Page 14 - JSOM Spring 2020

Colonel Aboard Space Station to Enlist 800 the course teaches the underlying principles of tourniquet ap-
Army Recruits plication and course participants will be able to apply other
tourniquet types in an emergency.” This is incorrect. We have
Later this month 800 Army recruits will have to look to the elected to use only the windlass tourniquets, which are effec-
sky as they take an oath of enlistment. Astronaut Col Andrew tive, straightforward to apply, and widely available.
Morgan will swear in recruits via a broadcast that will be
shown in 100 locations. This is the first time in history where It is inappropriate to use devices not meeting the standards, and
a nationwide oath will be administered from the International requiring training on multiple tourniquets will add unnecessary
Space Station. The ceremony and a question and answer ses- confusion and cost. We agree with the authors that “consensus
sion will be streamed online and through Army Facebook recommendations should focus on deploying a singular tourni-
pages. A former Special Operations physician, Morgan is one quet design for which the largest proportion of the population
of three current Army astronauts and is working on the ISS has been trained.” The authors conclude that “BCon trainees
as a flight engineer. He was selected to become an astronaut may not be prepared to administer bleeding care as tourni-
in 2013 and then began his new career in 2015, where he has quet design evolves.” This will only occur if we fail to develop
since completed seven space walks.
equipment standards for publicly accessible bleeding control
kits based on current evidence. We support the development
of intuitive tourniquets, but training will still be required to
empower individuals to take action. To achieve the goal of zero
preventable deaths, the emergency care community must work
to adopt standards for universal training and equipment.
Eileen M. Bulger, MD, Lenworth Jacobs, MD,
Ronald M. Stewart, MD
Source: JAMA Surgery Published online November 13, 2019 E1
© 2019 American Medical Association. All rights reserved.

Source: US Army, Ronald Bailey. Measles Information for Servicemembers Traveling
https://www.army.mil/article/224806/
army_astronaut_launches_to_international_space_station With Families
Erika Edwards reports on December 9, 2019, NBC News, that
Bleeding Control Training for the Lay Public:
Keep it Simple “many young children traveling abroad aren’t receiving the
vaccines they need to protect them from measles, a study pub-
The following letter to the editor was published: As lead- lished Monday in JAMA Pediatrics finds.
ers of the American College of Surgeons (ACS) Committee
on Trauma Stop the Bleed Program, we write to address the Kids are more likely to be exposed to measles when travel-
article “Effectiveness of the American College of Surgeons ing internationally than when they are at home in the United
Bleeding Control Basic Training Among Laypeople Applying State, said study coauthor Dr Emily Hyle, an assistant profes-
Different Tourniquet Types: A Randomized Clinical Trial” sor of medicine at Harvard Medical School. Worldwide, mea-
by McCarty et al. The ACS Bleeding Control course (BCon) sles cases have risen steadily in recent years.
was developed in 2016 to prepare lay responders for bleed-
ing emergencies. This course was based on lessons learned by But children in the United States generally are not slated to be
the US military and adopted the windlass Combat Application fully vaccinated against the highly contagious virus until at
Tourniquet as the most widely used device with proven effi- least age 4. That means kids traveling overseas may need the
cacy. The Committee on Tactical Combat Casualty Care eval- MMR vaccine, which protects against measles, mumps and
uates the evidence supporting commercial tourniquets, and rubella, before it’s usually recommended in the United States.”
we advocate for devices meeting those standards. As of May
2019, the list of approved devices includes 5 windlass and 3 For more information see https://www.nbcnews.com /health
ratcheting types. Elastic tourniquets were not recommended. /kids-health/young-children-traveling-abroad-aren-t-getting
The BCon course, now with more than 60,000 instructors and -measles-vaccines-they-n1098071 for the remainder of her
1 million students trained, seeks to empower lay individuals report.
to act under stress and confer competence in bleeding control
skills. The skills must be easy to implement, akin to evolu- In addition, although babies are born with a certain level of
tion of cardiopulmonary resuscitation training to a hands-only immunity, thanks to antibodies passed from their mothers,
approach. This study demonstrates that BCon is effective in there is a period of time when older infants may be partic-
teaching bystanders to use windlass style tourniquets. Not sur- ularly vulnerable to measles exposure. A study published in
prisingly, it is not effective to teach tourniquets not covered in November 2019 found that newborns’ immunity to measles,
the training. This study also emphasizes the ineffectiveness of which is passed on from their mothers, wanes much sooner
improvised tourniquets that are not included in BCon, owing than previously thought—perhaps within 3 months. See
to high failure rates and risk of increased hemorrhage. The https://www.nbcnews.com/health/kids-health/babies-may-not
authors state, “the BCon course informs participants that -be-protected-mom-s-measles-immunity-long-n1087356 for
other commercial tourniquets exist, with the presumption that more information.

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