Erez N Baruch1, Avi Benov2, Avi Shina3, Amy L Berg4, Amir Shlaifer5, Elon Glassberg6, James K Aden7, Tarif Bader8, John F Kragh9, Avraham Yitzhak10. 1. Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: erez_br@yahoo.com. 2. Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Surgery "A," Meir Medical Center, Kfar Saba, Israel. Electronic address: avi.benov@gmail.com. 3. Israel Defense Forces Medical Corps, Ramat Gan, Israel; Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel. Electronic address: avishina@yahoo.com. 4. Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: amylaurenberg@hotmail.com. 5. Israel Defense Forces Medical Corps, Ramat Gan, Israel; Orthopedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. Electronic address: shlaifer.md@gmail.com. 6. Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: elon.glassberg@gmail.com. 7. Damage Control Resuscitation, US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX, 78234. Electronic address: james.k.aden2.civ@mail.mil. 8. Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel. Electronic address: drtarifb@gmail.com. 9. Damage Control Resuscitation, US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX, 78234. Electronic address: john.f.kragh.civ@mail.mil. 10. Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: ayitzhak@gmail.com.
Abstract
INTRODUCTION: Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel. METHODS: Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed. The educational intervention was to allocate the participants into a monthly tourniquet practice program: either a single-application practice (SAP) group or a triple-application practice (TAP) group. Each group practiced according to its program. After 3 months, the participants' tourniquet use performance was reassessed. Assessments were conducted using the HapMed Leg Tourniquet Trainer (CHI Systems, Fort Washington, PA), a mannequin which measures time and pressure. RESULTS: A total of 151 participants dropped out, leaving 87 in the TAP group and 69 in the SAP group. On initial assessment, the TAP group and the SAP group performed similarly. Both groups improved their performance from the initial to the final assessment. The TAP group improved more than the SAP group in mean application time (faster by 18 vs 8 seconds, respectively; P = .023) and in reducing the proportion of participants who were unable to apply any pressure to the mannequin (less by 18% vs 8%, respectively; P = .009). CONCLUSION: Three applications per monthly practice session were superior to one. This is the first prospective validation of a tourniquet practice program based on objective measurements.
RCT Entities:
INTRODUCTION: Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel. METHODS: Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed. The educational intervention was to allocate the participants into a monthly tourniquet practice program: either a single-application practice (SAP) group or a triple-application practice (TAP) group. Each group practiced according to its program. After 3 months, the participants' tourniquet use performance was reassessed. Assessments were conducted using the HapMed Leg Tourniquet Trainer (CHI Systems, Fort Washington, PA), a mannequin which measures time and pressure. RESULTS: A total of 151 participants dropped out, leaving 87 in the TAP group and 69 in the SAP group. On initial assessment, the TAP group and the SAP group performed similarly. Both groups improved their performance from the initial to the final assessment. The TAP group improved more than the SAP group in mean application time (faster by 18 vs 8 seconds, respectively; P = .023) and in reducing the proportion of participants who were unable to apply any pressure to the mannequin (less by 18% vs 8%, respectively; P = .009). CONCLUSION: Three applications per monthly practice session were superior to one. This is the first prospective validation of a tourniquet practice program based on objective measurements.
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