Validation of an evaluation instrument for responders in tactical casualty care simulations

Usero-Pérez, Maria Del Carmen; Jiménez-Rodríguez, Maria Lourdes; González-Aguña, Alexandra; González-Alonso, Valentín; Orbañanos-Peiro, Luis; Santamaría-García, Jose María; Gómez-González, Jorge Luís

doi:10.1590/1518-8345.3052.3251

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 28 • 2020 • https://doi.org/10.1590/1518-8345.3052.3251 copy

Validation of an evaluation instrument for responders in tactical casualty care simulations^* * The publication of this article in the Thematic Series “Human Resources in Health and Nursing: Training and Practice in the Americas” is part of Activity 2.2 of Reference Term 2 of the PAHO/WHO Collaborating Center for Nursing Research Development, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to construct and validate a tool for the evaluation of responders in tactical casualty care simulations.

Method:

three rubrics for the application of a tourniquet, an emergency bandage and haemostatic agents recommended by the Hartford Consensus were developed and validated. Validity and reliability were studied. Validation was performed by 4 experts in the field and 36 nursing participants who were selected through convenience sampling. Three rubrics with 8 items were evaluated (except for the application of an emergency bandage, for which 7 items were evaluated). Each simulation was evaluated by 3 experts.

Results:

an excellent score was obtained for the correlation index for the 3 simulations and 2 levels that were evaluated (competent and expert). The mean score for the application of a tourniquet was 0.897, the mean score for the application of an emergency bandage was 0.982, and the mean score for the application of topical haemostats was 0.805.

Conclusion:

this instrument for the evaluation of nurses in tactical casualty care simulations is considered useful, valid and reliable for training in a prehospital setting for both professionals who lack experience in tactical casualty care and those who are considered to be experts.

Descriptors:
Rubric; Validation; Emergency Services; Simulation; Terrorism; Training

1^st Version	Panel of experts				CVI^* * CVI = Content Validity Index. Student level:	2^nd Version
1^st Version	1	2	3	4	CVI^* * CVI = Content Validity Index. Student level:	2^nd Version
Application of a tourniquet in a hot zone
Instructs the injured person to control the bleeding by self-care, if able to.	E^† † E = Expert,	E	E	B^‡ ‡ B = Beginner	0	Rejected
Applies measures to protect against biological agents.	E	B	E	E	0.5	Rejected
Positions the tourniquet correctly on the arm 4 fingers from the shoulder joint, leaving space for the application of a second tourniquet if necessary.	E	E	E	E	1	Remains
Passes the end of the strap through the inner slit of the buckle.	B	E	E	E	0.5	Rejected
Fastens the tourniquet around the arm using the velcro strap.	E	E	E	E	1	Remains
Twists the tensioning rod until bleeding stops.	E	E	E	E	1	Remains
Secures the tensioning rod into both of its 2 safety tabs.	E	E	E	E	1	Remains
Places the velcro safety strap over the tensioning rod to secure it and prevent it from accidentally releasing.	E	E	E	E	1	Remains
Passes the remaining strap through the first buckle slit.	E	E	E	E	1	Remains
Folds the excess band over itself and tightens it with your hand.	E	E	E	E	1	Remains
Writes 'T' on the front and the starting time of ischaemia.	E	E	E	E	1	Remains

1^st Version	Panel of experts				CVI^* * CVI = Content Validity Index; Student level:	2^nd Version
1^st Version	1	2	3	4	CVI^* * CVI = Content Validity Index; Student level:	2^nd Version
Application of a haemostatic dressing
Checks safety in the area.	E^† † B = Beginner;	E	B^‡ ‡ E = Expert	B	0	Rejected
Puts/has on nitrile gloves.	E	E	E	E	1	Remains
If there is a tourniquet, re-evaluates the previously placed tourniquet. Exposes the wound, and determines if a tourniquet is necessary.	E	E	E	E	1	Remains
Evaluates the wound to determine if a tourniquet is necessary.	E	E	E	E	1	Remains
Removes excess blood from the wound with a compress.	E	E	E	E	1	Remains
Applies haemostatic agent directly to the bleeding site.	E	E	E	E	1	Remains
Applies 3 minutes of direct pressure on the wound.	E	E	E	E	1	Remains
Provides coverage by placing a haemostatic emergency bandage over the wound.	E	E	E	E	1	Remains
Re-evaluates bleeding from the wound.	E	E	E	E	1	Remains
Application of an emergency bandage
Puts/has on nitrile gloves.	E	E	E	E	1	Remains
Prepares the material.	B	B	B	I	-1	Rejected
If the wound has a tourniquet, it is loosened without removing it to check the site of bleeding.	B	B	E	B	-0.5	Rejected
Applies the sterile dressing over the wound, and wraps it around until reaching the plastic pressure clamp.	E	E	E	E	1	Remains
Tucks the bandage inside the pressure clamp, and reverses the direction of the bandage.	E	E	E	E	1	Remains
Exerts pressure on the pressure clamp, which should be positioned on top of the sterile dressing over the wound, and on each turn, pressure is applied until the entire bandage is used.	E	E	E	E	1	Remains
Secures the bandage with the clamp.	E	E	E	E	1	Remains
Evaluates distal pulses and sensitivity.	E	E	E	E	1	Remains
Monitors the onset/increase in bleeding.	E	E	E	E	1	Remains

