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Assessing Hemorrhage Control and Tourniquet Skills in School-Aged Children
Cindy D Chang1,2,3, Nichole Bosson4,5,6, Marianne Gausche-Hill4,5
1Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Insights
Children as young as 8 can learn to control bleeding using a tourniquet. This study shows that early hemorrhage control training is feasible for young students.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Public Health Interventions
Background:
- Uncontrolled hemorrhage is a leading preventable cause of death in traumatic injuries.
- Children may witness and need to respond to traumatic events requiring hemorrhage control.
- The optimal age for initiating hemorrhage control training in children is not well-established.
Purpose of the Study:
- To determine if children aged 8 to 12 years can learn to identify the need for and properly apply a combat application tourniquet (CAT).
- To assess children's comprehension and psychomotor skills in using a CAT for hemorrhage control.
- To establish the earliest age at which children can be effectively trained in life-saving hemorrhage control techniques.
Main Methods:
- A prospective study involving children aged 8 to 12 years.
- Standardized training sessions on hemorrhage control and CAT application using manikins.
- Assessment of cognitive (comprehension) and psychomotor (skills) performance using a 4-question tool.
- Success defined as at least 60% of participants within each age group achieving correct scores on both assessments.
Main Results:
- High participant completion rate (99%, 322/326).
- Overall, 70% of participants correctly answered all assessment questions.
- 88% demonstrated correct comprehension, and 76% demonstrated accurate CAT placement skills.
- All age groups surpassed the 60% success threshold for both cognitive and psychomotor assessments.
- No significant association found between performance and participant age, sex, or BMI.
Conclusions:
- Children aged 8 years and older can successfully learn and apply hemorrhage control techniques using a combat application tourniquet.
- Hemorrhage control and CAT application training can be effectively initiated in children as early as the third grade.
- This research supports the implementation of early public health interventions for traumatic injury response among school-aged children.
Objectives:
Uncontrolled hemorrhage is the most preventable cause of death following traumatic injury; children may be called to act as bystanders when hemorrhage control is necessary. The earliest age that children can learn hemorrhage control remains undetermined. We aimed to identify whether children aged 8 to 12 years can identify when and how to use a combat application tourniquet (CAT) and can appropriately place and tighten it to achieve hemorrhage control.
Methods:
We conducted a prospective study of children aged 8 to 12 years old. A trained facilitator taught hemorrhage control and CAT placement on manikins in small group sessions. After each session, we assessed the comprehension and application skills of each participant using a standardized 4-question tool. If at least 60% of children within each age group correctly performed both comprehension (cognitive) and skills (psychomotor) assessments, the group was considered successful. We compared success rates between age groups and analyzed the association between performance and participant age, sex, and body mass index (BMI).
Results:
Of 326 eligible children, 322 completed the training and assessment (99%). Overall, 70% (225/322) of participants completed all 4 assessment questions correctly, 88% (284/322) of participants were able to answer both comprehension (cognitive) questions correctly, and 76% (246/322) of participants were able to accurately demonstrate both CAT placement skills (psychomotor) correctly. All age groups exceeded the 60% success rate in both assessments. Age, sex, and BMI were not significantly associated with assessment performance.
Conclusion:
Children as young as 8 years old can successfully learn hemorrhage control techniques and combat application tourniquet application, suggesting this training can begin as early as third grade.
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