). The effect of external bleeding control training courses on lay first-person responders' knowledge, skills, and attitudes in low- and middle-income countries: A systematic review. European Journal of Trauma and Emergency Surgery, 51(1), 252. https://doi.org/10.1007/s00068-025-02917-4

Abdul-Matinue, S. (2023). Child injuries and deaths from road traffic incidents in Ghana. University of Washington.

Ashwin, K. J., Thiagarajan, A. B., Ochieng, S. O., Okwiri, D. A., Arudo, J., Nathanael, S., & Rosman, S. L. (2024). Evaluating lay first responder (LFR) first aid kit supplies usage and appropriateness in Western Kenya. The Pan African Medical Journal, 48, 169. https://doi.org/10.11604/pamj.2024.48.169.44049

Bhaumik, S., Wogu, A. F., Finck, L., Jamison, M., Xiao, M., Finn, J., Lategan, H., Verster, J., Vries, S., Wylie, C., Hodson, L., Mayet, M., Wagner, L., Snyders, L., Doubell, K., Erasmus, E., Oosthuizen, G., Rees, C., Schauer, S. G., Dixon, J., & Mould-Millman, N. K. (2025). Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study. African Journal of Emergency Medicine, 15(2), 613-620. https://doi.org/10.1016/j.afjem.2025.02.002

Botchey, I. M., Jr., Hung, Y. W., Bachani, A. M., Paruk, F., Mehmood, A., Saidi, H., & Hyder, A. A. (2017). Epidemiology and outcomes of injuries in Kenya: A multisite surveillance study. Surgery, 162(6 Suppl.), S45-S53. https://doi.org/10.1016/j.surg.2017.01.030

Centers for Disease Control and Prevention. (2017). Web-based injury statistics query and reporting system (WISQARS). https://www.cdc.gov

Chang, C. D., Bosson, N., Gausche-Hill, M., Sobolewski, B., Schlesinger, S. A., Williams, M., Menninger, R., Harun, N., Zhang, Y., & Eckerle, M. (2025). Assessing hemorrhage control and tourniquet skills in school-aged children. JACEP Open, 6(3), 100078. https://doi.org/10.1016/j.acepjo.2025.100078

Consunji, R., Mekkodathil, A., Abdelrahman, H., El-Menyar, A., Peralta, R., Rizoli, S., & Al-Thani, H. (2024). Can "Stop the Bleed" training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review. European Journal of Trauma and Emergency Surgery, 50(6), 2775-2798. https://doi.org/10.1007/s00068-023-02422-6

Evans, K. M., Lake, B., Harrell, K. M., Longshore, S. W., Toschlog, E. A., & Walsh, D. S. (2023). Stop the Bleed®: Medical students as instructors of the bleeding control basics course. The American Surgeon, 89(2), 255-260. https://doi.org/10.1177/00031348211011153

Gowen, J. T., Sexton, K. W., Thrush, C., Privratsky, A., Beck, W. C., Taylor, J. R., Davis, B., Kimbrough, M. K., Jensen, H. K., Robertson, R. D., & Bhavaraju, A. (2020). Hemorrhage-control training in medical education. Journal of Medical Education and Curricular Development, 7, 2382120520973214. https://doi.org/10.1177/2382120520973214

Hewett, E. K., Douma, M. J., Alibertis, K., Charlton, N. P., Goldman, M. P., Harper-Kirksey, K., Hawkins, S. C., Hoover, A. V., Kule, A., Leichtle, S., McClure, S. F., Wang, G. S., Whelchel, M., White, L., & Lavonas, E. J. (2024). American Heart Association and American Red Cross guidelines for first aid. Circulation, 150(24), e519-e579. https://doi.org/10.1161/CIR.0000000000001281

Hilary, L., & McGeary, J. (2026). Optimizing airway management for global health in low-resource settings. Anesthesiology Clinics, 44(1), 157-171. https://doi.org/10.1016/j.anclin.2025.10.008

Holtz, C. (Ed.). (2023). Global health care: Issues and policies. Jones & Bartlett Learning.

Ishikura, H., & Kitamura, T. (2017). Trauma-induced coagulopathy and critical bleeding: The role of plasma and platelet transfusion. Journal of Intensive Care, 5(1), 2. https://doi.org/10.1186/s40560-016-0203-y

Jones, A. R., Miller, J., & Brown, M. (2023). Epidemiology of trauma-related hemorrhage and time to definitive care across North America: Making the case for bleeding control education. Prehospital and Disaster Medicine, 38(6), 780-783.

https://doi.org/10.1017/S1049023X23006428

Khakhuli, S. C. (2023). Exploring the influence of self-efficacy on competency-based teaching and learning outcomes in Grade Seven junior secondary school in Trans-Nzoia County, Kenya (Unpublished master's thesis). The Aga Khan University, Institute for Educational Development, East Africa.

