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

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Summary

Untrained civilians struggle to apply tourniquets effectively, with high failure rates. Formal training is crucial for laypersons to control extremity hemorrhage using commercially available devices.

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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.