A Preliminary Comparison of Three Tourniquet Instructions for Just-in-Time Guidance of a Simulated Tourniquet Application

Abstract

The American College of Surgeons (ACS) and the Department of Homeland Security (DHS) encourage the use of tourniquets as part of the “Stop the Bleed” campaign. Both have provided instructions for layperson tourniquet application in order to save the life of a hemorrhaging trauma victim. This study sought to compare the impact of using ACS and DHS instructions with manufacturer-provided instructions for the completion of simulated tourniquet application steps. Thirty surgical trainees completed a simulated tourniquet application with one of the three instruction sets. Their completion time and success for each step were measured. Participants that received ACS instructions failed the fewest number of steps (p < 0.01) and completed the task faster (Mean (SD) = 70 (33) seconds) compared to those with the manufacturer-provided instructions (p < 0.01). Tourniquet instruction sets need to be refined in order to optimize the success rate of just-in-time guidance for tourniquet application.

References

American College of Surgeons. (2016). Did You Know? Stop the Bleed and BleedingControl.org. The Cutting Edge: Post-Clinical Congress 2016 Edition, from https://www.facs.org/publications/newsletters/the-cutting-edge/postcc2016/dyk-stop-the-bleed

Beekley

A. C.

Sebesta

J. A.

Blackbourne

L. H.

Herbert

G. S.

Kauvar

D. S.

Baer

D. G.

. . .Group

s. C. S.H. R

. (2008). Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. Journal of Trauma and Acute Care Surgery, 64(2), S28-S37.

Combat Medic Advanced Skills Training (CMAST): Student Reference. (2005) (Phase 2 ed.).

Farley

Greenlee

Haigh

Cook

Enger

(2009). Deliberate practice and feedback: the benefit of a Surgical Olympics. Journal of surgical education, 66(2), 63.

Frangou

(2016). ‘Stop the Bleed’ Campaign Focuses on Saving Lives With Simple Techniques New Course to Train Civilians as Immediate Responders During Mass Casualty Events; Surgeons Urged to Take Lead. General Surgery News.

Jacobs

L. M.

Burns

K. J.

Langer

Kiewiet

Jonge

(2016). The Hartford Consensus: A National Survey of the Public Regarding Bleeding Control. Journal of the American College of Surgeons, 222(5), 948-955. doi: http://dx.doi.org/10.1016/j.jamcollsurg.2016.02.013

Kragh

J. F.

Jr Baer

D. G.

Walters

T. J.

(2007). Extended (16-hour) tourniquet application after combat wounds: a case report and review of the current literature. Journal of orthopaedic trauma, 21(4), 274-278.

Kragh

J. F.

Jr Walters

T. J.

Baer

D. G.

Fox

C. J.

Wade

C. E.

Salinas

Holcomb

J. B.

(2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery, 249(1), 1-7.

Lakstein

Blumenfeld

Sokolov

Lin

Bssorai

Lynn

Ben-Abraham

(2003). Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. Journal of Trauma and Acute Care Surgery, 54(5), S221-S225.

10.

Lee

Porter

K. M.

Hodgetts

T. J.

(2007). Tourniquet use in the civilian prehospital setting. Emergency Medicine Journal, 24, 584-587. doi: 10.1136/emj.2007.046359

11.

Mancini

M. E.

Cazzell

Kardong-Edgren

Cason

C. L.

Berryman

Lukes

(2009). Improving workplace safety training using a self-directed CPR-AED learning program. Aaohn Journal, 57(4), 159-169.

12.

Scerbo

M. H.

Mumm

J. P.

Gates

Love

J. D.

Wade

C. E.

Holcomb

J. B.

Cotton

B. A.

(2016). Safety and appropriateness of tourniquets in 105 civilians. Prehospital emergency care, 20(6), 712-722.

13.

Stiles

C. M.

Cook

Sztajnkrycer

M. D.

(2017). A descriptive analysis of tactical casualty care interventions performed by law enforcement personnel in the state of Wisconsin, 2010-2015. Prehospital and disaster medicine, 1-5.

14.

U.S. Department of Homeland Security. (2015). Presidential Policy Directive / PPD-8: National Preparedness Retrieved 02/09/2017, 2017, from https://www.dhs.gov/presidential-policy-directive-8-national-preparedness

15.

Wogalter

M. S.

Conzola

V. C.

Smith-Jackson

T. L.

(2002). Research- based guidelines for warning design and evaluation. Applied ergonomics, 33(3), 219-230.

16.

Yeung

Okamoto

Soar

Perkins

G. D.

(2011). AED training and its impact on skill acquisition, retention and performance–a systematic review of alternative training methods. Resuscitation, 82(6), 657-664.