The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons

Ross, Elliot; Mapp, Julian G.; Redman, Theodore T.; Brown, D L; Kharod, Chetan U.; Wampler, David

doi:10.1016/j.jemermed.2017.09.011

Cited by 33 publications

(32 citation statements)

References 22 publications

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“…41 Teaching appropriate tourniquet use is paramount as there are low rates of success for untrained persons attempting to place tourniquets (10.6%-23.4%). 42 However, it is essential to emphasize that even suboptimal tourniquet application may improve outcomes, 41,43 especially when compared to no intervention. Our participants improved their perceived ability to control hemorrhage with pressure and tourniquets, as well as their knowledge as to when to apply each hemorrhage control modality immediately following the course (all P < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Empowering Bystanders to Intervene: Trauma Responders Unify to Empower (TRUE) Communities

Tatebe

Speedy

Kang

et al. 2019

Journal of Surgical Research

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Background: Timely and effective bystander first aid can improve outcomes for trauma victims. Bystanders are present at most traumas and are more likely to assist with prior training. Materials and methods: An evidence-based course was created for the general public in highrisk Chicago neighborhoods focused on basic traumatic first aid, including scene management, hemorrhage control, and mitigating the psychological impact of trauma to overcome the bystander effect. Prospectively, participants completed knowledge-based and self-efficacy assessments precourse, postcourse, and 6 mo follow-up. The change in self-efficacy and knowledge scores was analyzed. Results: Over 32 courses, 503 participants were taught; 474 and 460 participants completed precourse and postcourse surveys, respectively, whereas 60 of 327 who consented for follow-up completed the 6-mo survey. Postcourse, participants were more likely to assist trauma victims and felt more confident in the quality of care they could provide; the effect remained significant at 6 mo (all P < 0.001). All seven self-efficacy empowerment-based questions individually demonstrated improvement from precourse to postcourse (P < 0.001), with an overall mean (SD) increase of 2.8 (2.1, P < 0.001); six maintained significance at follow-up with an overall mean increase of 2.8 (1.9, P < 0.001). Knowledge scores improved from 6.2 of 10 to 7.2 postcourse and 7.7 at follow-up (P < 0.001). Most improved were the ability to render first aid and apply tourniquets. Conclusions: The TFRC increased self-efficacy, successfully teaching initial trauma care, particularly hemorrhage control and scene safety, suggesting that a grassroots approach to trauma care may improve outcomes in communities that experience high violence rates.

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Section: Discussionmentioning

confidence: 99%

Empowering Bystanders to Intervene: Trauma Responders Unify to Empower (TRUE) Communities

Tatebe

Speedy

Kang

et al. 2019

Journal of Surgical Research

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“…Correct tourniquet application is not intuitive, and skill training provided on one type of device may not translate well or at all to other types of tourniquets. 25,26 Since the STB's inception, an increased number of publicly available hemorrhage control products have not been evaluated for effectiveness. In this context, experts proposed the establishment of formal standards for tourniquet design that take into account effectiveness, ease of use, and cost.…”

Section: Theme 2: Materialsmentioning

confidence: 99%

Defining a Research Agenda for Layperson Prehospital Hemorrhage Control

Goralnick¹,

Ezeibe²,

Chaudhary³

et al. 2020

JAMA Netw Open

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IMPORTANCE Trauma is the leading cause of death for US individuals younger than 45 years, and uncontrolled hemorrhage is a major cause of trauma mortality. The US military's medical advancements in the field of prehospital hemorrhage control have reduced battlefield mortality by 44%. However, despite support from many national health care organizations, no integrated approach to research has been made regarding implementation, epidemiology, education, and logistics of prehospital hemorrhage control by layperson immediate responders in the civilian sector. OBJECTIVE To create a national research agenda to help guide future work for prehospital hemorrhage control by laypersons. EVIDENCE REVIEW The 2-day, in-person, National Stop the Bleed (STB) Research Consensus Conference was conducted on February 27 to 28, 2019, to identify and achieve consensus on research gaps. Participants included (1) subject matter experts, (2) professional society-designated leaders, (3) representatives from the federal government, and (4) representatives from private foundations. Before the conference, participants were provided a scoping review on layperson prehospital hemorrhage control. A 3-round modified Delphi consensus process was conducted to determine high-priority research questions. The top items, with median rating of 8 or more on a Likert scale of 1 to 9 points, were identified and became part of the national STB research agenda. FINDINGS Forty-five participants attended the conference. In round 1, participants submitted 487 research questions. After deduplication and sorting, 162 questions remained across 5 a prioridefined themes. Two subsequent rounds of rating generated consensus on 113 high-priority, 27 uncertain-priority, and 22 low-priority questions. The final prioritized research agenda included the top 24 questions, including 8 for epidemiology and effectiveness, 4 for materials, 9 for education, 2 for global health, and 1 for health policy. CONCLUSIONS AND RELEVANCE The National STB Research Consensus Conference identified and prioritized a national research agenda to support laypersons in reducing preventable deaths due to life-threatening hemorrhage. Investigators and funding agencies can use this agenda to guide their future work and funding priorities.

