Building an Implementation Toolkit for Stop the Bleed Training: An Evidence-Based Practice Change

Background: School shootings are a common and devastating problem in America and a source of traumatic death for both students and teachers. After the shooting at Sandy Hook Elementary the American College of Surgeons (ACS) developed a course called Stop the Bleed (STB) which taught bystanders how to recognize and treat uncontrollable hemorrhage. The number one cause of preventable death after trauma, such as a gunshot wound, is uncontrolled hemorrhage. By implementing this course in a school system, it is hoped that fatalities can be reduced. Local Problem: In 2023, a bill was passed in Utah that mandated funds be set aside for schools to purchase STB kits for every classroom. In 2024, a needs assessment performed by a prior University of Utah student determined that there was no standardized training to ensure that all school staff knew how to use these kits. A toolkit was needed to help schools implement training in their individual facilities. Methods: This project was rolled out in phases. The first phase involved training nurses, and the 2nd and 3rd phase was training schoolteachers and staff. Multiple methods were utilized to gather data for this project including surveys with qualitative and quantitative questions. There were also qualitative discussions with stakeholders such as school staff, district safety officers, school nurses and local hospital trauma outreach education offices. Interventions: This project started with a pre-survey and discussions with key stakeholders. Then, a large training session with staff from a local public school district was planned. The training targeted teachers from elementary, middle and high schools. After the training was administered a postsurvey was sent to instructors to determine what barriers they discovered. This information was used to determine the best way to formulate a toolkit to help facilitate further training for staff from other school districts in the future. Results: The training was given to 15 school nurses and over two thousand staff. Twenty-five people took the post-training assessment survey. This survey identified some key elements to the development of the toolkit. These were barriers such as communication, the appropriate instructor-to-staff ratio, difficulty coordinating with multiple people, and the need to identify an STB champion for each school. The post-training survey was also helpful in identifying key elements in the sustainability of maintaining STB training in schools, such as ensuring one person in each school was trained as an instructor and assigning yearly refresher modules to staff. Conclusion: Developing a STB toolkit makes implementing STB training easier for schools or large school districts. The administration of this training ensures that all school staff can use the STB equipment they have in their classrooms and are more likely to help save a life in the future.