Kobusingye, O. C., Hyder, A. A., Bishai, D., Hicks, E. R., Mock, C. N., & Joshipura, M. (2005). Emergency medical systems in low- and middle-income countries: Recommendations for action. Bulletin of the World Health Organization, 83(8), 626-631.

Koome, G., Atela, M., Thuita, F., & Egondi, T. (2020). Health system factors associated with post-trauma mortality at the prehospital care level in Africa: A scoping review. Trauma Surgery & Acute Care Open, 5(1), e000530. https://doi.org/10.1136/tsaco-2020-000530

Kulkarni, A. J., Batra, A., Eisner, Z. J., Delaney, P. G., Pine, H., Klapow, M. C., & Raghavendran, K. (2024). Prehospital hemorrhage management in low- and middle-income countries: A scoping review. World Journal of Surgery, 48(3), 547-559. https://doi.org/10.1002/wjs.12054

Lei, R., Swartz, M. D., Harvin, J. A., Cotton, B. A., Holcomb, J. B., Wade, C. E., & Adams, S. D. (2019). Stop the Bleed training empowers learners to act to prevent unnecessary hemorrhagic death. The American Journal of Surgery, 217(2), 368-372. https://doi.org/10.1016/j.amjsurg.2018.09.025

Matinrad, N. (2022). Models for dispatch of volunteers in daily emergency response. https://doi.org/10.3384/9789179291853

Mock, C. N., Donkor, P., Gawande, A., Jamison, D. T., Kruk, M. E., Debas, H. T., & DCP3 Essential Surgery Author Group. (2015). Essential surgery: Key messages from disease control priorities (3rd ed.). The Lancet, 385(9983), 2209-2219. https://doi.org/10.1016/S0140-6736(15)60091-5

Nichols, R., & Horstman, J. (2022). Recommendations for improving Stop the Bleed: A systematic review. Military Medicine, 187, 1338-1345.

https://doi.org/10.1093/milmed/usac019

Peng, W., Liu, C., Lai, Y., Wang, Y., Liu, P., & Shen, J. (2023). An adhesive/anti-adhesive Janus tissue patch for efficient closure of bleeding tissue with inhibited postoperative adhesion. Advanced Science, 10(21), e2301427. https://doi.org/10.1002/advs.202301427

Reed, J. R., Carman, M. J., Titch, F. J., & Kotwal, R. S. (2018). Implementation and evaluation of a first-responder bleeding-control training program in a rural police department. Journal of Special Operations Medicine, 18(3), 57-61. https://doi.org/10.55460/DN8P-L4EL

Rossaint, R., Afshari, A., Bouillon, B., Cerny, V., Cimpoesu, D., Curry, N., Duranteau, J., Filipescu, D., Grottke, O., Grønlykke, L., Harrois,A., Hunt, B. J., Kaserer, A., Komadina, R., Madsen, M. H., Maegele, M., Mora, L., Riddez, L., Romero, C. S., Samama, C. M., Vincent, J. L., Wiberg, S., & Spahn, D. R. (2023). The European guideline on management of major bleeding and coagulopathy following trauma: Sixth edition. Critical Care, 27(1), 80. https://doi.org/10.1186/s13054-023-04327-7

Thoolen, S. J., & Maybritt, K. I. (2023). External hemorrhage control techniques for human space exploration: Lessons from the battlefield. Wilderness & Environmental Medicine, 34(2), 231-242. https://doi.org/10.1016/j.wem.2023.01.006

Wohlgemut, J. M., Pisirir, E., Stoner, R. S., Kyrimi, E., Christian, M., Hurst, T., Marsh, W., Perkins, Z. B., & Tai, N. R. M. (2024). Identification of major hemorrhage in trauma patients in the prehospital setting: Diagnostic accuracy and impact on outcome. Trauma Surgery & Acute Care Open, 9(1), e001214. https://doi.org/10.1136/tsaco-2023-001214

Zhu, H., & Liu, X. (2021). Advances of tumorigenesis, diagnosis at early stage, and cellular immunotherapy in gastrointestinal malignancies. Frontiers in Oncology, 11, 666340. https://doi.org/10.3389/fonc.2021.666340