Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-30T07:37:42.276Z Has data issue: false hasContentIssue false
  • English
  • Français

Tourniquet Training Program Assessed by a New Performance Score

Published online by Cambridge University Press:  08 October 2018

Thibault Martinez Open the ORCID record for Thibault Martinez [Opens in a new window] ,
Sandrine Duron ,
Jean-Vivien Schaal ,
Yoann Baudoin ,
Olivier Barbier ,
Jean-Louis Daban ,
Mathieu Boutonnet ,
Sylvain Ausset  and
Pierre Pasquier
Thibault Martinez*
Affiliation:
Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre, Percy Military Teaching Hospital, Clamart, France École du Val-de-Grâce, French Military Health Service Academy, Paris, France
Sandrine Duron
Affiliation:
Centre d’Epidémiologie et de Santé Publique des Armées, Marseille, France
Jean-Vivien Schaal
Affiliation:
Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre, Percy Military Teaching Hospital, Clamart, France
Yoann Baudoin
Affiliation:
14th Airborne Forward Surgical Team, Clamart, France Visceral Surgery, Percy Military Teaching Hospital, Clamart, France
Olivier Barbier
Affiliation:
14th Airborne Forward Surgical Team, Clamart, France Orthopaedic Surgery, Begin Military Hospital, Saint Mandé, France
Jean-Louis Daban
Affiliation:
Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre, Percy Military Teaching Hospital, Clamart, France
Mathieu Boutonnet
Affiliation:
Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre, Percy Military Teaching Hospital, Clamart, France
Sylvain Ausset
Affiliation:
Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre, Percy Military Teaching Hospital, Clamart, France École du Val-de-Grâce, French Military Health Service Academy, Paris, France
Pierre Pasquier
Affiliation:
Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre, Percy Military Teaching Hospital, Clamart, France 14th Airborne Forward Surgical Team, Clamart, France
*
Correspondence: Thibault Martinez, MD Federation of Anaesthesiology, Intensive Care Unit, Burns, and Operating Theatre Percy Military Teaching Hospital 101 Avenue Henry Barbusse 92140 Clamart, France E-mail: thibault.martinez@hotmail.fr
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Application of a tourniquet is the cornerstone in management of combat-related extremity hemorrhages. Continuous and appropriate training is required to use tourniquets correctly.

Hypothesis

The aim of this study was to analyze the impact of a refresher training session, conducted directly in the theater of military operations, on the performance of tourniquet use.

Methods

During their deployment (October 2015-April 2016) in the Central African Republic, a first simulation session evaluated soldiers from two combats platoons for the application of the SOFFT (Special Operation Forces Tactical Tourniquet; Tactical Medical Solutions; Anderson, South California USA) tourniquet. After randomization, a R (+) group underwent a refresher training session, while a R (−) group did not. Two months later, a second simulation session was conducted for both groups: R (+) and R (−). A dedicated score (one to seven points), including delay and effectiveness, evaluated the soldiers’ performance for tourniquet application.

Results

Twenty-six subjects were included in the R (+) group and 24 in the R (−) group. Between the two assessments, the score improved for 61.5% of subjects of the R (+) group and 37.5% subjects of the R (−) group (P=.09). More particularly, the performance score increased from 4.2 (SD=1.4) to 5.5 (SD=0.9; P=.002) in subjects of the R (+) group whose last training for tourniquet application was over six months prior.

Conclusion

A refresher tourniquet training session, conducted directly in a combat zone, is especially effective for soldiers whose last training session was over six months prior. A dedicated score can assess appropriately the performance of tourniquet training.

MartinezT, DuronS, SchaalJV, BaudoinY, BarbierO, DabanJL, BoutonnetM, AussetS, PasquierP. Tourniquet Training Program Assessed by a New Performance Score. Prehosp Disaster Med. 2018;33(5):519–525.

