Missing expectations: Windlass tourniquet use without formal training yields poor results

Area of Science:

• Emergency Medicine
• Trauma Care
• Public Health

Background:

• Civilian hemorrhage control education remains limited.
• Laypersons are the first responders in many emergencies.
• Effectiveness of commercially available tourniquets in untrained users is unknown.

Purpose of the Study:

• To assess laypersons' ability to apply three common tourniquets.
• To compare the performance of SAM XT, CAT, and SOFT-T tourniquets.
• To identify factors influencing successful tourniquet application.

Main Methods:

• Preclinical health science students were randomized to use SAM XT, CAT, or SOFT-T tourniquets.
• Participants had 1 minute to read instructions and apply the tourniquet to a trainer.
• Simulation survival, time to hemostasis, pressure, and blood loss were measured.

Main Results:

• Overall simulation survival was below 66%.
• Tourniquets performed similarly in pressure and time to stop bleeding.
• SOFT-T resulted in significantly less blood loss (433 mL) compared to SAM XT (686 mL) and CAT (624 mL).
• Previous experience significantly improved success rates (100% vs. 62%).

Conclusions:

• Commercially available tourniquets are not intuitive for untrained laypersons.
• High failure rates underscore the need for formal "Stop the Bleed" training.
• Further evaluation after training is planned to improve civilian hemorrhage control outcomes.