Craig Goolsby1,2, Andrew Branting2, Elizabeth Chen2, Erin Mack2, Cara Olsen3,2. 1. Department of Military & Emergency Medicine, Bethesda, MD. 2. Uniformed Services University of the Health Sciences, Bethesda, MD. 3. Department of Preventive Medicine and Biometrics, Bethesda, MD.
Abstract
OBJECTIVES: The objective was to determine whether just-in-time (JiT) instructions increase successful tourniquet application by laypersons. METHODS: This was a randomized pilot study conducted in August 2014. The study occurred at the Uniformed Services University campus in Bethesda, Maryland. A total of 194 volunteers without prior military service or medical training completed the study. The participant stood in front of a waist-down mannequin that had an exposed leg. An observer read a scenario card aloud that described a mass casualty event. The observer then asked the participant to apply a Combat Application Tourniquet (C-A-T) to the mannequin. Test participants received a 4 × 6-inch card, with JiT instructions, in addition to their C-A-T; controls received no instructions. Participants were randomized in a 3:1 ratio of instructions to no instructions. The study's primary outcome was the proportion of successfully applied tourniquets by participants receiving JiT instructions compared to participants not receiving instructions. Secondary outcomes included the time for successful tourniquet placement, reasons for failed tourniquet application, and participants' self-reported willingness and comfort using tourniquets in real-life settings. RESULTS: Just-in-time instructions more than doubled successful tourniquet placement. Participants supplied with JiT instructions placed a tourniquet successfully 44.14% of the time, compared to 20.41% of the time for controls without instructions (risk ratio = 2.16; 95% confidence interval = 1.21 to 3.87; p = 0.003). CONCLUSIONS: Just-in-time instructions increase laypeople's successful application of C-A-T. This pilot study provides evidence that JiT instructions may assist the lay public in providing effective point-of-injury hemorrhage control. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
RCT Entities:
OBJECTIVES: The objective was to determine whether just-in-time (JiT) instructions increase successful tourniquet application by laypersons. METHODS: This was a randomized pilot study conducted in August 2014. The study occurred at the Uniformed Services University campus in Bethesda, Maryland. A total of 194 volunteers without prior military service or medical training completed the study. The participant stood in front of a waist-down mannequin that had an exposed leg. An observer read a scenario card aloud that described a mass casualty event. The observer then asked the participant to apply a Combat Application Tourniquet (C-A-T) to the mannequin. Test participants received a 4 × 6-inch card, with JiT instructions, in addition to their C-A-T; controls received no instructions. Participants were randomized in a 3:1 ratio of instructions to no instructions. The study's primary outcome was the proportion of successfully applied tourniquets by participants receiving JiT instructions compared to participants not receiving instructions. Secondary outcomes included the time for successful tourniquet placement, reasons for failed tourniquet application, and participants' self-reported willingness and comfort using tourniquets in real-life settings. RESULTS: Just-in-time instructions more than doubled successful tourniquet placement. Participants supplied with JiT instructions placed a tourniquet successfully 44.14% of the time, compared to 20.41% of the time for controls without instructions (risk ratio = 2.16; 95% confidence interval = 1.21 to 3.87; p = 0.003). CONCLUSIONS: Just-in-time instructions increase laypeople's successful application of C-A-T. This pilot study provides evidence that JiT instructions may assist the lay public in providing effective point-of-injury hemorrhage control. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
Authors: Craig Goolsby; Kandra Strauss-Riggs; Michael Rozenfeld; Nathan Charlton; Eric Goralnick; Kobi Peleg; Matthew J Levy; Tim Davis; Nicole Hurst Journal: Am J Public Health Date: 2018-12-20 Impact factor: 9.308
Authors: Kandra Strauss-Riggs; Thomas D Kirsch; Erik Prytz; Richard C Hunt; Carl-Oscar Jonson; Jon Krohmer; Ira Nemeth; Craig Goolsby Journal: AEM Educ Train Date: 2020-04-16
Authors: Eric Goralnick; Muhammad A Chaudhary; Justin C McCarty; Edward J Caterson; Scott A Goldberg; Juan P Herrera-Escobar; Meghan McDonald; Stuart Lipsitz; Adil H Haider Journal: JAMA Surg Date: 2018-09-01 Impact factor: 14.766
Authors: Craig A Goolsby; Keke Schuler; Raphaelle Rodzik; Nathan Charlton; Vidya Lala; Kevin Anderson; Jeffrey L Pellegrino Journal: West J Emerg Med Date: 2021-06-29
Authors: Craig Goolsby; Luis E Rojas; Michael Andersen; Nathan Charlton; Laura Tilley; Jason Pasley; Todd E Rasmussen; Matthew J Levy Journal: J Am Coll Emerg Physicians Open Date: 2020-08-17
Authors: Craig A Goolsby; Kandra Strauss-Riggs; Victoria Klimczak; Kelly Gulley; Luis Rojas; Cassandra Godar; Sorana Raiciulescu; Arthur L Kellermann; Thomas D Kirsch Journal: AEM Educ Train Date: 2018-03-22