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High Tourniquet Failure Rates Among Non-Medical Personnel Do Not Improve with Tourniquet Training, Including Combat Stress Inoculation: A Randomized Controlled Trial

Published online by Cambridge University Press:  02 May 2019

Avishai Michael Tsur Open the ORCID record for Avishai Michael Tsur [Opens in a new window] ,
Yaara Binyamin ,
Lena Koren ,
Sharon Ohayon ,
Patrick Thompson  and
Elon Glassberg
Avishai Michael Tsur*
Affiliation:
The Israel Defence Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
Yaara Binyamin
Affiliation:
The Israel Defence Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
Lena Koren
Affiliation:
The Israel Defence Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
Sharon Ohayon
Affiliation:
The Israel Defence Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
Patrick Thompson
Affiliation:
The Israel Defence Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
Elon Glassberg
Affiliation:
The Israel Defence Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
*
Correspondence: Avishai Michael Tsur, MD Uri Ben Baruch 14, Ashdod, Israel E-mail: AvishaiTsur@gmail.com
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Abstract

Background:

The rate of failing to apply a tourniquet remains high.

Hypothesis:

The study objective was to examine whether early advanced training under conditions that approximate combat conditions and provide stress inoculation improve competency, compared to the current educational program of non-medical personnel.

Methods:

This was a randomized controlled trial. Male recruits of the armored corps were included in the study. During Combat Lifesaver training, recruits apply The Tourniquet 12 times. This educational program was used as the control group. The combat stress inoculation (CSI) group also included 12 tourniquet applications, albeit some of them in combat conditions such as low light and physical exertion. Three parameters defined success, and these parameters were measured by The Simulator: (1) applied pressure ≥ 200mmHg; (2) time to stop bleeding ≤ 60 seconds; and (3) placement up to 7.5cm above the amputation.

Results:

Out of the participants, 138 were assigned to the control group and 167 were assigned to the CSI group. The overall failure rate was 80.33% (81.90% in the control group versus 79.00% in the CSI group; P value = .565; 95% confidence interval, 0.677 to 2.122). Differences in pressure, time to stop bleeding, or placement were not significant (95% confidence intervals, −17.283 to 23.404, −1.792 to 6.105, and 0.932 to 2.387, respectively). Tourniquet placement was incorrect in most of the applications (62.30%).

Conclusions:

This study found high rates of failure in tourniquet application immediately after successful completion of tourniquet training. These rates did not improve with tourniquet training, including CSI. The results may indicate that better tourniquet training methods should be pursued.

Tsur, AM, Binyamin, Y, Koren, L, Ohayon, S, Thompson; P, Glassberg, E. High tourniquet failure rates among non-medical personnel do not improve with tourniquet training, including combat stress inoculation: a randomized controlled trial. Prehosp Disaster Med. 2019;34(3):282–287.

Keywords

extremitieshemorrhageshockhemorrhagictourniquetswoundsinjuries
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 3 , June 2019 , pp. 282 - 287
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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References

