Vuillemin Quentin, Schwartzbrod Pierre-Eric, Pasquier Pierre, Sibille Florian, Trousselard Marion, Ferrer Marie-Hélène
Legouest Military Hospital, 27 avenue de Plantières, 57077 Metz, France.
Besançon Military Medical Center, Quartier Joffre, 25009 Besançon, France.
Mil Med. 2018 Jan 1;183(1-2):e95-e103. doi: 10.1093/milmed/usx011.
Health care delivery in military conflicts implies high-stress environments. Hemorrhage is the first cause of survivable death among combat casualties, and tourniquet application is one of the most critical lifesaving interventions on the battlefield. However, previous studies have shown high failure rates in tourniquet application. Our study aimed to assess the correlation between personality traits that may interfere with effective tourniquet application in a simulated extremity hemorrhage.
Seventy-two French soldiers, previously trained to forward combat casualty care, were evaluated by self-administered questionnaires and submitted to the simulation in group of six. We focused on measuring the empathic personality of the subjects, their peer-to-peer relationships (altruism), as well as their relationship to themselves (mindfulness and self-esteem). The effectiveness of the tourniquet was evidenced by the interruption of the popliteal artery flow Doppler signal. A composite variable called "efficiency" was defined by elimination of popliteal pulse Doppler signal in less than 60 s.
Tourniquet application interrupted arterial flow in 37 participants (51.39%). Efficiency was obtained by 19 participants (26.39%). We observed that soldiers with high active altruism applied less-efficient tourniquet (odds ratio = 0.15; 95% confidence interval = 0.04-0.59). On the contrary, soldiers with high self-esteem scores applied more efficient tourniquet (odds ratio = 3.95; 95% confidence interval = 1.24-12.56). There was no significant difference concerning empathy and mindfulness scores.
Tourniquet application is technically simple but painful and may involve personal sensitivity. These initial findings highlight the necessity to further explore the psychological processes involved in lifesaving interventions. Self-esteem stands out as a real asset in terms of military competence and resilience, a major prerequisite in stressful situations. Changing altruistic motivations of soldiers is likely not desirable, but being aware of its potential effects may help to develop personal adaptive strategies and to optimize collective training.
军事冲突中的医疗服务意味着高压力环境。出血是战斗伤员中可避免死亡的首要原因，而使用止血带是战场上最关键的救命干预措施之一。然而，先前的研究表明止血带的应用失败率很高。我们的研究旨在评估在模拟肢体出血情况下可能干扰有效使用止血带的人格特质之间的相关性。
72名曾接受过前线战斗伤员护理培训的法国士兵通过自行填写问卷进行评估，并以六人一组的形式参与模拟。我们重点测量了受试者的共情人格、他们的同伴关系（利他主义）以及他们与自己的关系（正念和自尊）。通过腘动脉血流多普勒信号的中断来证明止血带的有效性。一个名为“效率”的复合变量定义为在60秒内消除腘动脉脉搏多普勒信号。
37名参与者（51.39%）的止血带应用中断了动脉血流。19名参与者（26.39%）达到了效率标准。我们观察到，积极利他主义程度高的士兵使用止血带的效率较低（优势比=低（优势比=0. =0.15；95%置信区间=0.04-0.59）。相反，自尊得分高的士兵使用止血带的效率更高（优势比=3.95；95%置信区间=1.24-12.56）。在共情和正念得分方面没有显著差异。
止血带的应用在技术上很简单，但很痛苦，可能涉及个人敏感性。这些初步发现凸显了进一步探索救生干预措施中所涉及的心理过程的必要性。就军事能力和恢复力而言，自尊是一项真正的资产，这是在压力情况下的一个主要先决条件。改变士兵的利他动机可能不可取，但意识到其潜在影响可能有助于制定个人适应策略并优化集体训练。
