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Integrated Compensatory Responses in a Human Model of Hemorrhage

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Published on: November 20, 2016

Provider Fatigue During Direct Manual Compression for Life-Threatening Bleeding.

Nathan Charlton¹, Keke Schuler², Chi H Ho³

¹Emergency Medicine, University of Virginia, Charlottesville, USA.

|October 4, 2021

Summary

Direct manual compression (DMC) pressure for severe bleeding decreases significantly over time due to rescuer fatigue. This decline impacts the effectiveness of first aid in trauma care, highlighting the need for further research.

Keywords:

first aid hemorrhage hemorrhagic shock penetrating wounds pressure traumatic shock

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Area of Science:

Trauma Care and Emergency Medicine
Physiology and Biomechanics of Injury Response

Background:

Hemorrhage is a primary cause of trauma mortality, particularly in pre-hospital settings.
Direct manual compression (DMC) is the standard first aid for external bleeding, but its efficacy is challenged by rescuer fatigue.

Purpose of the Study:

To evaluate the impact of rescuer fatigue on the effectiveness of direct manual compression (DMC) for controlling life-threatening bleeding.
To assess pressure decay over an eight-minute period simulating emergency medical services (EMS) response times.

Main Methods:

Prospective observational trial involving 33 adult participants applying pressure to a simulated severe bleeding model.
Measurement of applied pressure over eight minutes using a standardized 'CPR posture'.
Analysis using multilevel models, with gender, age, and weight as potential moderators.

Main Results:

Applied DMC pressure significantly declined over the eight-minute period, with a sharper decrease in the initial 250 seconds.
Rescuer fatigue demonstrably reduced compression pressure over time.
Gender was identified as a factor influencing pressure maintenance over time.

Conclusions:

Rescuer fatigue can compromise the quality of direct manual compression for life-threatening hemorrhage control.
Awareness of fatigue is crucial for first responders.
Further research is required to establish effective pressure benchmarks and quantify the impact of fatigue.