Stretch and Wrap Style Tourniquet Effectiveness With Minimal Training

Wall, Piper; Welander, John D.; Singh, Amarpreet; Sidwell, Richard A.; Buising, Charisse

doi:10.7205/milmed-d-12-00150

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…Retraining instructors on how to teach certain elements of first aid is expensive, but the benefits of someone learning how to use a tourniquet are potentially lifesaving [ 27 – 29 ]. Furthermore, tourniquets can be used by laypersons [ 30 – 32 ]. Therefore, we believe that tourniquet use should be added to the current Danish books and courses.…”

Section: Discussionmentioning

confidence: 99%

Danish first aid books compliance with the new evidence-based non-resuscitative first aid guidelines

Jensen

Møller

Viereck

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundThe European Resuscitation Council (ERC) released new guidelines on resuscitation in 2015. For the first time, the guidelines included a separate chapter on first aid for laypersons. We analysed the current major Danish national first aid books to identify potential inconsistencies between the current books and the new evidence-based first aid guidelines.MethodsWe identified first aid books from all the first aid courses offered by major Danish suppliers. Based on the new ERC first aid guidelines, we developed a checklist of 26 items within 16 different categories to assess the content; this checklist was adapted following the principle of mutually exclusive and collectively exhaustive questioning. To assess the agreement between four raters, Fleiss’ kappa test was used. Items that did not reach an acceptable kappa score were excluded.ResultsWe evaluated 10 first aid books used for first aid courses and published between 2009 and 2015. The content of the books complied with the new in 38% of the answers.In 12 of the 26 items, there was less than 50% consistency. These items include proximal pressure points and elevation of extremities for the control of bleeding, use of cervical collars, treatment for an open chest wound, burn dressing, dental avulsion, passive leg raising, administration of bronchodilators, adrenaline, and aspirin.ConclusionsDanish course material showed significant inconsistencies with the new evidence-based first aid guidelines. The new knowledge from the evidence-based guidelines should be incorporated into revised and updated first aid course material.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0472-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Danish first aid books compliance with the new evidence-based non-resuscitative first aid guidelines

Jensen

Møller

Viereck

et al. 2018

Scand J Trauma Resusc Emerg Med

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“…10 A variety of training programs exist. [11][12][13][14] There are few direct comparisons of the various programs, 15 and current knowledge is insufficient to propose a specific regimen. Furthermore, these programs are costly and lengthy, obligating a clear demonstration of effectiveness.…”

Section: Introductionmentioning

confidence: 99%

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

Tsur

Binyamin

Koren

et al. 2019

Prehosp. Disaster med.

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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.

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“…Pressure loss under applied tourniquets due to air leaks or muscle relaxation and the importance of rechecking 14 11. Summary points that tourniquets need to stop arterial flow, 15 that tourniquets are most lifesaving applied before shock, 1,19 that effective wider tourniquets allow arterial occlusion at lower pressures, 13,14 that forearm and lower leg are acceptable tourniquet locations, 16,17 and that it is important to recheck tourniquets frequently to ensure that arterial occlusion pressures are maintained. 14 The tourniquets available for the attendees to handle were Combat Application Tourniquets (CAT, Composite Resources, Rock Hill, SC), Stretch Wrap And Tuck-Tourniquets (SWAT-T, TEMS Solutions, Abingdon, VA), Ratcheting Medical Tourniquets (RMT, m2 Inc., Winooski, VT), and a Mechanical Advantage Tourniquet (MAT, Pyng Medical Corp., Richmond, Canada).…”

mentioning

confidence: 99%

“…The three important tourniquet concepts asked about were (1) the relationship between tourniquet width and pressure for arterial occlusion (an open-ended question regarding the understanding that wider tourniquets require less pressure for arterial occlusion 13,14 ), (2) the importance of achieving arterial occlusion (a multiple-choice question regarding the understanding that venous occlusion without arterial occlusion is harmful 15 ), and (3) appropriate extremity locations for tourniquets (on the most distal limb segment proximal to the injury 16,17 Va multiple-choice hand question and a multiple-choice foot question were asked to address this concept). Each of the concept questions, including the open-ended question, specifically had ''don't know'' as an available answer choice.…”

mentioning

confidence: 99%

What do the people who transport trauma patients know about tourniquets?

Wall

Welander

Smith

et al. 2014

Journal of Trauma and Acute Care Surgery

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Civilian prehospital providers encounter situations for tourniquet use, but many do not know information important for optimal tourniquet use. Therefore, if surgeons want civilian prehospital care to include the use of effective, arterial flow occluding tourniquets at appropriate limb locations, they need to communicate with their emergency medical service providers concerning tourniquet knowledge, training, protocols, and appropriate equipment.

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Stretch and Wrap Style Tourniquet Effectiveness With Minimal Training

Abstract: Proper application of the SWAT-T is easy and can stop extremity arterial flow but requires some training for many appliers.

Cited by 18 publications

References 14 publications

Danish first aid books compliance with the new evidence-based non-resuscitative first aid guidelines

Danish first aid books compliance with the new evidence-based non-resuscitative first aid guidelines

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

What do the people who transport trauma patients know about tourniquets?

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