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Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher.
Prehosp Emerg Care 2020; :1-14PE

Abstract

Introduction: One of the greatest casualty-care improvements resulting from US military operations in Iraq and Afghanistan has been the reduction of preventable death from massive extremity hemorrhage - largely due to the widespread use of limb tourniquets. More recently, tourniquet use in civilian, prehospital settings has shown promise in reducing deaths in cases of catastrophic arterial limb hemorrhage. Telephone instructions by trained emergency medical dispatchers (EMDs) on applying an available tourniquet may help achieve such a benefit.

Objectives:

The objective of the study was to determine whether layperson callers can effectively stop simulated bleeding using an improvised or a commercial tourniquet, when provided with scripted instructions via phone from a trained protocol-aided EMD.

Methods:

This was a prospective, randomized trial involving layperson volunteers, done at four locations in Salt Lake City, Utah, USA. Volunteers were assigned randomly to three groups: one for each of two commonly available commercial tourniquets and one for an improvised tourniquet.

Results:

A total of 246 subjects participated in the study at the four locations between February 11, 2019 and June 22, 2019. The overall median time for all trials (i.e., elapsed time from the start to the end of the simulation) was 3 minutes and 19 seconds. Median time to stop the bleeding (i.e., elapsed time from the start of the simulation to the time the participant was able to successfully stop the bleeding) was 2 minutes and 57seconds. Median tourniquet pressure was 256 mmHg and median-end blood loss was 1,365 mL. A total of 198 participants (80.49%) were able to completely stop the bleeding while 16 participants (6.5%) had the tourniquet applied with some bleeding still occurring, and 32 participants (13.01%) exceeded the threshold of 2,500 mL of blood loss, resulting in the "patient" not surviving.

Conclusions:

The study findings demonstrated that untrained bystanders provided with instructions via phone from a trained Emergency Medical Dispatcher applied a tourniquet and successfully stopped the bleeding completely in most cases.

Authors+Show Affiliations

International Academies of Emergency Dispatch, Clinical Research and Standards, Salt Lake City, United States.International Academies of Emergency, Salt Lake City, United States.International Academies of Emergency Dispatch, Salt Lake City, United States.International Academies of Emergency Dispatch, Salt Lake City, United States. Miami University, Oxford, 45056 United States.International Academies of Emergency Dispatch, Salt Lake City, United States. University of Utah, College of Social Work, Salt Lake City, 84112-9057 United States.International Academies of Emergency Dispatch, Salt Lake City, United States. Western Governors University, Salt Lake City, 84107-3280 United States.OnStar, Detroit, United States.Priority Solutions, Salt Lake City, United States.International Academies of Emergency Dispatch, Clinical Research and Standards, 139 East South Temple, Suite 200, salt lake city, 84111 United States.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31961756

Citation

Scott, Greg, et al. "Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions From an Emergency Medical Dispatcher." Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 2020, pp. 1-14.
Scott G, Olola C, Gardett MI, et al. Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher. Prehosp Emerg Care. 2020.
Scott, G., Olola, C., Gardett, M. I., Ashwood, D., Broadbent, M., Sangaraju, S., ... Clawson, J. J. (2020). Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher. Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, pp. 1-14. doi:10.1080/10903127.2020.1718259.
Scott G, et al. Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions From an Emergency Medical Dispatcher. Prehosp Emerg Care. 2020 Jan 21;1-14. PubMed PMID: 31961756.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ability of Layperson Callers to Apply a Tourniquet Following Protocol-Based Instructions from an Emergency Medical Dispatcher. AU - Scott,Greg, AU - Olola,Christopher, AU - Gardett,Marie Isabel, AU - Ashwood,Daniel, AU - Broadbent,Meghan, AU - Sangaraju,Srilakshmi, AU - Stiegler,Paul, AU - Fivaz,Conrad, AU - Clawson,Jeff J, Y1 - 2020/01/21/ PY - 2020/1/22/entrez PY - 2020/1/22/pubmed PY - 2020/1/22/medline SP - 1 EP - 14 JF - Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors JO - Prehosp Emerg Care N2 - Introduction: One of the greatest casualty-care improvements resulting from US military operations in Iraq and Afghanistan has been the reduction of preventable death from massive extremity hemorrhage - largely due to the widespread use of limb tourniquets. More recently, tourniquet use in civilian, prehospital settings has shown promise in reducing deaths in cases of catastrophic arterial limb hemorrhage. Telephone instructions by trained emergency medical dispatchers (EMDs) on applying an available tourniquet may help achieve such a benefit.Objectives: The objective of the study was to determine whether layperson callers can effectively stop simulated bleeding using an improvised or a commercial tourniquet, when provided with scripted instructions via phone from a trained protocol-aided EMD.Methods: This was a prospective, randomized trial involving layperson volunteers, done at four locations in Salt Lake City, Utah, USA. Volunteers were assigned randomly to three groups: one for each of two commonly available commercial tourniquets and one for an improvised tourniquet.Results: A total of 246 subjects participated in the study at the four locations between February 11, 2019 and June 22, 2019. The overall median time for all trials (i.e., elapsed time from the start to the end of the simulation) was 3 minutes and 19 seconds. Median time to stop the bleeding (i.e., elapsed time from the start of the simulation to the time the participant was able to successfully stop the bleeding) was 2 minutes and 57seconds. Median tourniquet pressure was 256 mmHg and median-end blood loss was 1,365 mL. A total of 198 participants (80.49%) were able to completely stop the bleeding while 16 participants (6.5%) had the tourniquet applied with some bleeding still occurring, and 32 participants (13.01%) exceeded the threshold of 2,500 mL of blood loss, resulting in the "patient" not surviving.Conclusions: The study findings demonstrated that untrained bystanders provided with instructions via phone from a trained Emergency Medical Dispatcher applied a tourniquet and successfully stopped the bleeding completely in most cases. SN - 1545-0066 UR - https://www.unboundmedicine.com/medline/citation/31961756/Ability_of_Layperson_Callers_to_Apply_a_Tourniquet_Following_Protocol-Based_Instructions_from_an_Emergency_Medical_Dispatcher L2 - http://www.tandfonline.com/doi/full/10.1080/10903127.2020.1718259 DB - PRIME DP - Unbound Medicine ER -