Department of General Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Türkiye.
Department of Cardiovascular Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Türkiye.
Ulus Travma Acil Cerrahi Derg. 2024 Jan;30(1):20-26. doi: 10.14744/tjtes.2023.13263.
Bleeding remains the leading cause of potentially preventable deaths both in military and civilian pre-hospital trauma settings. Conventional extremity tourniquets do not control bleeding if an iliac artery or a common femoral artery is injured. Stopping junctional bleeding is particularly challenging and requires the use of specifically designed junctional tourniquets. SAM® Junctional Tourniquet (SJT®, United States of America) and Tactical Abdominal Junctional Tourniquet (T-AJT®, Fora Group Türkiye) have been actively used by Turkish security forces. This study questioned the effect of training on combat medics' successful junctional tourniquet applications and application times (AT).
Our research on two different junctional tourniquet models was designed as a prospective randomized, crossover, single-blinded study. All 40 participants in the study were attendees of a 12-week combat medic training course with updated medical approvals, which were used as an eligibility criterion. Randomization was performed by drawing T-AJT®-SJT cards. The study consisted of pretraining and after-training tourniquet application phases. In each study phase, all participants' AT and the presence or absence of arterial flow were recorded for each group. Finally, the combat medics were presented with a 6-question survey.
Although training increased successful T-AJT® application rates, training was not statistically significantly associated with successful applications for any tourniquet types (p>0.05). The pretraining phase ATs for SJT® and T-AJT® were 55±11.8 and 93.8±2.9 seconds, respectively, and the difference was statistically significantly different (p<0.001). Likewise, after-training phase ATs for SJT® and T-AJT® were 49±22.6 and 79.2±17.5 seconds, respectively, and participants' SJT® ATs were significantly shorter (p<0.001). Overall, when participants' applied any of the tourniquet unsuccessfully, the odds of participants' lower Visual Analogue Scale scores were 0.2 (95% CI [0.08, 0.49]. p<0.001).
Our study basically investigates the effects of training on effective tourniquet application. Unfortunately, our after-training success rates remained unsatisfactory when compared to other studies. This is also the first study on T-AJT® tourniquet application, and further studies on its efficacy are also required.
在军事和民用创伤前环境中，出血仍然是潜在可预防死亡的主要原因。如果髂动脉或股总动脉受伤，传统的四肢止血带无法控制出血。阻止交界处出血特别具有挑战性，需要使用专门设计的交界处止血带。SAM®交界处止血带（SJT®，美国）和战术腹部交界处止血带（T-AJT®，Fora Group Türkiye）已被土耳其安全部队积极使用。这项研究质疑培训对战斗医护人员成功应用交界处止血带和应用时间（AT）的影响。
我们对两种不同的交界处止血带模型的研究设计为前瞻性随机、交叉、单盲研究。研究中的所有 40 名参与者均参加了为期 12 周的战斗医护人员培训课程，并获得了最新的医疗批准，这是作为资格标准。通过抽签 T-AJT®-SJT 卡进行随机化。研究包括培训前和培训后止血带应用阶段。在每个研究阶段，都记录了每个组的所有参与者的 AT 和动脉血流的存在或不存在。最后，向战斗医护人员提出了 6 个问题的调查。
尽管培训提高了 T-AJT®的应用成功率，但培训与任何止血带类型的成功应用均无统计学显著相关性（p>0.05）。SJT®和 T-AJT®的预培训阶段 AT 分别为 55±11.8 和 93.8±2.9 秒，差异具有统计学显著意义（p<0.001）。同样，SJT®和 T-AJT®的培训后阶段 AT 分别为 49±22.6 和 79.2±17.5 秒，参与者的 SJT®AT 明显更短（p<0.001）。总体而言，当参与者应用任何一种止血带不成功时，参与者较低的视觉模拟量表评分的几率为 0.2（95%置信区间 [0.08, 0.49]。p<0.001）。
本研究基本调查了培训对有效止血带应用的影响。不幸的是，与其他研究相比，我们的培训后成功率仍然不理想。这也是对 T-AJT®止血带应用的第一项研究，还需要进一步研究其疗效。
