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

Purpose: 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; 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.