Baruch Erez N, Kragh John F, Berg Amy L, Aden James K, Benov Avi, Shina Avi, Shlaifer Amir, Ahimor Alon, Glassberg Elon, Yitzhak Avraham
Prehosp Emerg Care. 2017 Jan-Feb;21(1):39-45. doi: 10.1080/10903127.2016.1209261. Epub 2016 Aug 5.
Tourniquet application is a lifesaving skill taught worldwide in first aid bleeding control courses. We observed performance among non-medical users of tourniquets in their confidence, competence, and reasons for failure.
179 Israeli military recruits without prior medical training underwent their standard first aid course where they learned Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC, USA) use. After course completion, they self-reported confidence in tourniquet use. User performance was assessed 7-14 days later using a HapMed™ mannequin that assessed time, pressure, and blood loss. Competent performance required in aggregate: 1) use with pressure of 200 mmHg or more, 2) hemorrhage volume of less than 638 mL, and 3) correct placement of the tourniquet. For failed performance, a reason for failure was reported independently by both the user and an expert observer.
45 of 179 user performances (25%) were competent. Users who reported high confidence had only a slightly higher chance of achieving competence in tourniquet application (r = 0.17, p = 0.022). The most common reason for failure was excess slack in the CAT's strap (experts 55%, users 39%), and too few turns of the windlass (23% and 31%, respectively) was the second most common reason. Expert and user evaluations had poor agreement (κ = 0.44, 95% CI 0.32-0.56).
The most common reason for failed use of tourniquets among non-medical users was excess slack in the tourniquet strap. Users self-evaluated their performance inaccurately and demonstrated a confidence-competence mismatch. These pitfalls in performance may help tourniquet instructors improve training of caregivers.
止血带应用是一项在全球急救出血控制课程中教授的救生技能。我们观察了非医疗人员使用止血带时的操作表现、信心、能力以及失败原因。
179名未接受过医学培训的以色列新兵参加了标准急救课程，学习使用战斗应用止血带（CAT；美国南卡罗来纳州罗克希尔的Composite Resources公司生产）。课程结束后，他们自我报告使用止血带的信心。7至14天后，使用HapMed™人体模型评估用户的操作表现，该模型可评估时间、压力和失血量。合格操作要求总体上满足：1）施加200毫米汞柱或更高的压力，2）失血量少于638毫升，3）止血带放置正确。对于操作失败的情况，用户和专家观察员分别独立报告失败原因。
179名用户的操作表现中有45例（25%）合格。报告高度自信的用户在止血带应用中达到合格的几率仅略高（r = 0.17，p = 0.022）。最常见的失败原因是CAT绑带松弛过度（专家报告占55%，用户报告占39%），绞盘转动圈数过少（分别为23%和31%）是第二常见原因。专家和用户的评估一致性较差（κ = 0.44, 95% CI 0.32 - 0.56）。
非医疗人员使用止血带失败的最常见原因是止血带绑带松弛过度。用户对自己的操作表现评估不准确，表现出信心与能力不匹配。这些操作中的缺陷可能有助于止血带培训人员改进对护理人员的培训。
