Retention of Tourniquet Application Skills Following Participation in a Bleeding Control Course

The American College of Surgeons' Stop the Bleed program has trained more than 1 million individuals to recognize and treat external hemorrhage. Central to this training is tourniquet application. No published studies review the retention of this skill after initial class participation.

One hundred fourteen volunteers agreed to participate. A random sample of 57 was selected and 46 participated. Upon return 6 months later, each participant demonstrated tourniquet application. An observer compared the application process with steps on a checklist. Each step completed correctly was tallied, and the total score for all 10 steps was computed as a percentage correct between 0% and 100%.

The baseline score on the tourniquet skill test was 100% following initial training. At 6 months, mean scores were lower, 69% (SD = 31%) (χ² = 52.09, df = 1, P < 0.001). Fourteen volunteers (30%) attained a score of 100%, and 28 volunteers (61%) achieved a passing score. Bleeding was stopped or reduced to non-life-threatening levels by 34 participants (74%). Participants with passing scores were more likely to stop or reduce the bleeding than those with failing scores (97% vs 35%; χ² = 20.99, df = 1, P < 0.001). Of the 17 volunteers who failed, 18% stopped the bleeding, 18% slowed bleeding to a non-life-threatening level, and 64% were unable to control bleeding.

At 6 months, 39% of participants were unable to successfully apply a tourniquet, and 26% were unable to control life-threatening bleeding. This study demonstrates that refresher training is needed within 6 months of initial training.