J. C. McCarty1,2, J. P. Herrera-Escobar1, Z. G. Hashmi1, M. A. Chaudhary1, E. De Jager1, C. J. Ezeibe1, R. M. Nunez1, A. H. Haider1, E. Goralnick1,3, E. J. Caterson1,2 1Brigham And Women’s Hospital,Center For Surgery And Public Health, Department Of Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Division Of Plastic Surgery,Boston, MA, USA 3Brigham And Women’s Hospital,Department Of Emergency Medicine,Boston, MA, USA
Introduction: The American College of Surgeons Bleeding Control Basic (B-Con) course is the most common hemorrhage control training for laypeople; teaching participants skills on how to pack a wound, apply pressure, and apply a commercial tourniquet. In most scenarios in the civilian sector, however, a tourniquet would not be immediately available in the event of a trauma. The Hartford Consensus states improvised tourniquets are an option if a commercial tourniquet is not available, but with minimal supporting data. The objective of this study was to evaluate laypeople’s 1) ability to improvise a tourniquet after B-Con training and 2) evaluate what participant’s perceived actions before and after the training if a commercial tourniquet were not available.
Methods: B-Con course participants were evaluated on their ability to fashion and apply an improvised tourniquet to a high-fidelity Hapmed trainer, which simulates bleeding and provides an estimated blood loss (EBL), immediately after B-Con training. Participants were provided gauze, shoestring, a belt, and a rod to act as a windlass. No feedback was given to participants about which materials to use. Participants were administered questionnaires before and after the B-Con course, but before testing, assessing what participants would do if presented with life-threatening extremity bleeding in the absence of a commercial tourniquet. Descriptive statistics were used to describe the primary and secondary outcomes.
Results: 61 laypeople were evaluated. 32.8% (n=20) participants correctly fashioned and applied an improvised tourniquet. Of the available materials, 82.0% (n=50) used the windlass, 62.3% (n=38) used the shoelace, 47.5% (n=29) used gauze, and 18.0% (n=11) used the belt. The leather belt broke in 45.5% (n=5/11) of cases. 11 participants did not use a windlass and had a 0% success rate. When a commercial tourniquet was not available, pre-training 27.9% would apply an improvised tourniquet and 72.1%(n=44) would apply pressure. Post-training, 26.2% (n=16) would apply an improvised tourniquet and 72.1% (n=44) would apply pressure. Of those that would place an improvised tourniquet post-training, 8 (50%) applied the tourniquet correctly. 66.7% (n=40) reported the tourniquet was the most important skill taught in the course and 23.3% (n=14) thought it was how to apply pressure with your hands.
Conclusion: Civilian laypeople are unlikely to have a tourniquet when called upon to respond to a bleeding victim and, even with ideal supplies, can improvise a tourniquet less than a third of the time. The emphasis on tourniquet training for laypeople, rather than teaching pressure and packing alone, should be re-evaluated to align with the scenarios laypeople are likely to face.