BLEED TIME Simulation Study – Bleeding Limb, Effectiveness and Efficiency in Determining Time to Intervene on Mangled Extremity

Timothy J Bikman,1,2 William F Selde,1 William B Belk,3 Manoj Pathak,4 Craig E Palm,5 Simon J Thompson6 1Emergency Department, Billings Clinic, Billings, MT, USA; 2Simulation Experiential Learning Laboratory, Billings Clinic, Billings, MT, USA; 3Medical Simulation & Innovative Education, Air Methods Corporation, Greenwood Village, CO, USA; 4Department of Mathematics & Statistics, Murray State University, Murray, KY, USA; 5Trauma Services, Billings Clinic, Billings, MT, USA; 6Collaborative Science & Innovation, Billings Clinic, Billings, MT, USACorrespondence: Simon J Thompson, Collaborative Science & Innovation, Billings Clinic, Billings, MT, USA, Tel +1 503 267 7314, Fax +1 406 435 1586, Email [email protected]: Simulation-based education plays a pivotal role in preparing healthcare providers for rare, high-acuity emergencies such as hemorrhagic extremity trauma. Advances in simulation fidelity, including hemorrhagic pumping systems (HPS), may enhance realism, urgency, and clinical decision-making. However, evidence on how such enhancements affect provider performance remains limited.Patients and Methods: In this randomized case-control study at a rural Level I trauma center simulation learning laboratory, emergency care providers (n = 146) managed a simulated extremity trauma scenario using either standard moulage (Group A; No HPS) or an active HPS (Group B). Participants were stratified by profession/licensure prior to recruitment. Within each professional stratum participants were randomized to ensure balanced representation, into the two groups and the timed endpoints included (i) First Intervention, (ii) Tourniquet-only Application, and (iii) Scenario Completion. Subgroup analyses were conducted by healthcare license (Emergency Medical Technician (EMT), Registered Nurse (RN), Others (neither EMT or RN licensure)) and years of licensure (< 5 vs ≥ 5 years).Results: Participants using the HPS performed the first intervention significantly faster (mean = 54.9s) than those with No HPS (mean = 71.9s; p=0.002). EMTs and “Others” showed significant time improvements with HPS use, while RN performance did not differ. Tourniquet-only and Scenario Completion times were unaffected by HPS presence. Among RNs, those with < 5 years of experience performed significantly faster in the first intervention than their more experienced peers (p=0.039); no other timing differences reached statistical significance based on licensure length.Conclusion: Enhanced realism within simulation-based education incorporating dynamic bleeding systems improves response time in initial trauma interventions, particularly among EMTs and less-experienced providers. While total scenario times and tourniquet application did not differ, early engagement appears positively influenced by simulation fidelity. Integrating high-fidelity elements like HPS into trauma training may strengthen learner urgency, decision-making, and improve real-world provider readiness.Plain Language Summary: This study explored how realistic bleeding simulations affect emergency care providers’ response times to a serious leg or arm injury. The goal was to see if adding a system that mimics real bleeding (called a hemorrhagic pumping system, or HPS) could improve how quickly and effectively providers react in a training scenario.Researchers tested 146 emergency workers at a rural trauma center. About half of them used a standard setup with no active bleeding (Group A), while the rest used a more realistic system that included simulated bleeding (Group B). They measured how long it took participants to start treating the injury, apply a tourniquet, and complete the full scenario.The study found that those who used the bleeding system started treatment faster, about 17 seconds quicker on average. This improvement was especially true for Emergency Medical Technicians (EMTs) and providers without specific nursing or EMT licenses. Nurses did not show a difference overall, but newer nurses (with less than five years of experience) responded faster than more experienced ones.Adding realistic bleeding did not change how fast tourniquets were applied or how long the entire scenario took to complete. However, it did make a difference in how quickly providers reacted at the start.In summary, using more realistic bleeding in trauma simulations helps improve early response times, especially for newer or non-nurse providers. This suggests that adding lifelike features such as active bleeding to training could better prepare emergency workers for real-world trauma situations.Keywords: medical simulation training, emergency medical services, clinical decision-making, dynamic bleeding models, high fidelity simulation training, trauma education