Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to "stop the bleed"

Bethany R Lowndes, Katherine Law, Amro Abdelrahman, Erik Prytz, Carl Oscar Jonson, Matthew Sztajnkrycer, Hunter Hawthorne, Walter Franz, Renaldo Blocker, M. Susan Hallbeck

Research output: Contribution to journalArticle

Abstract

Objective: The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions. Methods: Thirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees. Results: Participants with ACS instructions passed the greatest number of steps (p > 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p > 0.01). Participants (80%) reported favorable views toward tourniquets but 30-60% did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements. Conclusions: ACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.

Original languageEnglish (US)
Pages (from-to)28-36
Number of pages9
JournalMilitary medicine
Volume184
DOIs
StatePublished - Mar 1 2019

Fingerprint

Tourniquets
Exsanguination
Aptitude
Focus Groups
Surgeons
Guidelines

Keywords

  • Hemorrhage
  • Instructions
  • Usability

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to "stop the bleed". / Lowndes, Bethany R; Law, Katherine; Abdelrahman, Amro; Prytz, Erik; Jonson, Carl Oscar; Sztajnkrycer, Matthew; Hawthorne, Hunter; Franz, Walter; Blocker, Renaldo; Hallbeck, M. Susan.

In: Military medicine, Vol. 184, 01.03.2019, p. 28-36.

Research output: Contribution to journalArticle

Lowndes, BR, Law, K, Abdelrahman, A, Prytz, E, Jonson, CO, Sztajnkrycer, M, Hawthorne, H, Franz, W, Blocker, R & Hallbeck, MS 2019, 'Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to "stop the bleed"', Military medicine, vol. 184, pp. 28-36. https://doi.org/10.1093/milmed/usy331
Lowndes, Bethany R ; Law, Katherine ; Abdelrahman, Amro ; Prytz, Erik ; Jonson, Carl Oscar ; Sztajnkrycer, Matthew ; Hawthorne, Hunter ; Franz, Walter ; Blocker, Renaldo ; Hallbeck, M. Susan. / Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to "stop the bleed". In: Military medicine. 2019 ; Vol. 184. pp. 28-36.
@article{2ad25a10c8c14be2b9ee78ea0ba6ba1d,
title = "Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to {"}stop the bleed{"}",
abstract = "Objective: The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions. Methods: Thirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees. Results: Participants with ACS instructions passed the greatest number of steps (p > 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p > 0.01). Participants (80{\%}) reported favorable views toward tourniquets but 30-60{\%} did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements. Conclusions: ACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.",
keywords = "Hemorrhage, Instructions, Usability",
author = "Lowndes, {Bethany R} and Katherine Law and Amro Abdelrahman and Erik Prytz and Jonson, {Carl Oscar} and Matthew Sztajnkrycer and Hunter Hawthorne and Walter Franz and Renaldo Blocker and Hallbeck, {M. Susan}",
year = "2019",
month = "3",
day = "1",
doi = "10.1093/milmed/usy331",
language = "English (US)",
volume = "184",
pages = "28--36",
journal = "Military Medicine",
issn = "0026-4075",
publisher = "Association of Military Surgeons of the US",

}

TY - JOUR

T1 - Preliminary investigation of civilian clinician perspectives & just-in-time guidance for tourniquet use to "stop the bleed"

AU - Lowndes, Bethany R

AU - Law, Katherine

AU - Abdelrahman, Amro

AU - Prytz, Erik

AU - Jonson, Carl Oscar

AU - Sztajnkrycer, Matthew

AU - Hawthorne, Hunter

AU - Franz, Walter

AU - Blocker, Renaldo

AU - Hallbeck, M. Susan

PY - 2019/3/1

Y1 - 2019/3/1

N2 - Objective: The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions. Methods: Thirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees. Results: Participants with ACS instructions passed the greatest number of steps (p > 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p > 0.01). Participants (80%) reported favorable views toward tourniquets but 30-60% did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements. Conclusions: ACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.

AB - Objective: The American College of Surgeons (ACS) encourages clinicians to provide training to laypeople on tourniquet application. It is unclear whether clinicians are confident in their abilities and equipped with adequate knowledge, skills, and resources. This study aimed to determine surgical trainee knowledge and attitudes regarding tourniquet application and compare the effectiveness of instructions. Methods: Thirty surgical trainees performed a tourniquet application simulation using a Combat Application Tourniquet and one of the three instructions sets developed by ACS, Department of Homeland Security, and the tourniquet manufacturer. Participants reported tourniquet knowledge, attitudes, and confidence and discussed the instructions. One instruction set was updated and compared to the original set with 20 new trainees. Results: Participants with ACS instructions passed the greatest number of steps (p > 0.01) and completed the task significantly faster compared to those with manufacturer instructions (p > 0.01). Participants (80%) reported favorable views toward tourniquets but 30-60% did not align with to ACS tourniquet guidelines. Focus group participants suggested revisions to the ACS instructions. Comparing the original and revised version of these instructions resulted in no significant improvements. Conclusions: ACS instructions provide guidance; however, improvements to tourniquet instruction are needed for success in controlling exsanguinating hemorrhage.

KW - Hemorrhage

KW - Instructions

KW - Usability

UR - http://www.scopus.com/inward/record.url?scp=85063669938&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063669938&partnerID=8YFLogxK

U2 - 10.1093/milmed/usy331

DO - 10.1093/milmed/usy331

M3 - Article

VL - 184

SP - 28

EP - 36

JO - Military Medicine

JF - Military Medicine

SN - 0026-4075

ER -