Page 23 - Journal of Special Operations Medicine - Winter 2016

Learning Curves of Emergency Tourniquet Use

Exploring for Utility in Training

John F. Kragh Jr, MD; Robert L. Mabry; Donald L. Parsons;
David W. Broussard; James K. Aden 3rd, PhD; Michael A. Dubick, PhD

ABSTRACT

Background: Emergency tourniquet use to control hem- Introduction
orrhage from limb wounds is associated with improved Since 11 September 2001, knowledge, research, and de-
survival and control of shock. In 2013, we introduced velopment of emergency tourniquets have increased.
1–3
a way to measure learning curves of tourniquet users. With such increases, tourniquet use has been improved
With a dataset from an unrelated study, we had an op- to become safer and more effective. Recently gen-
4–6
portunity to explore learning in detail. The study aim erated knowledge includes that tourniquet use is as-
was to generate hypotheses about measurement meth- sociated with prevention and control of shock and
ods in the learning of tourniquet users. Methods: We improved survival of patients, although the extent of
gathered data from a previous experiment that yielded the treatment’s effect upon outcomes of interest needs
a convenient sample of repeated tourniquet applications more study. 1,2,7–9 Although the tourniquet as a medical
used as a marker of learning. Data on consecutive appli- device has been tested, improved, and its efficacy docu-
cations on a manikin were used in the current report and mented, the user of the tourniquet has not been studied
Lifesaving. Combat Ready. were associated with two users, three models of tourni- as thoroughly as the device itself. 10–12 The performance
quet, and six metrics (i.e., effectiveness, pulse cessation,
blood loss, time to effectiveness, windlass turn number, of the tourniquet user appears essential for best tourni-
quet care, but little scientific attention has been brought
™
Arrow EZ-IO T.A.L.O.N. IO Needle T.A.L.O.N. IO Needle and pressure applied). There were 840 tests (140 tests to bear on the analysis of human factors of tourniquet
™
®
®
NSN 6515-01-626-6395 per user, two users, three models). Results: Unique char- use in first aid. 13–15
acteristics of learning were associated with each user.
Hypotheses generated included the following: trainee
• VERSATILE: 7-site IO device There has been occasional use of learning curves in med-
(sternum, proximal humerus, proximal & distal tibia) learning curves can vary in shape (e.g., flat, curved) by icine that can help assess the level of procedural skill in
which metric of learning is chosen; some metrics may caregivers. 16–18 In 2013, Savage et al. demonstrated in a
• LIFE-SAVING: Delivers fluids and medications rapidly EZ-Connect ® show much learning, whereas others show almost none; study of the differential performance of models of field
Extension Set
and accurately for casualty resuscitation use of more than one metric may assess more compre- tourniquet that ease of learning by users was similar
hensively than using only one metric but may require
• CONVENIENT: No need for additional gear, multiple needles more assessment time; number of uses required can among three models that shared a strap-and-windlass
19
or special removal tools Sternal vary by instructional goal (e.g., expertise, competence); design. In 2013, Schreckengaust et al. found that tour-
Locator niquet training of military Servicepersons fostered fast
awareness of the utility of specific metrics may vary by
• SIMPLE: Designed for any level responder instructor; and some, but not all, increases in experience and effective application of leg tourniquets while per-
20
are associated with improved performance. Conclu- formance declined under simulated combat. In 2013,
we introduced a way to measure learning curves of
sions: This first-aid study generated hypotheses about tourniquet users, but such learning has not yet been ex-
teleflex.com/military caregiver learning for further study of tourniquet educa- plored systematically. 21,22 For example, it is unclear what
tion and standards.
measures of learning can be made readily available to
tourniquet instructors and what measures might serve
Keywords: first aid device/education/standards/methods;
Rx Only - Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.See Instructions For Use for detailed information regarding the Instructions For Use, caregivers; hemorrhage/prevention and control/therapy; as useful feedback to trainees. A later experiment we
Contraindications, Potential Adverse Events, Warnings, and Cautions.The T.A.L.O.N Needle Set is manufactured in the USA. Potential complications may include local or systemic infection, performed had existing data available as a convenient
hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. resuscitation; emergency medical services sample to study. 23
Teleflex, the Teleflex logo, Arrow, EZ-Connect, EZ-IO and T.A.L.O.N are trademarks or registered trademarks of Teleflex Incorporated or its affiliates, in the U.S. and/or other countries.
Information in this document is not a substitute for the product Instructions for Use. The products in this document may not be available in all countries. Please contact your local representative.
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