Prior to using REBOA, providers should have a thorough knowledge of the device, its indications, use and potential complications. For teams who do not routinely perform REBOA in clinical practice when not deployed, an organized curriculum-based REBOA training course should be completed before deployment where REBOA could be used. Organized, curriculum-based REBOA training courses such as the American College of Surgeon’s Basic Endovascular Skills for Trauma (BEST) course or the ‘Resuscitation Adjuncts: Prehospital Transfusion & REBOA’ (RAPToR) Course are available. Training can also be requested by emailing CPGtrainingrequest@PrytimeMedical.com. Successful completion of a REBOA training, including a didactic and hands on skills component, is recommended prior utilization of the device. Skills training can be achieved through high-fidelity simulation, perfused cadaver or live tissue training. Critical skills include access to the CFA with ultrasound and cut down, sheath placement and positioning, and REBOA operation and removal. Anatomically correct models are critical for accurate training of CFA access skills, and thus perfused cadavers are recommended to meet this requirement.^61-63

Ultimately, the decision to perform REBOA on patients at high risk for hemorrhagic death will depend on the specific injury pattern, individual provider experience, team training, and local resources.