Keywords

emergency medicineextremitieshemorrhagetourniquet
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 5 , October 2018 , pp. 519 - 525
Copyright
© World Association for Disaster and Emergency Medicine 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Champion, HR, Bellamy, RF, Roberts, CP, Leppaniemi, A. A profile of combat injury. J Trauma. 2003;54(5 Suppl):S13-S19.Google Scholar
2. Kragh, JF, Littrel, ML, Jones, JA, et al. Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590-597.Google Scholar
3. Mozingo, DW. Eliminating Preventable death on the battlefield. Yearb Surg. 2012;2012(12):40-41.Google Scholar
4. Eastridge, BJ, Mabry, RL, Seguin, P, et al. Death on the battlefield (2001–2011). J Trauma Acute Care Surg. 2012;73(6):S431-S437.Google Scholar
5. Pasquier, P, Dubost, C, Boutonnet, M, et al. Pre-deployment training for forward medicalization in a combat zone: the specific policy of the French Military Health Service. Injury. 2014;45(9):1307-1311.Google Scholar
6. Kragh, JF, Lunati, MP, Kharod, CU, et al. Assessment of groin application of junctional tourniquets in a manikin model. Prehosp Disaster Med. 2016;31(4):358-363.Google Scholar
7. Savage, LcEC, Tenn, C, Vartanian, O et al. A comparison of live tissue training and high-fidelity patient simulator. J Trauma Acute Care Surg. 2015;79(4 Suppl 2):S157-163.Google Scholar
8. Lakstein, D, Blumenfeld, A, Sokolov, T, et al. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54(5 Suppl):S221-S225.Google Scholar
9. Kragh, JF, Walters, TJ, Baer, DG, et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(2 Suppl):S38-NaN-S50.Google Scholar
10. Schreckengaust, R, Littlejohn, L, Zarow, GJ. Effects of training and simulated combat stress on leg tourniquet application accuracy, time, and effectiveness. Mil Med. 2014;179(2):114-120.Google Scholar
11. Unlu, A, Kaya, E, Guvenc, I, et al. An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases. J R Army Med Corps. 2015;161(4):332-335.Google Scholar
12. Barbier, O, Pasquier, P, Racle, M, Baudoin, Y, Malgras, B. Dynamic insights on surgical activity in a new modern warfare: the French Role 2 in Bangui, Central African Republic. Mil Med. 2017;182(3):e1756-e1761.Google Scholar
13. Kragh, JF, Walters, TJ, Baer, DG, et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg. 2009;249(1):1-7.Google Scholar
14. Higgs, MAJAR, Maughon, LMJ, Usn, MC, Ruland, CRT, Usn, MC, Reade, LTCMC. Effect of uniform design on the speed of combat tourniquet application: a simulation study. Mil Med. 2016;181(8):753-755.Google Scholar
15. Baruch, EN, Kragh, JF, Berg, AL, et al. Confidence-competence mismatch and reasons for failure of non-medical tourniquet users. Prehosp Emerg Care. 2016;3127(August):1-7.Google Scholar
16. Savage, E, Pannell, D, Payne, E, O’Leary, T, Tien, H. Re-evaluating the field tourniquet for the Canadian Forces. Mil Med. 2013;178(6):669-675.Google Scholar
17. Kragh, JF, Mabry, RL, Parsons, DL, Broussard, DW, Aden, JK, Dubick, MA. Learning curves of emergency tourniquet use exploring for utility in training. J Spec Oper Med. 2016;16(4).Google Scholar
18. Kirkpatrick, DL, Kirkpatrick, JD. Evaluating Training Programs, The Four Levels. San Francisco, California USA: Berrett-Koehler Publishers, Inc.: 2006.Google Scholar
19. Goolsby, C, Branting, A, Chen, E, Mack, E, Olsen, C. Just-in-time to save lives: a pilot study of layperson tourniquet application. Acad Emerg Med. 2015;22(9):1113-1117.Google Scholar
20. Heldenberg, E, Aharony, S, Wolf, T, Vishne, T. Evaluating new types of tourniquets by the Israeli Naval special warfare unit. Disaster Mil Med. 2015;1(1):1-7.Google Scholar
21. Calkins, D, Snow, C, Costello, M, Bentley, TB. Evaluation of possible battlefield tourniquet systems for the far-forward setting. Mil Med. 2000;165(May):379-384.Google Scholar
22. Jaffer, U, Aslam, M, Kasivisvanathan, V, Patni, R, Midwinter, M, Standfield, N. Evaluation of rapid training in ultrasound guided tourniquet application skills. Int J Surg. 2012;10(9):563-567.Google Scholar
23. Wenke, JC, Walters, TJ, Greydanus, DJ, Pusateri, AE, Convertino, V. Physiological evaluation of the U.S. Army one-handed tourniquet. Mil Med. 2005;170(9):776-781.Google Scholar
24. Kragh, JF, O’Neill, ML, Walters, TJ, et al. The military emergency tourniquet program’s lessons learned with devices and designs. Mil Med. 2011;176(10):1144-1152.Google Scholar
25. Baruch, EN, Benov, A, Shina, A, et al. Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use performance. Am J Emerg Med. 2016;34(12):2356-2361.Google Scholar
26. Hill, J, Montgomery, L, Hopper, K, Roy, L. Evaluation of self-applied tourniquets for combat applications, second phase. US Navy Exp Diving Unit Tech Rep NEDU-TR-07-07. 2007.Google Scholar
27. Kragh, JF, Dubick, MA. Skill decay or maintenance between tourniquet uses among first aid caregivers: Exploration in a manikin model. Am J Emerg Med. 2016;34(9):1897-1899.Google Scholar
28. Lane, ME, Hourani, LL, Bray, RM, Williams, J. Prevalence of perceived stress and mental health indicators among reserve-component and active-duty military personnel. Am J Public Health. 2012;102(6):1213-1220.Google Scholar
29. McNulty, PAF. Reported stressors and health care needs of active duty Navy personnel during three phases of deployment in support of the war in Iraq. Mil Med. 2005;170(6):530-535.Google Scholar
30. Walters, TJ, Wenke, JC, Kauvar, DS, McManus, JG, Al, E. Effectiveness of self-applied tourniquets in human volunteers. Prehosp Emerg Care. 2005;9(4):416-422.Google Scholar
31. Pasquier, P, Mérat, S, Malgras, B, et al. A serious game for massive training and assessment of French soldiers involved in forward combat casualty care (3D-SC1): development and deployment. JMIR Serious Games. 2016;4(1):e5.Google Scholar
32. Planchon, J, Vacher, A, Comblet, J, et al. Serious game training improves performance in combat life-saving interventions. Injury. 2018;49(1):86-92.Google Scholar