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Aquatic Feasibility of Limbs Application of Tourniquets (AFLAT) during a Lifeguard Water Rescue: A Simulation Pilot Study

Published online by Cambridge University Press:  08 February 2024

Roberto Barcala Furelos ,
Andrew Schmidt ,
José Manteiga Urbón ,
Silvia Aranda García Open the ORCID record for Silvia Aranda García [Opens in a new window] ,
Martín Otero-Agra ,
Nicolò di Tullio ,
Joel de Oliveira ,
Santiago Martínez Isasi Open the ORCID record for Santiago Martínez Isasi [Opens in a new window]  and
Felipe Fernández-Méndez Open the ORCID record for Felipe Fernández-Méndez [Opens in a new window]
Roberto Barcala Furelos
Affiliation:
REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
Andrew Schmidt
Affiliation:
Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, Florida USA
José Manteiga Urbón
Affiliation:
REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
Silvia Aranda García
Affiliation:
GRAFAIS Research Group, Institut Nacional d’Educació Física de Catalunya (INEFC), University of Barcelona, Barcelona, Spain CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain, University of Santiago de Compostela, Santiago de Compostela, Spain
Martín Otero-Agra
Affiliation:
REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain School of Nursing, Universidade de Vigo, Pontevedra, Spain
Nicolò di Tullio
Affiliation:
Sant’Anna School of Advanced Studies, Institute of Management, Piazza Martiri della Libertà, Pisa, Italy
Joel de Oliveira
Affiliation:
REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain Surfing Medicine International, the Netherlands
Santiago Martínez Isasi*
Affiliation:
Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain, University of Santiago de Compostela, Santiago de Compostela, Spain Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
Felipe Fernández-Méndez
Affiliation:
REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain School of Nursing, Universidade de Vigo, Pontevedra, Spain
*
Correspondence: Santiago Martinez-Isasi Faculty of Nursing University of Santiago de Compostela Av. Xoán XXIII, Spain E-mail: santiago.martinez.isasi@usc.es
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Abstract

Introduction:

Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments.

Objective:

The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet.

Methodology:

A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills.

Results:

With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46).

Conclusions:

Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.

Keywords

bleedingdrowninglifeguardssimulationtourniquet
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 39 , Issue 1 , February 2024 , pp. 52 - 58
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Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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