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Tourniquet application by schoolchildren-a randomized crossover study of three commercially available models
Alaa El Bashtaly1, Elene Khalil, Francois Méthot
1From the Faculty of Medicine (A.E.B., F.M., L.L.-H.), Université de Montreal; Pediatric Emergency Medicine (E.K.), Montreal Children's Hospital, Montreal, Quebec; Faculty of Medicine (J.M.F.), University of Alberta, Edmonton, Alberta; and Adult Emergency Medicine (V.H.), McGill University Health Centre, Montreal, Quebec, Canada.
Insights
The mechanical advantage tourniquet (MAT) is the most effective for children aged 10-12, showing higher success rates, faster application times, and greater preference compared to other models. This finding aids in selecting appropriate child-use tourniquets.
Area of Science:
- Pediatric trauma care
- Emergency medical devices
- Public health interventions
Background:
- Life-threatening hemorrhage is a leading cause of preventable trauma mortality.
- Commercial tourniquets are proven effective and safe for adult civilian use.
- Limited data exist on tourniquet application efficacy by children.
Purpose of the Study:
- To compare the effectiveness of three commercially available tourniquets for application by children.
- To identify the optimal tourniquet model for pediatric use in emergency situations.
Main Methods:
- A randomized crossover study involving 96 children aged 10-12 years in Montreal elementary schools.
- Participants received brief training and practice on three tourniquet models.
- Evaluated success rate, time to application, and user preference for each tourniquet.
Main Results:
- The mechanical advantage tourniquet (MAT) demonstrated superior success rates (67%) compared to the Combat Application Tourniquet (CAT, 44%) and Stretch Wrap and Tuck Tourniquet (SWATT, 24%).
- MAT application was significantly faster (57 seconds) than CAT (80 seconds) and SWATT (90 seconds).
- Children showed a strong preference for the MAT (64%) over CAT (30%) and SWATT (6%).
Conclusions:
- The mechanical advantage tourniquet (MAT) is the most effective tourniquet for school-aged children.
- Findings support MAT selection for facilities purchasing tourniquets for student use.
- This research provides crucial data for improving pediatric emergency preparedness.
Background:
Life-threatening hemorrhage is a major cause of preventable mortality in trauma. Studies have demonstrated the effectiveness and safety of commercial tourniquets when used by adult civilians. However, there are no data about tourniquet application by children.This study's goal is to determine which of three commercially available tourniquets is most effective when used by children.
Methods:
A randomized crossover study was conducted in four elementary schools in Montreal to compare three commercially available tourniquets. The study population is primary school children aged 10 to 12 years (5th-6th grade). A total of 181 students were invited to participate; 96 obtained parental approval and were recruited. Participants underwent a short 7-minute video training on the use of three commercial tourniquets and were subsequently given a 2-minute practice period. Students were evaluated on their ability to successfully apply the tourniquet and the time to complete application. After applying all three tourniquets, the students selected their favorite model. The primary outcome is the proportion of successful applications per tourniquet model. Secondary outcomes include time to successful application for each tourniquet model and tourniquet model preference.
Results:
The mechanical advantage tourniquet (MAT) outperformed the combat application tourniquet (CAT) and the stretch wrap and tuck tourniquet (SWATT) in terms of success rate (MAT, 67%; CAT, 44%; SWATT, 24%; p < 0.0001), time to application (MAT, 57 seconds; CAT, 80 seconds; SWATT, 90 seconds; p < 0.0001), and preference (MAT, 64%; CAT, 30%; SWATT, 6%; p < 0.0001).
Conclusion:
In this study, the MAT performs better in terms of success rate, time to application, and preference when used by school-aged children. This study can be helpful when facilities are purchasing tourniquets for use by students.
