J. C. Xu1, C. Kwan1, C. Pugh1 1University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA
Introduction:
Junctional hemorrhage is a leading cause of preventable military death. Tourniquets for these difficult anatomical regions exist and are approved by the FDA to stop bleeding until arrival at a medical facility. The purpose of this study is to compare preferences and changes in performance when using a newly designed visual bleeding feedback system(VBFS) when training novices. We hypothesize that users will indicate higher levels of confidence after training and greater improvements in training time with theleeding feedback system compared to those who train without feedback (WF).
Methods:
Medical students (N=15) and community emergency medics (N=4) with no junctional tourniquet experience were randomized in a single-blind, crossover, controlled study to start either in the VBFS group or the WF group. All subjects underwent training in the following order; instructional videos, hands on practice, three recorded skill trials in VBFS or WF, and crossover to WF or VBFS for another three trails. Participant agreement with statements asserting confidence in efficient and accurate tourniquet application and usefulness of the VBFS was assessed using a pre-and post-Likert scale with ratings from 1 to 7, with 1 being least agreement and 7 being most. Video and audio data were also collected and analyzed to assess total trail time and tourniquet application time. Group confidence scores and trial times were calculated via paired t-test.
Results:
Participants indicated very high ratings for VBFS usefulness (6.37/7.0 +/-1.25) and recommendation to others (6.74/7.0 +/- 0.56). While there was no statistical difference in group confidence or time for the pre-and post-tests before the crossover, there was a significant reduction in application times between the 1st and 6th trial (80.5 s vs 44.4 s, p = 0.032) after crossover. It is also notable that participants in the in the VBFS spent more time than the WF groups (37.9 s vs 21.4 s, = 0.56) indicating active use of the visual feedback system. It is also noted that participants started with a fairly high confidence level in the pre-training phase compared to confidence after the 6th trial, (5.11/7.0 vs 5.37/7.0, p = 0.35).
Conclusion:
Trial times were increased when using the VBFS and all users rated VBFS highly. Participants were equally confident in tourniquet application after just watching a video compared to finishing the entire training with its six applications on a bleeding and non-bleeding model. Given that most participants were novices to this type of tourniquet, it is possible that they were overly confident in their original self-assessed abilities. This over confidence necessitates the need for developing effective scenario based training curricula for this deceptively straightforward life-saving task.