J. C. McCarty1, M. A. Chaudhary1, E. J. Caterson1,4, S. A. Goldberg2, M. L. McDonald1, C. Goolsby3, A. Haider1, E. Goralnick2 3Uniformed Services University Of The Health Sciences,Military & Emergency Medicine,Bethesda, MD, USA 4Brigham And Women’s Hospital,Division Of Plastic Surgery, Department Of Surgery, Harvard Medical School,Boston, MA, USA 1Brigham And Women’s Hospital,Center For Surgery And Public Health, Department Of Surgery, Harvard Medical School,Boston, MA, USA 2Brigham And Women’s Hospital,Department Of Emergency Medicine, Harvard Medical School,Boston, MA, USA
Introduction: Uncontrolled hemorrhage is an important cause of preventable death. With the increasing incidence of mass casualty events in western nations as a result of urban terrorism, several initiatives have been launched to empower laypersons to act as first responders and perform hemorrhage control (HC) including but not limited to the ACS “Stop the Bleed” campaign in the United States, Just-in-time point of care education, and web-based education. A central tenet of these is application of extremity tourniquets. This study assessed laypersons’, who self-reported prior training, ability to control bleeding with a tourniquet.
Methods: Employees of a major National Football League stadium participated in this study assessing ability to apply a Combat Application tourniquet (CAT) in an emergency. As a subgroup analysis of a larger study, participants who self-reported prior: 1) first aid (FA) training or 2) FA + HC training were included and presented an emergency scenario requiring tourniquet application on a mannequin. Correct application was assessed by time to application and appropriate tourniquet tightness. Prior to this, we obtained demographic data including open-ended questions on type of training participants had received and administered a survey to assess likelihood to help in a scenario requiring HC and comfort level in effectively controlling hemorrhage. The effect of FA training compared to FA + HC training was analyzed using Chi-square to compare correct tourniquet application and Mann-Whitney U test to compare reported likelihood to help and comfort level in HC.
Results: 206 participants were included. Overall, only 27% correctly applied a tourniquet. There was no difference in correct tourniquet application between those reporting just FA training and those reporting prior FA + HC training (table). However, the likelihood to help in an emergency and reported comfort level to effectively control bleeding of those participants with prior HC training was significantly higher than those with just FA training (table). Within the open-ended questions, no participants reported formal ACS “Stop the Bleed” training.
Conclusion: Despite self-reported prior training, a great majority of participants were unable to correctly apply a tourniquet. Prior reported HC training was associated with an increase in these laypersons intention to act to control bleeding, but it did not improve correct tourniquet application compared to those with just FA training. As work continues to identify the most effective method of layperson empowerment to act as effective first responders, these findings highlight the importance of high quality hemorrhage control training with proven long term retention.
