Page 36 - JSOM Winter 2017

Glove effects on performance were found consistently with
three of eight glove types. Furthermore, performance times
(i.e., time to hemorrhage control, trial time, overall time) with
thicker gloves were generally slower than those with thinner
gloves. The thinnest glove type, examination gloves, resulted Figure 2 Four
in performance much like bare hands, whereas the thickest Components of
glove type, cold gloves layered under mittens, was significantly Best Care.
outperformed by bare hands. Glove effects were negative by
slowing and worsening performance, and three groups (cold
gloves, mittens, and cold gloves layered under mittens) of-
ten had significant effects, whereas others, like examination
gloves, flight gloves, and glove liners, had no significant ef- Best care can be seen as that type of pyramid with only four faces,
fects. For time to determination of bleeding control and blood each of which is a triangle, as shown in the diagram. For example,
tourniquet caregiving includes dynamic interplay of its components: a
loss, the glove effects for each of these same three groups were patient, a caregiver, a situation, and an intervention, as represented in
worse than bare hands. the pyramid. Each corner is a component, and each edge is a potential
interaction between components. Each component can change, which
may alter the status of any other component. In tourniquet use, the
Actionable insights about gloves include the following: (1) first change sought is in the patient: control of bleeding. The patient
instructors can underscore that, on average, first aid perfor- changes over time because of the intervention (tourniquet use) as the
mance while already wearing examination gloves is similar to limb under the tourniquet is compressed and gets smaller. A limb be-
performance with bare hands; (2) tactical instructors can un- coming smaller under the tourniquet over time can cause the wound
derscore that, on average, first aid performance while already to restart bleeding, another patient change. Such another change indi-
wearing tactical gloves like flight gloves is similar to perfor- cates a need for the caregiver to periodically recheck the patient and
the tourniquet to detect rebleeding early for prompt correction, such
mance with bare hands; and (3) instructors can inform users as by tightening the tourniquet more. This pyramid organizes many
that, on average, performance is worse with thicker gloves like observations in caregiving.
cold weather gloves. However, in this study, the time to don
gloves was not studied. Situations regarding gloves in standard with different levels of experience. Performance was biased to-
precautions are outlined in World Health Organization guid- ward user 1 because he owned the gloves, had the best fit, and
ance, although the guideline is hospital oriented. was most experienced user.
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Device effects in use of tourniquets were found only for con- Future directions for scholarly work are many. A literature re-
tinuous metrics and were minor because they were often domi- view of glove science, including textile and garment sciences,
nated by user effects. may find information relevant to operational medicine. The
operational medicine community may develop subject matter
The US Army reported in 2016 a new concept of tourniquet use experts in topics such as glove science (e.g., personal protec-
as four dynamically interrelated components: patient, caregiver, tive equipment topic assigned to the gear guy as a committee’s
situation, and intervention. Interaction among these compo- point man), skill development education, and talent manage-
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nents was represented schematically as a pyramid (Figure 2). ment. In this study, pressures were problematic yet varied little
Corners represented components and edges represented rela- by user; additional research may lead to an explanation. Other
tionships between components. Each component can change, directions are listed in Table 4.
and any change may affect any other component. The pyramid
alters the perception from just seeing the tourniquet to look- Table 4 Other Directions for Research
ing at each component and at each interaction between com- Control groups can be either negative (bare hands) or positive
ponents. It is easy for people to repeat that tourniquets save (examination gloves).
lives. 38,39 Tourniquets do not save people. People save people. Survey instructors and course directors for precautions practiced,
A person uses a tourniquet. A tourniquet is just a tool. It is not problems with compliance, and awareness challenges (e.g.,
comprehension of precaution guidelines or glove science).
magic. In the end, lifesaving is about people. When we demys-
tify tourniquets in this way for caregivers, they are empowered User performance assessments may be useful, especially if
conducted locally.
as they realize that it makes sense, and they can learn this new Study time to don or doff gloves, performance effects, and benefits
skill like they learned prior skills. Furthermore, we paraphrase and risks to user and patient.
what educators have told us about the pyramid idea, “Well, Gloves as fomites may be worthy of study.
duh! Users are the focus and need help preparing for care. Other first aid interventions may have user effects worthy of analysis.
That’s why education exists.” The pyramid is a general way
to understand best care, and tourniquet use is one intervention Videotape survey of student compliance with precautions during
classes.
with substantial evidence illustrating such understanding. Measure duration of assessments of wounds, tourniquets, pulses,
bleeding, and patients.
The limitations of this study are based in its design as labora- Measure torques of rod required by hand dominance, sex, age, and
tory simulation and not caregiving in the wild. The findings number of hands used.
of this study pertain to the present methods, gloves, users, Study decisions or judgments under uncertainty while rendering
and tourniquet model, so readers should not extrapolate its first aid.
findings beyond that. The numbers of users, glove types, and Study the qualities of supervision of users.
tourniquet devices were limited, and so findings are not fully Study space-suit gloves, firefighter gloves, nuclear-biological-
generalizable. This study was a first attempt to compare glove chemical gloves, military cold-weather gloves, and medieval
types that may be used under different military situations and chainmail layered under armored gauntlet gloves among jousting
how gloves affect tourniquet performance as applied by users knight reenactors.

34 | JSOM Volume 17, Edition 4/Winter 2017