Developing “Herd Immunity” in a Civilian Community Through Incorporation of “Just-In-Time” Tourniquet Application Training

Abstract

Introduction:Herd immunity, a concept normally applied in vaccinated populations, is a preventative measure to determine if a significant portion of a population can protect vulnerable individuals against a certain disease. Like vaccines, tourniquet education can be a form of herd immunity to protect vulnerable individuals in a population and prevent the loss of life from a peripheral hemorrhage. The authors have identified a deficiency in simple, quick, and effective hemorrhage control education. Therefore, to maximize herd immunity, the novel educational platform evaluates the efficacy of “Just-in-Time” (JiT) tourniquet application training.Hypothesis/Problem:The authors hypothesize that the utilization of JiT training will be effective in promoting both competence and confidence for individuals to utilize tourniquets in response to a disaster environment.Methods:This Institutional Review Board-approved study recruited medical students who were trained in hemorrhage control measures at a Level 1 Trauma Center. Tourniquet training sessions were held, and naïve civilians received tourniquet education. The subjects received a five- to ten-minute lesson on indications, contraindications, and application techniques of commercial and improvisational tourniquets. Participants subsequently applied a tourniquet to an instructor’s arm to demonstrate proper tourniquet application for a brachial artery hemorrhage. Pre- and post-educational surveys were completed to test participant competency and confidence.Results:Of the 104 subjects who completed the course, 97 had no prior training in hemorrhage control techniques, including commercial and improvisational tourniquet application. The mean pre-test score was 2.27/5.00 and the mean post-test score was 4.38/5.00, P <.001 (n = 97). When queried “How competent would you feel applying a tourniquet (commercial or improvisational) on an individual with a bleeding wound?” 92/97 felt confident (95%), one felt less confident, and four felt no difference in confidence levels (P <.001).Conclusion:Just-in-Time training is an effective method in teaching naïve civilians proper tourniquet application. This platform could serve as an alternative to more extensive training programs and requires less time, costs, and resources. If a significant number of individuals in a local community can effectively apply a tourniquet in a disaster scenario, a “herd immunity” effect could be achieved to control peripheral hemorrhages.

The Effectiveness of a Serious Game Versus Online Lectures for Improving Medical Students' Coronavirus Disease 2019 Knowledge

“…Our study suggests that a game-based computer application based on curricular objectives of COVID-19 instruction is an effective learning methodology. Other studies of games used to teach medical students have shown that serious games are comparable to lectures in terms of knowledge gains when measured immediately after learning method application, [16][17][18][19][20][21] a result which our study replicates. The advantage of gamebased learning strategies is the active participation and interaction at the center of the learning experience; lectures do not sufficiently engage the medical students.…”

Evaluating the Effectiveness of the Chemical-Mass Casualty Incident Response Education Module (C-MCIREM): A Pilot Simulation Study With a Before and After Design

“…With the occurrence of a number of major disasters around the world over the past 40 years, including the COVID-19 pandemic, there is a growing need for disaster training [1][2][3][4][5][6][7][8][9][10][11][12]. Accordingly, various disaster medicine educational programs have been developed and their effectiveness has been tested [1][2][3][4][5][6][7][8][9][10][11][12].…”

“…With the occurrence of a number of major disasters around the world over the past 40 years, including the COVID-19 pandemic, there is a growing need for disaster training [1][2][3][4][5][6][7][8][9][10][11][12]. Accordingly, various disaster medicine educational programs have been developed and their effectiveness has been tested [1][2][3][4][5][6][7][8][9][10][11][12]. In particular, chemical disasters, such as the Seveso dioxin leakage disaster in Italy, the methyl isocyanate leakage disaster in Bhopal, India, and the Gumi fluoric acid gas leakage disaster in Korea in 2012, have attracted a great deal of attention worldwide [13][14][15][16].…”

“…which the "proposed chemical mass casualty triage system" proposed by Cone et al and the concept of "validating signs and symptoms of irritant gas syndrome agent (IGSA) exposure" proposed by Culley et al were merged and applied to overcome the shortcomings of the START triage, which is the existing traumabased disaster classification at the prehospital or hospital stage, and to determine the appropriate treatment for severe patients and the priority of antidote provision (Appendices/Tables 4, 5 and Appendices/Figure 4) [21,23]. Finally, to evaluate the effectiveness of C-MCIREM and contribute to the improvement of education quality through future updates, we developed a survey for assessment of overall educational satisfaction.…”

Tourniquet application by schoolchildren—a randomized crossover study of three commercially available models

“…27 One notable training approach is the Just in Time method, wherein laypersons are taught tourniquet application onsite during a mass-casualty event; these courses have proven effective at increasing success rates in laypersons. 28,29 Pediatric populations remain poorly examined, however, despite injury being the most common cause of morbidity and mortality in children and adolescents world-wide. [30][31][32][33] Some studies have demonstrated the effectiveness of commercially available tourniquets when applied on children as young as 2 years old, both in military and civilian settings.…”