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“…The Center for Homeland Defense and Security estimates that school shootings in the United States reached a peak in 2018, with 97 incidents noted and a total of 56 people killed (Center for Homeland Defense & Security Naval Postgraduate School, ). School shootings generally do not last long enough for police or first responders to arrive during ongoing violence; furthermore, most crime scenes are not determined to be safe enough for emergency responders to enter in order to provide timely aid to injured victims (Ross et al, ). Investigators estimate that among 1,753,168 calls to the emergency response system, overall emergency personnel response time was a median of 7 (interquartile range [IQR] 4–10) minutes; suburban (median 6, IQR 4–10 min) and urban (median 6, IQR 4–9 min) locations saw a shorter response time compared to rural locations (median 13, IQR 8–19 min) (Mell et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…In order to successfully achieve hemorrhage control, bleeding control techniques must be applied both quickly and accurately. Investigators demonstrated that less than 20% of laypersons were able to correctly place a commercially available tourniquet without training (Ross et al, ). Furthermore, investigators estimate that correct tourniquet placement by lay bystanders would not exceed 55% given current models of commercially available tourniquets (Ross et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…Investigators demonstrated that less than 20% of laypersons were able to correctly place a commercially available tourniquet without training (Ross et al, ). Furthermore, investigators estimate that correct tourniquet placement by lay bystanders would not exceed 55% given current models of commercially available tourniquets (Ross et al, ). However, experts also emphasize that any bystander may initiate bleeding control through application of manual pressure when tourniquets are unavailable or responders are not trained in their use (Jacobs, Warshaw, & Burns, ).…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of “Stop the Bleed” training among K‐12 faculty and staff in Alabama

Jones

Brown

Esslinger³

et al. 2019

Public Health Nursing

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Objectives To evaluate “Stop the Bleed” (STB) training among/K12 personnel in an Alabama school system, and to assess participants’ perceived readiness to train peers in STB methods. Design and Sample We performed a cross‐sectional observational study with a convenience, nonprobability sample of 466 full‐time personnel who received STB training. Data were collected using an anonymous online survey. Measurements We asked participants to recall feelings related to STB both prior to and after completing training using a 5‐point Likert scale (5 = “Strongly Disagree”, 1 = “Strongly Agree”). We used logistic regression to evaluate the association among posttraining feelings and perceived preparedness to train others in STB. Results Participants were primarily female (78%), aged 41 ± 10 years, who held faculty positions (94%). Results revealed increased knowledge of (4 [IQR 2–4] vs. 2 [1–2], p < .001) and comfort with (4 [2–5] vs. 2 [1–2], p < .001) STB skills. Participants felt more empowered to organize STB training (4 [3–5] vs. 3 [2–4], p < .001); those who felt empowered to organize STB training were eight times more likely to feel capable of teaching STB. Conclusions After STB training, K‐12 personnel felt empowered to organize additional STB trainings and capable of teaching STB methods to others.

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The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons

Cited by 33 publications

References 22 publications

Empowering Bystanders to Intervene: Trauma Responders Unify to Empower (TRUE) Communities

Empowering Bystanders to Intervene: Trauma Responders Unify to Empower (TRUE) Communities

Defining a Research Agenda for Layperson Prehospital Hemorrhage Control

Evaluation of “Stop the Bleed” training among K‐12 faculty and staff in Alabama

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