Defining a Research Agenda for Layperson Prehospital Hemorrhage Control: A Consensus Statement.

Importance Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military's medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector. Objective To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons. Evidence Review The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda. Findings Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a priori-defined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy. Conclusions and Relevance The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities. Question What are the key areas and questions on which future research of prehospital hemorrhage control by laypersons should be focused? Findings In this consensus statement, a cohort of 45 subject matter experts, professional society leaders, and funding agency representatives conducted a 3-round modified Delphi consensus process to identify and prioritize key research gaps in prehospital hemorrhage control by laypersons. Participants identified 113 high-priority questions in the themes of epidemiology and effectiveness, materials, education, global health, and health policy, with the top 24 questions constituting the prioritized national research agenda. Meaning The National Stop the Bleed Research Consensus Conference identified and prioritized a research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. This consensus statement uses a Delphi consensus process to create a national research agenda to help guide future work in prehospital hemorrhage control performed by layperson immediate responders.