McCarty Justin C, Caterson Edward J, Chaudhary Muhammed A, Herrera-Escobar Juan P, Hashmi Zain G, Goldberg Scott A, Goolsby Craig, Lipsitz Stuart, Haider Adil H, Goralnick Eric
Center for Surgery and Public Health (CSPH), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Center for Surgery and Public Health (CSPH), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Injury. 2019 Jan;50(1):10-15. doi: 10.1016/j.injury.2018.09.041. Epub 2018 Sep 24.
Application of extremity tourniquets is a central tenet of multiple national initiatives to empower laypersons to provide hemorrhage control (HC). However, the efficacy of the general population who self-report prior first-aid (FA) or HC training on individual's ability to control bleeding with a tourniquet remains unknown. Therefore, the objective of this study was to assess the effectiveness of laypeople with self-reported prior FA or HC training to control bleeding with a tourniquet.
Employees of a stadium were assessed via simulation in their ability to apply a Combat Application Tourniquet. As a subgroup analysis of a larger study, participants who self-reported: 1) No prior training, 2) FA training only or 2) FA + HC training were compared. Logistic regression adjusting for age, gender, education, willingness-to-assist, and comfort level in HC was performed.
317 participants were included. Compared to participants with no prior training (14.4%,n = 16/111), those with FA training only (25.2%,n = 35/139) had a 2.12-higher odds (95%CI:1.07-4.18) of correct tourniquet application while those with FA + HC (35.8%,n = 24/67) had a 3.50-higher odds (95%CI:1.59-7.72) of correct application. Participants with prior FA + HC were more willing-to-assist and comfortable performing HC than those without prior training (p < 0.05). However, reporting being very willing-to-assist [OR0.83,95%CI:0.43-1.60] or very comfortable [OR1.11,95%CI:0.55-2.25] was not associated with correct tourniquet application.
Self-reported prior FA + HC training, while associated with increased likelihood to correctly apply a tourniquet, results in only 1/3 of individuals correctly performing the skill. As work continues in empowering and training laypeople to act as immediate responders, these findings highlight the importance of effective layperson education techniques.
应用肢体止血带是多项国家倡议的核心原则，这些倡议旨在使非专业人员能够进行出血控制（HC）。然而，自我报告曾接受过急救（FA）或HC培训的普通人群使用止血带控制出血的能力如何，目前尚不清楚。因此，本研究的目的是评估自我报告曾接受过FA或HC培训的非专业人员使用止血带控制出血的有效性。
通过模拟评估体育场员工应用战斗应用止血带的能力。作为一项更大规模研究的亚组分析，对自我报告为以下情况的参与者进行了比较：1）未曾接受过培训；2）仅接受过FA培训；3）接受过FA + HC培训。进行了逻辑回归分析，并对年龄、性别、教育程度、协助意愿和对HC的舒适度进行了校正。
共纳入317名参与者。与未曾接受过培训的参与者（14.4%，n = 16/111）相比，仅接受过FA培训的参与者（25.2%，n = 35/139）正确应用止血带的几率高2.12倍（95%CI：1.07 - 4.18），而接受过FA + HC培训的参与者（35.8%，n = 24/67）正确应用止血带的几率高3.50倍（95%CI：1.59 - 7.72）。与未曾接受过培训的参与者相比，曾接受过FA + HC培训的参与者更愿意提供协助，且在进行HC时更自在（p < 0.05）。然而，报告非常愿意提供协助[OR 0.83，95%CI：0.43 - 1.60]或非常自在[OR 1.11，95%CI：0.55 - 2.25]与正确应用止血带并无关联。
自我报告曾接受过FA + HC培训，虽然与正确应用止血带的可能性增加相关，但仅有三分之一的人能够正确掌握该技能。随着使非专业人员能够并培训其成为即时响应者的工作不断推进，这些发现凸显了有效的非专业人员教育技术的重要性。
