Page 99 - JSOM Winter 2018

A Novel, Perfused-Cadaver Simulation Model
for Tourniquet Training in Military Medics

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Daniel Grabo, MD *; Travis Polk, MD ; Aaron Strumwasser, MD ; Kenji Inaba, MD ;
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Christopher Foran, MD ; Chase Luther, BS ; Michael Minneti, BS ; Shane Kronstedt, BS ;
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Alison Wilson, MD ; Demetrios Demetriades, MD, PhD 2
ABSTRACT
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Background: Exsanguinating limb injury is a significant cause associated with improved hemorrhage control and improved
of preventable death on the battlefield and can be controlled survival rates for combat casualties with major limb trauma
with tourniquets. US Navy corpsmen rotating at the Navy when applied in the prehospital setting and in the absence of
Trauma Training Center receive instruction on tourniquets. shock. In addition, the use of tourniquets is not associated
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We evaluated the effectiveness of traditional tourniquet in- with limb loss or adverse outcomes, including nerve palsies.
struction compared with a novel, perfused-cadaver, simulation Tourniquets are a critical component of the Tactical Combat
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model for tourniquet training. Methods: Corpsmen volun- Casualty Care (TCCC) paradigm currently practiced by the

teering to participate were randomly assigned to one of two US military. The application of tourniquets, moreover, is cur-
tourniquet training arms. Traditional training (TT) consisted rently the most common field intervention performed during
of lectures, videos, and practice sessions. Perfused-cadaver battlefield mass casualty events. 7
training (PCT) included TT plus training using a regionally
perfused cadaver. Corpsmen were evaluated on their ability to With the effectiveness and low complication risk of tourni-
achieve hemorrhage control with tourniquet(s) using the per- quet application firmly established, attention must turn to the
fused cadaver. Outcomes included (1) time to control hemor- existing training provided to our military personnel prior to
rhage, (2) correct placement of tourniquet(s), and (3) volume combat deployment for this lifesaving intervention. In a 2014
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of simulated blood loss. Participants were asked about confi- study, current training modalities used in the Combat Casu-
dence in understanding indications and skills for tourniquets. alty Care Course for US Navy medical personnel still yielded
Results: The 53 corpsmen enrolled in the study were randomly inferior accuracy, time, and effectiveness of tourniquet appli-
assigned as follows: 26 to the TT arm and 27 to the PCT arm. cation in simulated combat situations when compared with
Corpsmen in the PCT group controlled bleeding with the first classroom settings. In a recent review of tourniquet use by
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tourniquet more frequently (96% versus 83%; p < .03), were the military, Kragh and Dubick stated, “Training is today the
quicker to hemorrhage control (39 versus 45 seconds; p < .01), quintessential item to be addressed for tourniquet use: Op-
and lost less simulated blood (256mL versus 355mL; p < .01). timal user development is the most likely of all factors to
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There was a trend toward increased confidence in tourniquet improve outcomes.” There is a paucity of literature at this
application among all corpsmen. Conclusions: Using a per- time evaluating training modalities for tourniquet application,
fused-cadaver training model, corpsmen placed tourniquets yielding objective measurements that prove the efficacy of the
more rapidly and with less simulated-blood loss than their training prior to deployment.
traditional training counterparts. They were more likely to
control hemorrhage with first tourniquet placement and gain Students at the Navy Trauma Training Center (NTTC) at
confidence in this procedure. Additional studies are indicated the Los Angeles County and University of Southern Califor-
to identify components of effective simulation training for nia (LAC+USC) Medical Center in Los Angeles receive train-
tourniquets. ing in lifesaving battlefield procedures, including tourniquet
application. This is not a formal TCCC training course, but
Keywords: tourniquet; tactical combat casualty care; military traditional instructional modalities for tourniquet education
medics; perfused-cadaver training; high-fidelity simulation and training are used and include slide-based lectures that re-
training view indications, pertinent anatomy and technical instruction,
a video presentation on proper application, and practice ses-
sions in which the students place tourniquets on their training
partner and themselves.
Introduction
Exsanguinating limb injury is one of the most common causes The purpose of the current study was to evaluate the addition
of preventable death on the battlefield in the Global War of a novel, perfused-cadaver training model for providing su-
on Terror. Tourniquet use on the battlefield, however, is perior predeployment training to US Navy corpsmen in the
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*Correspondence to Daniel Grabo, MD, Division of Trauma, Acute Care Surgery, Surgical Critical Care, West Virginia University, Health Sci-
ences Center South, PO Box 9238, Morgantown, WV 26506 or daniel.grabo@hsc.wvu.edu
1 Drs Grabo and Wilson are at the Division of Trauma, Acute Care Surgery and Critical Care, West Virginia University, Morgantown, WV. Drs
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Polk, Strumwasser, Inaba, Foran, and Demetriades are at the Division of Acute Care Surgery, Keck School of Medicine of University of Southern
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California, Los Angeles, CA. Messrs Luther and Minneti are at the Keck School of Medicine of University of Southern CA. Mr Kronstedt is at
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the Joint Special Operations Medical Training Center, Fort Bragg, NC.
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