Page 31 - JSOM Winter 2017

Assessment of User, Glove, and Device Effects on
Performance of Tourniquet Use in Simulated First Aid

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John F. Kragh Jr, MD *; James K. Aden 3rd, PhD ; Connor D. Lambert ;
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Virgil K. Moore III, BBA ; Michael A. Dubick, PhD 1

ABSTRACT
Background: The effects of users, glove types, and tourniquet effort called “Stop The Bleed” advises people to “Protect
devices on the performance of limb tourniquet use in simu- yourself from blood-borne infections by wearing gloves, if
lated first aid were measured. Materials and Methods: Four available.” Standard precautions are an approach to control
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users conducted 180 tests of tourniquet performance in eight infection by considering all human blood and certain other
glove groups compared with bare hands as a control. Results: body fluids to carry infectious pathogens like viruses, which
Among tests, 99% (n = 179) had favorable results for each of can cause diseases such as hepatitis. Besides hand hygiene,
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the following: effectiveness (i.e., bleeding control), distal pulse the use of personal protective equipment like gloves should
stoppage, and tourniquet placement at the correct site. How- be guided by the assessment of situational risks, including the
ever, only 90% of tests ended with a satisfactory result, which anticipated extent of personal contact with fluids. 7–10
is a composite outcome of aggregated metrics if all (patient
status is stable, tourniquet placement is good, and pressure is Beyond caregiving, military Servicepersons use an array of
good) are satisfactory. Of 18 unsatisfactory results, 17 (94%) glove types, such as cold-weather gloves with over-mittens in
were due to pressure problems. Most of the variance of the ma- arctic environments or tactical gloves for shooting. In a pre-
jority of continuous metrics (time to determination of bleed- vious study, we unwrapped tourniquets from their packages
ing control, trial time, overall time, pressure, and blood loss) while wearing gloves and compared this performance with do-
could be attributed to the users (62%, 55%, 61%, 8%, and ing the same with bare hands; the current study followed that
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68%, respectively). Glove effects impaired and slowed perfor- one to check performance in simulated caregiving.
mance; three groups (cold gloves layered under mittens, mit-
tens, and cold gloves) consistently had significant effects and Although nonsterile gloves are the most common type of per-
five groups (examination gloves, flight gloves, leather gloves, sonal protective equipment used in caregiving, there is little
glove liners, and glove liners layered under leather gloves) did science to help us understand how performance of manual
not. For time to bleeding control and blood loss, performance caregiving skills differs by the type of gloves worn. 12–20 We
using these same three glove groups had worse results com- looked at how results were affected by users, gloves, and tour-
pared with bare hands by 26, 18, and 17 seconds and by 188, niquets, with all three individually identified in this study. For
116, and 124mL, respectively. Device effects occurred only example, when a tourniquet had wear and tear after use, it
with continuous metrics and were often dominated by user was replaced by another device of the same model. Statisti-
effects. Conclusion: In simulated first aid with tourniquets cally, we could then compare effects of individual users, glove
used to control bleeding, users had major effects on most per- types, and devices. The purpose of this study was to measure
formance metrics. Glove effects were significant for three of the effects of users, glove types, and tourniquet devices on per-
eight glove types. Tourniquet device effects occurred only with formance of limb tourniquet use in simulated first aid.
continuous metrics and were often dominated by user effects.
Materials and Methods
Keywords: glove; mitten; manual skill; psychomotor perfor-
mance; tourniquet; first aid; hemorrhage, prevention and The study was a controlled experiment conducted following
control protocol guidelines at the US Army Institute of Surgical Re-
search from April to July 2016. The study followed our earlier
study involving the same persons, materials, and protocol.
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Introduction
There were nine glove groups. Bare hands were the control
In first aid training, learners are routinely taught to consider group. The eight experimental groups were (1) examination
precautions when rendering care, such as by donning clean gloves, (2) flight gloves, (3) glove liners, (4) leather gloves,
gloves to protect their hands from the blood of patients or (5) glove liners layered under leather gloves, (6) cold gloves,
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from injury on sharp spicules of bone. A US public safety (7) mittens, and (8) cold gloves layered under mittens. Four
*Correspondence to 3698 Chambers Pass, Joint Base San Antonio Fort Sam Houston, TX 78234-7767; or john.f.kragh.civ@mail.mil
1 Dr Kragh, Mr Moore, and Dr Dubick are at the US Army Institute of Surgical Research, where Dr Kragh is a researcher of bleeding control, Mr
Moore is a research associate in bleeding control, and Dr Dubick is a resuscitation researcher and is the manager of the Damage Control Resus-
citation task area. Dr Kragh also is an associate professor in the Department of Surgery, Uniformed Services University of the Health Sciences,
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Bethesda, MD. Dr Aden is a statistician at the Brooke Army Medical Center, Fort Sam Houston, TX. Cadet Lambert is a US Military Academy
cadet at West Point, NY, where he studies mechanical engineering.
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