Page 102 - JSOM Winter 2018

Corpsmen in the PCT group lost significantly less simulated TABLE 2 Outcome Measures
blood on the pressurized-cadaver hemorrhage model when Traditional Cadaver
compared with the TT group (PCT: 256mL versus TT: 355mL; Training Training
p = .01; Figure 4). There was no variation noted in the per- (n = 42 (n = 54
fused cadavers with regard to the measurements of pressure Outcome Measurements) Measurements) P Value
in the femoral artery occluded proximal to the injury by the Cadaver mean arterial 95 (1.7) 92 (2.7) .98
tourniquet (TT: 95mmHg versus PCT: 92mmHg; p = .9.) pressure, mmHg
Bleeding controlled 83 96 .03*
with first tourniquet, %
Corpsmen in both groups reported an increase in their self-re-
ported confidence in understanding the indications for and tech- Time to control of 45 (2.3) 39 (2.0) .01*
bleeding with first
nique of limb tourniquet application in extremity hemorrhage. tourniquet, sec
A statistically significant trend of improvement among those Position of first
trained in the PCT model was noted for improved confidence in tourniquet from apex 7.6 (0.7) 5.5 (0.2) .03*
the ability to place a tourniquet in extremity hemorrhage (p = of injury, cm
.06; Figure 5). Please see Table 2 for detailed results description. Achieved control with
second tourniquet, % 86 50 .41
FIGURE 4 Mean simulated blood loss was higher in the TT than the Time to control of
PCT. Standard error bars are shown as well. PCT, perfused-cadaver bleeding with two 99 (1.9) 76 (1.4) .12
training; TT, traditional training. tourniquets, sec
Total simulated blood 355 (30) 256 (21) .01*
loss, mL
Data are represented as mean (SEM) or percentages, where appropri-
ate. *Significant.

in the military (93%) and had taken TCCC training (>80%).
The TT group had more experience in tourniquet training
overall and on a cadaver-based model than did the PCT group.
Neither group, however, had significant experience in real-life
casualty tourniquet experience.

Despite this similar baseline background, the PCT group were
better able to control bleeding with the first tourniquet in the
perfused cadaver limb-hemorrhage model, although there was
no difference in overall ability to control hemorrhage (when
second tourniquet was used). In addition, the PCT group
FIGURE 5 Mean confidence scores as self-reported by the corpsmen was quicker to control bleeding with the first tourniquet and
using a survey and 5-point Likert scale (0 = no confidence to 4 = very lost less blood in their limb hemorrhage simulation scenar-
confident). Scores are reported for pre- and post-training, indications ios. Corpsmen in both groups were accurate in the location of
and technique for extremity tourniquets. Standard error bars are placement of the tourniquet. This is critically important when
shown. PCT, perfused-cadaver training; TT, traditional training.
compressing a bleeding vessel that might have retracted prox-
imally and allowing sufficient area in which to place a second
tourniquet, if needed.
The results of this study indicate not only that the technical
factors associated with limb tourniquet application improved
with a perfused-cadaver training model but also that corpsmen
in both groups had improved confidence in understanding the
indications for and technique of limb tourniquet application
for hemorrhage control. Those in the PCT arm, however,
trended toward significant improvement in self-reported con-
fidence in limb tourniquet application. The use of a simulated
bleeding, fresh-tissue model that allows for vessel compression
and real tissue manipulation may be a factor in improving the
trainees’ confidence in this lifesaving procedure. It has been
established in the psychology literature, however, that self-
estimation of confidence does not correlate directly with test
performance and ability. Self-evaluation instruments, such as
11
Discussion
the ones used in the current study, are best used for individual
The military medics or US Navy corpsmen in this study were self-analysis and personal reflection. As such, the corpsmen’s
12
a heterogeneous group of young people, mostly men (>80%). self-reported confidence in knowledge or technique does not
They were not new trainees; on average, they possessed almost necessarily indicate actual knowledge or skills gained.
8 years of military experience and at least one combat deploy-
ment. Although they did not have much civilian tourniquet Cadaver-based training has been shown to be superior to tradi-
training, nearly all had previously received tourniquet training tional simulation and slide-based lecture in teaching lifesaving

100 | JSOM Volume 18, Edition 4 / Winter 2018