The Windlass Tourniquet: Is It Taking the Wind Out of the “Stop the Bleed” Sails?

Schlanser, Victoria; Tatebe, Leah C; Karalius, Vytas P.; Liesen, Erik; Pekarek, Sydney; Impens, Ann; Ivkovic, Katarina; Bajani, Francesco; Khalifa, Andrew; Dennis, Andrew

doi:10.1016/j.jss.2021.09.033

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…Interestingly, the overall 62% arterial occlusive placement parallels the 66% successful placement rate in the first-year medical students without formal training 10 . Immediately after Stop The Bleed training, 92% could place a windlass tourniquet, 27 but skills decay has been repeatedly documented, which plateaus around 60% 11,28–30 . Despite this, neither FD nor the Police Department mandates regular refresher training on tourniquet placement.…”

Section: Discussionmentioning

confidence: 99%

“…10 Immediately after Stop The Bleed training, 92% could place a windlass tourniquet, 27 but skills decay has been repeatedly documented, which plateaus around 60%. 11,[28][29][30] Despite this, neither FD nor the Police Department mandates regular refresher training on tourniquet placement. The apparent upper limit on sustained competency without ongoing remedial training calls into question the windlass design itself.…”

Section: Discussionmentioning

confidence: 99%

“…9 Our previous studies on tourniquet training and usage efficacy found similar success rates in those without formal training (65%, 72%, and 61%) 10 and 1 month after formal Stop The Bleed Training (63%, 70%, and 58%) using the same tourniquets. 11 There are a number of studies evaluating tourniquet application in simulated settings, 8,12,13 but these investigations do not represent the interaction between a first responder and actively hemorrhaging patient.…”

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confidence: 99%

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The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation

Tatebe

Schlanser

Hampton

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:As tourniquets have become more prevalent, device use has been questioned. This study sought to characterize the incidence, indication, and efficacy of tourniquet placement in acute trauma resuscitation. METHODS:Nine regional level 1 trauma centers prospectively enrolled for 12 months adult patients (18 years or older) who had a tourniquet placed. Age, sex, mechanism, tourniquet type, indication, applying personnel, location placed, level of occlusion, and degree of hemostasis were collected. Major vascular injury, imaging and operations performed, and outcomes were assessed. Analyses were performed with significance at p < 0.05. RESULTS:A total of 216 tourniquet applications were reported on 209 patients. There were significantly more male patients (183 [88%]) and penetrating injuries (186 [89%]) with gunshots being most common (127 [61%]). Commercial tourniquets were most often used (205 [95%]). Ninety-two percent were placed in the prehospital setting (by fire/paramedics, 56%; police, 33%; bystanders, 2%).The most common indications were pooling (47%) and pulsatile (32%) hemorrhage. Only 2% were for amputation. The most frequent location was high proximal extremity (70%). Four percent were placed over the wound, and 0.5% were distal to the wound. Only 61% of applications were arterial occlusive. Median application time was 30 minutes (interquartile range, 20-40 minutes).Imaging was performed in 54% of patients. Overall, 36% had a named arterial injury. Tourniquet application failed to achieve hemostasis in 22% of patients with a named vascular injury. There was no difference in hemostasis between those with and without vascular injury ( p = 0.12) or between who placed the tourniquet ( p = 0.07). Seventy patients (34%) required vascular operations. Thirty-four percent of patients were discharged home without admission. CONCLUSION:Discerning which injuries require tourniquets over pressure dressings remains elusive. Trained responders had high rates of superfluous and inadequate deployments. As tourniquets continue to be disseminated, emphasis should be placed on improving education, device development, and quality control.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation

Tatebe

Schlanser

Hampton

et al. 2021

J Trauma Acute Care Surg

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Can “Stop The Bleed” training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review

Consunji,

Mekkodathil,

Abdelrahman

et al. 2024

Eur J Trauma Emerg Surg

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Background In many regions of the world, most trauma deaths occur within 1–2 h of injury due to uncontrolled bleeding. For this reason, training lay first-person responders in trauma care, focusing on hemorrhage control, has been recommended. We hypothesized that STOP THE BLEED (STB) training courses that teach laypersons how to stop traumatic compressible bleeding immediately are needed to potentially prevent deaths due to hemorrhage. This systematic review will analyze the effect of the STB training course on the knowledge, skill, and attitudes of lay first-person responders for hemorrhage control. Methods PubMed and Google Scholar databases were used to identify relevant peer-reviewed research articles describing evaluations of STB courses for laypersons from December 1 2013 to October 31 2022. In addition, a hand search of article references was undertaken. Studies were included if they implemented the STB course; trainees were laypersons, and the study had some outcome measures such as knowledge, skill, confidence gained, and willingness to provide or utilization of care provided to and outcomes of trauma patients. Results The database searches yielded 2,893 unique papers. We retained 33 articles for full-text review, resulting in 24 eligible papers. Gray literature and manual searches yielded 11 additional publications for a total of 35 studies. The most reported finding was a statistically significant increase in hemorrhage control knowledge or tourniquet application skills in 26 studies. Twenty-two studies reported statistically significant improvements in willingness, confidence, comfort, and likelihood to respond to a bleeding patient, and 6 studies reported substantial reductions in the retention of bleeding control knowledge or skills. Only one study reported on the effect on patient outcomes. Conclusion STB courses for laypersons have demonstrated significant improvements in knowledge, skill, confidence, and willingness to intervene to stop traumatic exsanguination. The evaluation of clinically relevant patient outcomes, specifically their effect on preventable deaths from traumatic exsanguination, is needed to strengthen further the evidence behind the recommendations for more widespread teaching of “STB” courses.

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Invited Commentary: Doing It Right

Ho¹,

Alam²

2022

Journal of the American College of Surgeons

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The Windlass Tourniquet: Is It Taking the Wind Out of the “Stop the Bleed” Sails?

Cited by 3 publications

References 37 publications

The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation

The tight rope act: A multicenter regional experience of tourniquets in acute trauma resuscitation

Can “Stop The Bleed” training courses for laypersons improve hemorrhage control knowledge, skills, and attitudes? A systematic review

Invited Commentary: Doing It Right

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