Heron, M. Deaths: leading causes for 2015. Natl Vital Stat Rep. 2017;66(5):1–76.Google ScholarPubMed
Bellamy, RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149(2):55–62.CrossRefGoogle ScholarPubMed
Mabry, RL, Holcomb, JB, Baker, AM, et al. United States army rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma. 2000;49(3):529.CrossRefGoogle ScholarPubMed
Kragh, JF, Walters, TJ, Baer, DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249(1):1–7.CrossRefGoogle ScholarPubMed
Kragh, JF, O’Neill, ML, Walters, TJ, et al. The military emergency tourniquet program’s lessons learned with devices and designs. Mil Med. 2011;176(10):1144–1152.CrossRefGoogle ScholarPubMed
Kragh, JF, Littrel, ML, Jones, JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–597.CrossRefGoogle ScholarPubMed
Jacobs, LM, Sinclair, J, Rotondo, M, et al. Active shooter and international mass-casualty events: The Hartford Consensus II. Bull Am Coll Surg. 2015;100(1 Suppl):35–39.Google ScholarPubMed
Taylor, DM, Vater, GM, Parker, PJ. An evaluation of two tourniquet systems for the control of prehospital lower limb hemorrhage. J Trauma. 2011;71(3):591–595.CrossRefGoogle ScholarPubMed
Sanak, T, Brzozowski, R, Dabrowski, M, et al. Evaluation of tourniquet application in a simulated tactical environment. Ulus Travma Acil Cerrahi Derg. 2018;24(1):9–15.Google Scholar
King, DR, van der Wilden, G, Kragh, JF, Blackbourne, LH. Forward assessment of 79 prehospital battlefield tourniquets used in the current war. J Spec Oper Med. 2012;12(4):33–38.Google ScholarPubMed
Goolsby, C, Branting, A, Chen, E, Mack, E, Olsen, C. Just-in-time to save lives: a pilot study of layperson tourniquet application. Acad Emerg Med. 2015;22(9):1113–1117.CrossRefGoogle ScholarPubMed
Wall, PL, Welander, JD, Singh, A, Sidwell, RA, Buising, CM. Stretch and wrap style tourniquet effectiveness with minimal training. Mil Med. 2012;177(11):1366–1373.CrossRefGoogle ScholarPubMed
Jacobs, LM, Burns, KJ. Tourniquet application training for individuals with and without a medical background in a hospital setting. J Trauma Acute Care Surg. 2015;78(2):442–445.CrossRefGoogle Scholar
Unlu, A, Kaya, E, Guvenc, I, et al. An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases. J R Army Med Corps. 2015;161(4):332–335.CrossRefGoogle ScholarPubMed
Baruch, EN, Benov, A, Shina, A, et al. Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use performance. Am J Emerg Med. 2016;34(12):2356–2361.CrossRefGoogle ScholarPubMed
Schulz, KF, Altman, DG, Moher, D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Trials. 2010;11:32.CrossRefGoogle Scholar
Sullivan, KM, Dean, A, Soe, MM. On academics: OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Reports. 2009;124(3):471–474.CrossRefGoogle Scholar
Twig, G, Vivante, A, Bader, T, et al. Body mass index and kidney disease-related mortality in midlife: a nationwide cohort of 2.3 million adolescents. Obesity. 2018;26(4):776–781.CrossRefGoogle ScholarPubMed
Gates, B. Bill Gates: my plan to fix the world’s biggest problems. The Wall Street Journal. 2013.Google Scholar
Jacobs, LM. The Hartford Consensus III: implementation of bleeding control: if you see something do something. Bull Am Coll Surg. 2015;100(1 Suppl):40–46.Google ScholarPubMed
Jacobs, LM. The Hartford Consensus IV: a call for increased national resilience. Bull Am Coll Surg. 2016;101(3):17–24.Google Scholar
Schreckengaust, R, Littlejohn, L, Zarow, GJ. Effects of training and simulated combat stress on leg tourniquet application accuracy, time, and effectiveness. Mil Med. 2014;179(2):114–120.CrossRefGoogle ScholarPubMed
Rometti, MRP, Wall, PL, Buising, CM, Gildemaster, Y, Hopkins, JW, Sahr, SM. Significant pressure loss occurs under tourniquets within minutes of application. J Spec Oper Med. 2016;16(4):15–26.Google Scholar
Clumpner, BR, Polston, RW, Kragh, JF, et al. Single versus double routing of the band in the combat application tourniquet. J Spec Oper Med. 2013;13(1):34–41.Google ScholarPubMed
Goolsby, C, Chen, E, Branting, A, et al. Analysis of layperson tourniquet application using a novel color-coded device. Disaster Med Public Health Prep. 2016;10(2):274–280.CrossRefGoogle ScholarPubMed
Nachman, D, Benov, A, Shovali, A, et al. Slack reducing band improves combat application tourniquet pressure profile and hemorrhage control rate. Mil Med. 2017;182(S1):53–58.CrossRefGoogle ScholarPubMed
Kragh, JF Jr, Moore, VK 3rd, Aden, JK 3rd, Parsons, DL, Dubick, MA. Short report comparing generation 6 versus prototype generation 7 Combat Application Tourniquet(R) in a manikin hemorrhage model. J Spec Oper Med. 2016;16(1):14–17.Google Scholar
Kragh, JF, Burrows, S, Wasner, C, et al. Analysis of recovered tourniquets from casualties of operation enduring freedom and operation new dawn. Mil Med. 2013;178(7):806–810.CrossRefGoogle ScholarPubMed
Shlaifer, A, Yitzhak, A, Baruch, EN, et al. Point of injury tourniquet application during operation protective edge-what do we learn? J Trauma Acute Care Surg. 2017;83(2):278–283.CrossRefGoogle ScholarPubMed
Savage, E, Pannell, D, Payne, E, O’Leary, T, Tien, H. Re-evaluating the field tourniquet for the Canadian forces. Mil Med. 2013;178(6):669–675.CrossRefGoogle ScholarPubMed
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