Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T20:06:32.584Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of Layperson Tourniquet Application Using a Novel Color-Coded Device

Published online by Cambridge University Press:  01 February 2016

Craig Goolsby ,
Elizabeth Chen ,
Andrew Branting ,
Elizabeth Weissbrod ,
Jason David ,
Krista Moore  and
Cara Olsen
Craig Goolsby*
Affiliation:
Uniformed Services University of the Health Sciences, Military & Emergency Medicine, Bethesda, Maryland National Center for Disaster Medicine and Public Health, Rockville, Maryland Val G. Hemming Simulation Center, Silver Spring, Maryland
Elizabeth Chen
Affiliation:
Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland
Andrew Branting
Affiliation:
Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland
Elizabeth Weissbrod
Affiliation:
Val G. Hemming Simulation Center, Silver Spring, Maryland Henry M. Jackson Foundation, Bethesda, Maryland
Jason David
Affiliation:
Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland
Krista Moore
Affiliation:
Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Maryland
Cara Olsen
Affiliation:
Uniformed Services University of the Health Sciences, Department of Preventive Medicine and Biometrics, Bethesda, Maryland.
*
Correspondence and reprint requests to Craig Goolsby, Uniformed Services University of the Health Sciences, Department of Military & Emergency Medicine, 4301 Jones Bridge Road, Bethesda, Maryland 20814 (e-mail: [email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To determine whether a color-coded tourniquet designed for public use increases successful tourniquet application by laypeople.

Methods

This was a randomized study conducted on April 25, 2015. The study occurred during the Maryland Day activity at the University of Maryland in College Park, Maryland. Investigators recruited participants with posters displayed at major crosswalks around a central testing area. A total of 157 volunteers aged 18 years or older and without prior military service or medical training were enrolled. A participant stood in front of a waist-down mannequin with an isolated leg injury while an investigator read aloud a mass causality scenario. The investigator then asked the participant to apply a tourniquet to the mannequin’s leg. All participants received a 4-step illustrated just-in-time (JiT) instruction card designed to facilitate layperson tourniquet application. Test participants received a color-coded tourniquet designed for layperson use with instructions printed on the device. Control participants received a black Combat Application Tourniquet (C-A-T; Composite Resources, Rock Hill, SC). Participants were randomized in a 1:1 ratio in blocks of 50. The primary outcome was the proportion of successful tourniquet applications by those who received color-coded tourniquets compared to those who received black tourniquets. Secondary outcomes included validation of previous data analyzing layperson success with tourniquet application, time for successful placement, reasons for failed applications, and participant self-willingness and comfort using tourniquets. We also analyzed demographic data on the study population and inter-rater reliability regarding the assessment of successful tourniquet application.

Results

Participants supplied with color-coded tourniquets successfully placed the device 51.38% of the time, compared to 44.71% of the time for controls using a black tourniquet (risk ratio: 1.15; 95% confidence interval: 0.83-1.59; P=0.404). Participants’ self-reported willingness to use a tourniquet rose from 40.8% before the study to 80.3% after the study (P<0.05).

Conclusions

The color-coded device did not significantly increase laypeople’s proportion of successful tourniquet applications when compared with a standard black device. However, this study reproduced pilot study data showing that laypeople can successfully apply tourniquets about half the time if provided JiT instructions. Age, sex, race, income, and highest level of education were not found to impact one’s ability to properly apply a tourniquet. Laypeople’s willingness to apply tourniquets doubled to 80% after brief exposure to the device. These results affirm the feasibility of engaging laypeople as immediate lifesavers of trauma victims and justify further efforts to boost rates of proper application. (Disaster Med Public Health Preparedness. 2016;10:274–280)

Keywords

disaster medicineemergency medicineeducationpublic health professionalmass casualty incidentsmilitary medicine
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 10 , Issue 2 , April 2016 , pp. 274 - 280
Copyright
Copyright © Society for Disaster Medicine and Public Health, Inc. 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Stop the Bleed. Department of Homeland Security website. http://www.dhs.gov/stopthebleed. Last published November 20, 2015. Accessed October 6, 2015.Google Scholar
2. Jackson, D. Obama team promotes emergency lessons for bystanders. USA Today. http://www.usatoday.com/story/theoval/2015/10/06/obama-stop-the-bleed-program-first-responders/73442708. Published October 6, 2015. Accessed October 6, 2015.Google Scholar
3. Kotwal, RS, Montgomery, HR, Kotwal, BM, et al. Eliminating preventable death on the battlefield. Arch Surg. 2011;146(12):1350-1358. http://dx.doi.org/10.1001/archsurg.2011.213.Google Scholar
4. Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73:S431-S437. http://dx.doi.org/10.1097/TA.0b013e3182755dcc.Google Scholar
5. Jacobs, LM Jr; Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events. Hartford Consensus III: implementation of bleeding control—If you see something do something. Bull Am Coll Surg. 2015;100(7):20-26.Google Scholar
6. Jacobs, LM, Wade, D, McSwain, NE, et al. Hartford Consensus: a call to action for THREAT, a medical disaster preparedness concept. J Am Coll Surg. 2014;218(3):467-475. http://dx.doi.org/10.1016/j.jamcollsurg.2013.12.009.Google Scholar
7. Schroll, R, Smith, A, McSwain, NE Jr, et al. A multi-institutional analysis of prehospital tourniquet use. J Trauma Acute Care Surg. 2015;79(1):10-14. http://dx.doi.org/10.1097/TA.0000000000000689.CrossRefGoogle ScholarPubMed
8. Goolsby, C, Branting, A, Chen, E, et al. Just-in-time to save lives: a pilot study of layperson tourniquet application. Acad Emerg Med . 2015;22(9):1113-1117. (Epub August 20, 2015) 10.1111/acem.12742.CrossRefGoogle ScholarPubMed
9. National Center for Injury Prevention and Control. 10 Leading Causes of Death by Age Group, United States – 2013. http://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2013-a.pdf. Accessed January 15, 2016.Google Scholar
10. Kellermann, A, Mabry, R. Bringing a battlefield lesson home. Acad Emerg Med. 2015;22(9):1093-1095.Google Scholar
11. Kragh, JF Jr, O’Neill, ML, Walters, TJ, et al. Minor morbidity with emergency tourniquet use to stop bleeding in severe limb trauma: research, history, and reconciling advocates and abolitionists. Mil Med. 2011;176(7):817-823. http://dx.doi.org/10.7205/MILMED-D-10-00417.CrossRefGoogle ScholarPubMed
12. Mabry, RL. Tourniquet use on the battlefield. Mil Med. 2006;171(5):352-356. http://dx.doi.org/10.7205/MILMED.171.5.352.CrossRefGoogle ScholarPubMed
13. Einspruch, EL, Lynch, B, Aufderheide, TP, et al.. Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study. Resuscitation. 2007;74(3):476-486. http://dx.doi.org/10.1016/j.resuscitation.2007.01.030.CrossRefGoogle Scholar
14. Kragh, JF Jr, Walters, TJ, Baer, DG, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(suppl):S38-S50. http://dx.doi.org/10.1097/TA.0b013e31816086b1.Google Scholar
15. Urban, J, Thode, H, Stapleton, E, et al. Current knowledge of and willingness to perform Hands-Only CPR in laypersons. Resuscitation. 2013;84(11):1574-1578. http://dx.doi.org/10.1016/j.resuscitation.2013.04.014.CrossRefGoogle ScholarPubMed