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Developing “Herd Immunity” in a Civilian Community Through Incorporation of “Just-In-Time” Tourniquet Application Training

Published online by Cambridge University Press:  28 August 2019

Cameron Marcus ,
Josef Pontasch ,
Joseph Duff ,
Trisha Khambadkone ,
Brian Fink ,
Corion Jones ,
Kristopher Brickman  and
Paul Rega
Cameron Marcus*
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Josef Pontasch
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Joseph Duff
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Trisha Khambadkone
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Brian Fink
Affiliation:
Professor, School of Population Health, University of Toledo, Toledo, OhioUSA
Corion Jones
Affiliation:
Research Coordinator, University of Toledo, Toledo, OhioUSA
Kristopher Brickman
Affiliation:
Associate Dean of Innovation, University of Toledo, Toledo, OhioUSA
Paul Rega
Affiliation:
Assistant Professor, Director of EM Simulation Education & UTMC Medical Advisor for Disaster Preparedness, University of Toledo, Toledo, OhioUSA
*
Correspondence: Cameron Marcus, BS University of Toledo, Emergency Medicine 3000 Arlington Ave MS#1088 Toledo, Ohio USA 43614 E-mail: Cameron.marcus@rockets.utoledo.edu
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Abstract

Introduction:

Herd immunity, a concept normally applied in vaccinated populations, is a preventative measure to determine if a significant portion of a population can protect vulnerable individuals against a certain disease. Like vaccines, tourniquet education can be a form of herd immunity to protect vulnerable individuals in a population and prevent the loss of life from a peripheral hemorrhage. The authors have identified a deficiency in simple, quick, and effective hemorrhage control education. Therefore, to maximize herd immunity, the novel educational platform evaluates the efficacy of “Just-in-Time” (JiT) tourniquet application training.

Hypothesis/Problem:

The authors hypothesize that the utilization of JiT training will be effective in promoting both competence and confidence for individuals to utilize tourniquets in response to a disaster environment.

Methods:

This Institutional Review Board-approved study recruited medical students who were trained in hemorrhage control measures at a Level 1 Trauma Center. Tourniquet training sessions were held, and naïve civilians received tourniquet education. The subjects received a five- to ten-minute lesson on indications, contraindications, and application techniques of commercial and improvisational tourniquets. Participants subsequently applied a tourniquet to an instructor’s arm to demonstrate proper tourniquet application for a brachial artery hemorrhage. Pre- and post-educational surveys were completed to test participant competency and confidence.

Results:

Of the 104 subjects who completed the course, 97 had no prior training in hemorrhage control techniques, including commercial and improvisational tourniquet application. The mean pre-test score was 2.27/5.00 and the mean post-test score was 4.38/5.00, P <.001 (n = 97). When queried “How competent would you feel applying a tourniquet (commercial or improvisational) on an individual with a bleeding wound?” 92/97 felt confident (95%), one felt less confident, and four felt no difference in confidence levels (P <.001).

Conclusion:

Just-in-Time training is an effective method in teaching naïve civilians proper tourniquet application. This platform could serve as an alternative to more extensive training programs and requires less time, costs, and resources. If a significant number of individuals in a local community can effectively apply a tourniquet in a disaster scenario, a “herd immunity” effect could be achieved to control peripheral hemorrhages.

Keywords

disasterseducationherd immunitytourniquets
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 5 , October 2019 , pp. 481 - 485
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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