Page 16 - JSOM Winter 2023

TABLE 2 Answers to Seven Questions in Training Video
Applier-Tourniquet Experience (Any or No)
Question Answer Elements Required with Answers Scored as Incorrect/Inadequate
Why would you apply an Serious or life-threatening or severe Any Experience “to prevent further injury to a life-
emergency-use limb tourniquet? bleeding or to stop blood loss threatening injury on a limb”
No Experience “3 to 4 finger widths above the heart of
the injury”
Where would you place an Proximal to injury or closer to the heart No Experience “You would place an emergency-use limb
emergency-use limb tourniquet? or body than the injury or 3–4 fingers tourniquet 3–4 finger widths closer to the heart than the
or 2–3 inches closer to the heart or body injury and not on a limb.”
than the injury
How tight should you pull the As tight as possible or very tight Any Experience “to stop all blood flow to the limb – should
strap of an emergency-use limb indent the skin and then lose Doppler when fully secured
tourniquet? and tightened.”
Any Experience “till blood flow to the limb has stopped”
No Experience “tight enough to stop all blood flow”
What are two good techniques to Any two of: prevent slipping, pull Any Experience “pull the strap tight”
use when pulling the strap? parallel to limb surface at redirect, pull No Experience “pull perpendicular to the leg, straight”
using body weight, and secure the strap No Experience “secure and hold”
if needed
What indication should be visible Limb indentation or skin indentation Any Experience “bleeding has stopped”
when the strap is secured? No Experience “__”
No Experience “no slippage/rod secured/latch click 3 times”
When your hands are off a Tighter than when all blood flow 3 Any Experience and 4 No Experience had some version of:
completed application of an stopped or no bleeding or no pulse as tight as possible
emergency-use limb tourniquet, No Experience “there should be an indentation of the skin
how tight should the tourniquet be? where the tourniquet is”
No Experience “very”
What is a research indicator of Doppler or audible pulse Any Experience “color/indented leg”
blood flow? No Experience “?”

and removed each tourniquet 31–38 and placed the next assigned Applier Information
tourniquet. Sixty-four appliers with varying previous tourniquet experi-
ence (Figure 3A) were predominantly right-handed (n=61), fe-
This study occurred early in the COVID-19 pandemic. Every- male (n=46), and 18–22 years of age (n=59; remaining 5 were
one wore face masks. Clear plastic curtains separated appliers aged 28, 40, 55, 60, and 62 years). Answers to the questions
from recipients’ upper bodies and from researchers. (Table 2) indicated appliers remembered information pre-
sented in the training video. Of the 5.1% of answers missing
22
Application Process Scoring the required elements (Table 2), some had correct information
Videos were used for scoring application processes (Appendix for variations of the questions.
B). Research assistant pairs provided consensus scores; final
scores were determined by a researcher (PW). Major group- No appliers had a problem-free application of every tour-
ings from scoring are shown as the x-axis labels in Figure 2 niquet. There were 66 problem-free applications by 31
and are defined in Appendix C. appliers (Figure 2 and Figure 3B). As shown in Figure 3B,
more appliers (18 of 31 versus 13 of 33; p=.21) with any
Statistical Analysis tourniquet experience had more problem-free applications
To control for order effects, the orders of watching appli- (48 of 248 versus 18 of 264; p<.0001). Critical application
cation videos 14–21 and of tourniquet applications were sepa- problems were considered “Not Occluded at Done” and
rately randomized with 8 × 8 Latin squares using hamsterand “Not Correctly Secured at Done” (Figure 3C, 3D). In 3C,
wheel.com. more appliers (17 versus 12; p=.21) with any tourniquet ex-
perience had more occluded applications (225 versus 219;
Process scores were organized in Microsoft Office Ex- p=.013). In Figure 3D, more appliers (10 versus 1; p=.0023)
cel 2003 (Microsoft Corp., www.microsoft.com). Graph- with any tourniquet experience correctly secured tourni-
ing and statistical analyses were performed with GraphPad quets in more applications (203 versus 200; p=.11).
Prism, version 7.04 for Windows (GraphPad Software Inc.,
www.graphpad.com). Fisher exact and chi-square tests were Design-Related Mechanical Problems
used for contingency data with statistical significance set at Most application problems belonged to the applier (Figure 2),
p≤.05. but design-related mechanical problems occurred in 22 appli-
cations by 21 appliers (Figure 3E). Design-related problems
were similarly frequent in appliers with and without experi-
Results
ence (11 versus 10 appliers, p=.79; and 11 versus 11 applica-
The results are complex and discrete. The discussion section tions p>.9999, Figure 3E). The SOFTTW5 problem related to
will synthesize information from the results into messages re- mis-threading (Figure 2 filled red circles); the applier dislodged
garding tourniquet use in the field. the sliding piece from the redirect buckle, preventing strap

14 | JSOM Volume 23, Edition 4 / Winter 2023