High-School Students Can Stop the Bleed: A Randomized, Controlled Educational Trial

Acad Pediatr. 2021 Mar;21(2):321-328. doi: 10.1016/j.acap.2020.05.012. Epub 2020 May 27.


Objective: To determine high-school students' ability to learn hemorrhage control skills and knowledge via 3 educational modalities.

Background: Trauma is the leading cause of death for young Americans, and there are calls to teach children about hemorrhage control. However, little is known about adolescents' ability to perform hemorrhage control, and the ideal way(s) to teach them.

Methods: This randomized controlled trial enrolled high-school students from 39 states at a 2019 national conference. After answering questions about their willingness to use tourniquets, participants received hemorrhage control education in 1 of 3 formats: instructor-led, web-only, or blended (combining web and instructor-led). Participants were then assessed on their ability to apply a tourniquet and to identify wounds that require a tourniquet. Finally, they completed an attitude questionnaire.

Results: Two hundred and four (82%) of 248 participants applied a tourniquet correctly: 72 (88%) instructor-led, 50 (61%) web-only, and 79 (94%) blended. The instructor-led and blended arms were superior to the web-only arm (P < .001). Nearly all participants passed an assessment requiring them to identify wounds warranting a tourniquet (99% instructor-led and blended, and 98% web-only). All modalities improved participants' self-reported willingness and comfort in using tourniquets (P < .001).

Conclusions: This is the first study to demonstrate that high-school students can learn hemorrhage control via multiple methods. Blended and instructor-led education led to highly successful skill performance. Students learned to identify wounds requiring tourniquets and showed an improved willingness to aid from all modalities. These findings should encourage educators to offer multiple educational modalities.

Keywords: Stop the Bleed; hemorrhage control; high-school students; medical education; simulated; tourniquet.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Child
  • Hemorrhage* / therapy
  • Humans
  • Schools
  • Students
  • Surveys and Questionnaires
  • Tourniquets*
  • United States