• Elliot M Ross, Julian G Mapp, Theodore T Redman, Derek J Brown, Chetan U Kharod, and David A Wampler.
• Office of the Medical Director, University of Texas Health Science Center San Antonio, San Antonio, Texas; San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston, Texas; Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME2) Research Group, San Antonio, Texas.
• J Emerg Med. 2018 Mar 1; 54 (3): 307-314.

BackgroundThe "Stop the Bleed" campaign in the United States advocates for nonmedical personnel to be trained in basic hemorrhage control and that "bleeding control kits" be available in high-risk areas. However, it is not clear which tourniquets are most effective in the hands of laypersons.ObjectivesThe objective of this pilot study was to determine which tourniquet type was the most intuitive for a layperson to apply correctly.MethodsThis project is a randomized study derived from a "Stop the Bleed" education initiative conducted between September 2016 and March 2017. Novice tourniquet users were randomized to apply one of three commercially available tourniquets (Combat Action Tourniquet [CAT; North American Rescue, LLC, Greer, SC], Ratcheting Medical Tourniquet [RMT; m2 Inc., Winooski, VT], or Stretch Wrap and Tuck Tourniquet [SWAT-T; TEMS Solutions, LLC, Salida, CO]) in a controlled setting. Individuals with formal medical certification, prior military service, or prior training with tourniquets were excluded. The primary outcome of this study was successful tourniquet placement.ResultsOf 236 possible participants, 198 met the eligibility criteria. Demographics were similar across groups. The rates of successful tourniquet application for the CAT, RMT, and SWAT-T were 16.9%, 23.4%, and 10.6%, respectively (p = 0.149). The most common causes of application failure were: inadequate tightness (74.1%), improper placement technique (44.4%), and incorrect positioning (16.7%).ConclusionOur pilot study on the intuitive nature of applying commercially available tourniquets found unacceptably high rates of failure. Large-scale community education efforts and manufacturer improvements of tourniquet usability by the lay public must be made before the widespread dissemination of tourniquets will have a significant public health effect.Published by Elsevier Inc.

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