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Injury. 2019 Jan;50(1):10-15. doi: 10.1016/j.injury.2018.09.041. Epub 2018 Sep 24.

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

Author information

1
Center for Surgery and Public Health (CSPH), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2
Center for Surgery and Public Health (CSPH), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
3
Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4
Department of Military & Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
5
Center for Surgery and Public Health (CSPH), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: egoralnick@bwh.harvard.edu.

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.

KEYWORDS:

Bystanders; Hemorrhage; Layperson; Preventable death; Tourniquet; Trauma

PMID:
30274758
DOI:
10.1016/j.injury.2018.09.041
[Indexed for MEDLINE]

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