Prehosp Emerg Care. 2020 Nov-Dec;24(6):831-838. doi: 10.1080/10903127.2020.1718259. Epub 2020 Mar 3.
: One of the greatest casualty-care improvements resulting from US military operations in Iraq and Afghanistan has been the reduction of preventable death from massive extremity hemorrhage - largely due to the widespread use of limb tourniquets. More recently, tourniquet use in civilian, prehospital settings has shown promise in reducing deaths in cases of catastrophic arterial limb hemorrhage. Telephone instructions by trained emergency medical dispatchers (EMDs) on applying an available tourniquet may help achieve such a benefit.: The objective of the study was to determine whether layperson callers can effectively stop simulated bleeding using an improvised or a commercial tourniquet, when provided with scripted instructions via phone from a trained protocol-aided EMD.: This was a prospective, randomized trial involving layperson volunteers, done at four locations in Salt Lake City, Utah, USA. Volunteers were assigned randomly to three groups: one for each of two commonly available commercial tourniquets and one for an improvised tourniquet.: A total of 246 subjects participated in the study at the four locations between February 11, 2019 and June 22, 2019. The overall median time for all trials (i.e., elapsed time from the start to the end of the simulation) was 3 minutes and 19 seconds. Median time to stop the bleeding (i.e., elapsed time from the start of the simulation to the time the participant was able to successfully stop the bleeding) was 2 minutes and 57 seconds. Median tourniquet pressure was 256 mmHg and median-end blood loss was 1,365 mL. A total of 198 participants (80.49%) were able to stop the bleeding while 16 participants (6.5%) had the tourniquet applied with some bleeding still occurring, and 32 participants (13.01%) exceeded the threshold of 2,500 mL of blood loss, resulting in the "patient" not surviving.: The study findings demonstrated that untrained bystanders provided with instructions via phone from a trained Emergency Medical Dispatcher applied a tourniquet and successfully stopped the bleeding completely in most cases.
: 美国在伊拉克和阿富汗的军事行动带来的最大伤员救治改进之一是减少了可预防的四肢大出血死亡——这在很大程度上要归功于广泛使用四肢止血带。最近，在平民、院前环境中使用止血带已显示出在减少灾难性动脉肢体出血导致的死亡方面的潜力。经过培训的紧急医疗调度员（EMD）通过电话提供使用现有止血带的指导，可能有助于实现这一益处。: 研究目的是确定在接受经过培训的协议辅助 EMD 通过电话提供脚本指导的情况下，非专业的呼叫者是否可以有效地使用临时或商业止血带来控制模拟出血。: 这是一项在美国犹他州盐湖城的四个地点进行的前瞻性、随机试验，涉及非专业志愿者。志愿者被随机分配到三个组：两个常用商业止血带组和一个临时止血带组。: 共有 246 名受试者在 2019 年 2 月 11 日至 2019 年 6 月 22 日期间在四个地点参加了该研究。所有试验的总体中位数时间（即从模拟开始到结束的时间）为 3 分 19 秒。停止出血的中位数时间（即从模拟开始到参与者能够成功止血的时间）为 2 分 57 秒。止血带压力中位数为 256mmHg，中位末端失血量为 1365mL。共有 198 名参与者（80.49%）能够止血，16 名参与者（6.5%）的止血带应用时仍有出血，32 名参与者（13.01%）的失血量超过 2500mL，导致“患者”无法存活。: 研究结果表明，未经培训的旁观者在接受经过培训的紧急医疗调度员通过电话提供的指导后，使用止血带并在大多数情况下成功完全止血。