Variables	Pilot Study	Competent Level	Expert Level
Total	15	26	10
Sex
Male	40%(6)	50% (13)	40% (4)
Female	60%(9)	50% (13)	60%(6)
Mean age	25.40	26.7	39.0 years
Time in AF^* * AF = Armed Forces (mean)	New	New	10.9 (years)
Teaching experience	no	No	yes
Number of international missions in which they participated (mean)	0	0.03	3.6

Item	Competent			Expert
Item	CCI^* * CCI = Correlation Coefficient Index;	p	Cronbach's alpha	CCI^* * CCI = Correlation Coefficient Index;	p	Cronbach's alpha
Application of a tourniquet
Places the tourniquet correctly on the arm 4 fingers from the shoulder joint, leaving space for the application of a second tourniquet if necessary.	0.633	≤0.001	0.705	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;
Fastens the tourniquet around the arm using the velcro strap.	1.000^‡ ‡ Agreement is 100% for all YES or NO results of the 3 instructors for all students			1.000^‡ ‡ Agreement is 100% for all YES or NO results of the 3 instructors for all students
Twists the tensioning rod until bleeding stops.	1.000^‡ ‡ Agreement is 100% for all YES or NO results of the 3 instructors for all students			1.000^‡ ‡ Agreement is 100% for all YES or NO results of the 3 instructors for all students
Secures the tensioning rod into both of its 2 safety tabs.	0.650	≤0.001	0.644	1.000^‡ ‡ Agreement is 100% for all YES or NO results of the 3 instructors for all students
Place the velcro safety strap over the tensioning rod to secure it and prevent it from being accidentally released.	0.800	≤0.001	0.794	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;
Passes the remaining band through the first buckle slit.	0.767	≤0.001	0.762	1.000 ^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;
Folds the excess band over itself and tightens it by hand.	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;
Writes a "T" on the front and the starting time of ischaemia.	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;	≤0.001	1.000^† † Agreement is 100%; the 3 instructors make the same assessment for each student: yes or no;
Points	0.724	≤0.001	0.748	0.990	≤0.001	0.992

Item	Competent			Expert
Item	CCI^* * CCI = Correlation Coefficient Index;	p	α^† † Cronbach's alpha;	CCI^* * CCI = Correlation Coefficient Index;	p	α^† † Cronbach's alpha;
Application of a topical haemostatic agent
Puts/has on nitrile gloves.	0.844	≤0.001	0.846	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;
If there is a tourniquet, re-evaluates the previously placed tourniquet. Exposes the wound, and determines if the tourniquet is necessary.	0.810	≤0.001	0.816	0.609	0.074	0.636
Evaluates the wound to determine if a tourniquet is necessary.	0.731	≤0.001	0.765	0.372	0.262	0.356
Removes excess blood from the wound with the aid of a compress.	1.000	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;
Applies haemostatic agent directly to the bleeding site.	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student			1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student
Applies 3 minutes of direct pressure to the wound.	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student			0.780	0.017	0.780
Covers the wound with a haemostatic emergency bandage.	0.921	≤0.001	0.924	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student
Re-evaluates bleeding from the wound.	0.866	≤0.001	0.875	0.597	0.064	0.656
Points	0.842	≤0.001	0.838	0.905	≤0.001	0.909
Application of an emergency bandage
Has/puts on nitrile gloves.	0.898	≤0.001	0.898	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;
Applies the sterile dressing over the wound, wraps it around until reaching the plastic pressure clamp.	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student			1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student
Inserts the bandage into the pressure clamp, and reverses direction.	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student			1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student
Exerts pressure on the pressure clamp, which is positioned over the sterile dressing on the wound, and for each turn, pressure is applied until the entire bandage is used.	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student			1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student
Secures the bandage with the clamp.	1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student			1.000^§ § Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for each student
Evaluates distal pulses and sensitivity.	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;
Monitors the onset/increase in bleeding.	0.982	≤0.001	0.982	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;
Points	0.980	≤0.001	0.981	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;	≤0.001	1.000^‡ ‡ Agreement is 100%; the 3 instructors agree on the assessment (YES or NO) for the item for all students evaluated;

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E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Maria Del Carmen Usero-Pérez E-mail: cuseroperez@hotmail.com https://orcid.org/0000-0002-8796-6232