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Successes and Challenges of Implementing Stop the Bleed Training for School Nurses and Educators in Rhode Island
Shriya R. Perati
*1, Anita Gandhi
2, Amber Sale
1, Camille Marangi
1, Melinda Delaney
2, Brent Emigh
3, Elizabeth Renaud
41The Warren Alpert Medical School of Brown University, Providence, RI; 2Division of Internal Medicine and Pediatrics, Rhode Island Hospital, Providence, RI; 3Division of Trauma and Surgical Critical Care, Department of Surgery, Rhode Island Hospital, Providence, RI; 4Division of Pediatrics, Department of Surgery, Rhode Island Hospital, Providence, RI
Background: Injury from trauma is the leading cause of death among children and adolescents, and exsanguinating hemorrhage is a common contributor. Public knowledge regarding appropriate treatment of significant bleeding prior to emergency assistance is limited. Stop the Bleed® (STB) is an educational module focused on teaching the general public techniques to treat hemorrhage. In Rhode Island (RI), a public health initiative has introduced STB education into local schools. This study examines the factors influencing the successful integration of STB training for school nurses and educators in RI, aiming to provide a model for other small states or counties.
Study Design: Using a train-the-trainer model, instructor teams of surgeons and medical students collaborated with the RI School Nurses Association to conduct large-scale STB training. Participating school nurses were then encouraged to help coordinate training sessions at their respective schools. Surveys were administered before and after training sessions to assess willingness to intervene, participant concerns, perceived training value, and system preparedness. Wilcoxon signed-rank tests were used to evaluate response changes.
Results: 217 surveys were administered to school nurses and personnel and 130 paired pre- and post-training surveys were completed. Before training, 75.9% of participants reported concerns of intervening incorrectly during a bleeding emergency. All participants (100%) expressed a desire to learn hemorrhage control and viewed the skills as valuable for professional development. However, 40.6% of participants were reluctant to attend an uncompensated work-related training and 43.8% expressed concerns that participation would take time away from work opportunities or family responsibilities. To address this, most trainings were held during school hours or professional development days. After training, participants demonstrated an increased willingness to intervene in bleeding emergencies and decreased concerns of performing skills incorrectly (p<0.01). 93.2% of participants expressed interest in advocating for more widespread STB training at their schools. Still, 72.6% of participants reported that their school would require financial support to obtain adequate hemorrhage control supplies.
Conclusions: STB training effectively increased confidence and willingness to intervene, but financial constraints, access to hemorrhage control supplies, and liability concerns remain obstacles to widespread adoption. Engagement of medical students as assistant trainers and leadership from surgeons, physicians, and our state STB champion enhanced training capacity. Strong interest in expanding STB highlights its perceived value, but sustainable implementation will require institutional support, funding, and policies ensuring accessibility. Legislative efforts are underway to support funding of STB kits in schools and integration of STB training into high school health curriculum.
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