Application of Different Commercial Tourniquets by Laypersons: Would Public‐access Tourniquets Work Without Training?

Abstract

Background: The White House "Stop the Bleed" campaign has renewed interest in public-access bleeding kits and the use of tourniquets by the lay public. The objective of this study was to determine which type of tourniquet could be applied most effectively by the lay public using only manufacturer instructions included with each tourniquet.Methods: This prospective study randomized participants to one of four different tourniquets (SOFTT-W, CAT, RMT, SWAT-T). Participants were all over 18 years of age. Individuals with prior military, EMS, or patient-care medical experience were excluded. Using only the manufacturer's packaging instructions, participants were asked to apply a tourniquet on a simulated bleeding arm. A trained observer noted if tourniquet application by the participant was effective, partially effective, or ineffective based on reduction or cessation of simulated blood flow. Participant's application of the tourniquet was also timed (in seconds) by the observer. The primary outcome of our study was the effectiveness of application for each of the four tourniquets. Secondary outcome was time to effective application.Results: A total of 176 participants were enrolled. For untrained laypersons the RMT had the highest effective application rate of 64.4% and was also the most rapidly applied at 100.9 AE 8.8 seconds (95% confidence interval [CI] = 83.1 to 118.6). The SWAT-T had the highest ineffective application rate (55.5%) than any other tourniquet type (p = 0.002). There was no effect of age or education on time to application for any tourniquet type. Effective applications were performed significantly faster than partially effective or ineffective applications (93.4 AE 5.8 [95% CI = 81.7 to 104.9] vs. 136.7 AE 8.7 [95% CI = 118.8 to 154.7] vs. 151.9 AE 8.3 [95% CI = 135.2 to 168.6]; p ≤ 0.001). There was no difference in time between partial and ineffective applications (p = 0.261). Conclusions:Our study suggests that laypersons could benefit from prior training to effectively apply tourniquets in emergency situations. Of the tourniquets studied, the RMT was the most effectively and most rapidly applied.

Arterial Occlusion Effectiveness of Space Blanket‒Improvised Tourniquets for the Remote Setting

“…Effective use of TQs as first aid needs regular training. 6,28 Table 2. Survey results regarding ease of handling and practicability (operator) and efficacy (Investigator 2) in 23 measurements when using the Combat Application Tourniquet (CAT) and in 23 measurements when using a space blanket (SB) as an improvised tourniquet…”

A framework for the design and implementation of Stop the Bleed and public access trauma equipment programs

“…Due to the variety of commercial tourniquets available, we recommend that a given community's training program include familiarization with the type of equipment contained in that community's bleeding control kits. Equipment provided and purchased should align with educational programs and vice versa 55 , 56 …”

“…Specific populations should also be targeted for bleeding control education: public safety personnel, security personnel at large event venues, industrial and construction workers, anyone taught CPR, and high school students. Due to the variety of commercial tourniquets available, we recommend that a given community's training program include familiarization with the type of equipment contained in that community's bleeding control kits. Equipment provided and purchased should align with educational programs and vice versa 55 , 56 …”

A comparison of efficacy, efficiency, and durability in novel tourniquet designs

“…Finally, the TMT is a newer tourniquet and differs from the previous two tourniquets by the addition of a dual locking mechanism if the velcro fails. While there are studies that have compared the CAT and SOFTT-W 10,11 and the CAT and TMT, 12,13 there is no study to date that directly compares the efficacy and efficiency of these three popular tourniquets. In addition, there are limited data evaluating the tourniquet durability and the ability to maintain vascular occlusion during patient movement.…”