Can they stop the bleed? Evaluation of tourniquet application by individuals with varying levels of prior self-reported training

Authors

Justin C. McCarty, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Edward J. Caterson, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Muhammed A. Chaudhary, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Juan P. Herrera-Escobar, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Zain G. Hashmi, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Scott A. Goldberg, Harvard Medical School, Boston, MA, USA
Craig Goolsby, University of the Health Sciences, Bethesda, MD, USA
Stuart Lipsitz, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
Adil H. Haider, righam and Women's Hospital, Harvard Medical School, Boston, MA, USAFollow
Eric Goralnick, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Document Type

Article

Department

General Surgery

Abstract

Background: Application of extremity tourniquets is a central tenet of multiple national initiatives to empower laypersons to provide hemorrhage control (HC). However, the efficacy of the general population who self-report prior first-aid (FA) or HC training on individual's ability to control bleeding with a tourniquet remains unknown. Therefore, the objective of this study was to assess the effectiveness of laypeople with self-reported prior FA or HC training to control bleeding with a tourniquet.
Study design: Employees of a stadium were assessed via simulation in their ability to apply a Combat Application Tourniquet. As a subgroup analysis of a larger study, participants who self-reported: 1) No prior training, 2) FA training only or 2) FA + HC training were compared. Logistic regression adjusting for age, gender, education, willingness-to-assist, and comfort level in HC was performed.
Results: 317 participants were included. Compared to participants with no prior training (14.4%,n = 16/111), those with FA training only (25.2%,n = 35/139) had a 2.12-higher odds (95%CI:1.07-4.18) of correct tourniquet application while those with FA + HC (35.8%,n = 24/67) had a 3.50-higher odds (95%CI:1.59-7.72) of correct application. Participants with prior FA + HC were more willing-to-assist and comfortable performing HC than those without prior training (p < 0.05). However, reporting being very willing-to-assist [OR0.83,95%CI:0.43-1.60] or very comfortable [OR1.11,95%CI:0.55-2.25] was not associated with correct tourniquet application.
Conclusion: Self-reported prior FA + HC training, while associated with increased likelihood to correctly apply a tourniquet, results in only 1/3 of individuals correctly performing the skill. As work continues in empowering and training laypeople to act as immediate responders, these findings highlight the importance of effective layperson education techniques

Publication (Name of Journal)

Injury

Recommended Citation

McCarty, J. C., Caterson, E. J., Chaudhary, M. A., Herrera-Escobar, J. P., Hashmi, Z. G., Goldberg, S. A., Goolsby, C., Lipsitz, S., Haider, A. H., Goralnick, E. (2019). Can they stop the bleed? Evaluation of tourniquet application by individuals with varying levels of prior self-reported training. Injury, 50(1), 10-15.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/266