Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-18T13:45:57.913Z Has data issue: false hasContentIssue false

Teaching and Evaluation Methods of the Use of the Tourniquet in Severe Limb Bleeding among Health Care Professionals: A Systematic Review

Published online by Cambridge University Press:  19 October 2021

María Sobrido-Prieto
Affiliation:
Departamento de Ciencias da Saúde, Universidade de A Coruña (UDC), A Coruña, Galicia, Spain
Santiago Martínez-Isasi*
Affiliation:
CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Galicia, Spain Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Spain Faculty of Nursing, Universidade de Santiago de Compostela, Spain
Marta Pérez-López
Affiliation:
Servicio de Urgencias, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas; Universidade da Coruña (UDC), A Coruña, Galicia, Spain
Felipe Fernández-Méndez
Affiliation:
CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Galicia, Spain Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Spain School of Nursing, Universidade de Vigo, Pontevedra, Spain REMOSS Research Group, Universidade de Vigo, Pontevedra, Galicia, Spain
Roberto Barcala-Furelos
Affiliation:
CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Galicia, Spain Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Spain REMOSS Research Group, Universidade de Vigo, Pontevedra, Galicia, Spain Faculty of Education and Sport Sciences, Universidade de Vigo, Pontevedra, Spain
Daniel Fernández-García
Affiliation:
Servicio de Radiología Vascular e Intervencionista, Hospital Universitario de León, Leon, Castilla y León, Spain
*
Correspondence: Santiago Martínez-Isasi Facultad de Enfermería Campus Norte, Avenida de Xoán XXIII, s/n 15782 Santiago de Compostela, Galicia, Spain E-mail: [email protected]

Abstract

Introduction and Objectives:

Massive hemorrhage (MH) is a growing pathology in military settings and increasingly in civilian settings; it is now considered a public health problem in the United States with large-scale programs. Tourniquets are the fastest and most effective intervention in MH if direct pressure is not effective.

The Liaison Committee on Resuscitation (ILCOR) recognizes a knowledge gap in optimal education techniques for first aid providers. This review aims to describe training and evaluation methods for teaching tourniquet use to both health care and military professionals.

Methods:

The MEDLINE, CINAHL, WEB of Science, and Scopus databases were reviewed (from 2010 through April 2020). The quality of the selected studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) scale. Studies that met at least 65% of the included items were included. Data were extracted independently by two reviewers.

Results:

Ten of the 172 articles found were selected, of which three were randomized clinical trials. Heterogeneity was observed in the design of the studies and in the training and evaluative methods that limit the comparison between studies.

Conclusions:

The results suggest that the training strategies studied are effective in improving knowledge, attitudes, and practical skills. There is no universal method, learning is meaningful but research should be directed to find out which ones work best.

Type
Systematic Review
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alberdi, F, García, I, Atutxa, L, Zabarte, M. Epidemiologia del trauma grave. Med Intensiva. 2014;38(9):580588.CrossRefGoogle Scholar
Latuska, KM, Graf, RL, Zwislewski, A, Meyer, LK, Nanassy, AD. Stop the bleed training improves knowledge, skills, and confidence among school nurses. J Contin Educ Nurs. 2019;50(11):501507.CrossRefGoogle ScholarPubMed
Bulger, EM, Snyder, D, Schoelles, K, et al. An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18(2):163173.CrossRefGoogle ScholarPubMed
Llau, JV, Acosta, FJ, Escolar, G, et al. Documento multidisciplinar de consenso sobre el manejo de la hemorragia masiva (documento HEMOMAS). Med Intensiva. 2015;39(8):483504.CrossRefGoogle Scholar
Rossaint, R, Bouillon, B, Cerny, V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition. Crit Care. 2016;20:100.CrossRefGoogle ScholarPubMed
Alonso-Algarabel, M, Esteban-Sebastià, X, Santillán-García, A, Vila-Candel, R. Utilización del torniquete en la asistencia extrahospitalaria: revisión sistemática. Emergencias. 2019;31(1):4754.Google Scholar
Doyle, GS, Taillac, PP. Tourniquets: a review of current use with proposals for expanded prehospital use. Prehosp Emerg Care. 2008;12(2):241256.CrossRefGoogle ScholarPubMed
Champion, HR, Bellamy, RF, Roberts, CP, Leppaniemi, A. A profile of combat injury. J Trauma. 2003;54(5 Suppl):S1319.Google ScholarPubMed
Hirsch, M, Carli, P, Nizard, R, et al. The medical response to multisite terrorist attacks in Paris. Lancet. 2015;386(10012):25352538.CrossRefGoogle ScholarPubMed
Zideman, DA, De Buck, ED, Singletary, EM, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 9. First aid. Resuscitation. 2015;95:278287.CrossRefGoogle ScholarPubMed
Jacobs, LM Jr. The Hartford Consensus III: implementation of bleeding control--if you see something do something. Bull Am Coll Surg. 2015;100(7):2026.Google Scholar
American College of Surgeons. Guidance for STOP THE BLEED Course Instructors. https://www.stopthebleed.org/training#public. Accessed May 18, 2021.Google Scholar
Butler, FK Jr., Holcomb, JB, Giebner, SD, McSwain, NE, Bagian, J. Tactical combat casualty care 2007: evolving concepts and battlefield experience. Mil Med. 2007;172(11 Suppl):119.CrossRefGoogle ScholarPubMed
Marcus, C, Pontasch, J, Duff, J, et al. Developing “herd immunity” in a civilian community through incorporation of “just-in-time” tourniquet application training. Prehosp Disaster Med. 2019;34(5):481485.CrossRefGoogle Scholar
Kleinman, ME, Perkins, GD, Bhanji, F, et al. ILCOR scientific knowledge gaps and clinical research priorities for cardiopulmonary resuscitation and emergency cardiovascular care: a consensus statement. Circulation. 2018;137(22):e802e819.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 2009;3(3):e123130.Google ScholarPubMed
Cobos-Carbó, A, Augustovski, F. Declaración CONSORT 2010: actualización de la lista de comprobación para informar ensayos clínicos aleatorizados de grupos paralelos. Med Clin (Barc). 2011;137(5):213215.CrossRefGoogle Scholar
Hart, D, Rush, R, Rule, G, et al. Training and assessing critical airway, breathing, and hemorrhage control procedures for trauma care: live tissue versus synthetic models. Acad Emerg Med. 2018;25(2):148167.CrossRefGoogle ScholarPubMed
Lei, R, Swartz, MD, Harvin, JA, et al. Stop the bleed training empowers learners to act to prevent unnecessary hemorrhagic death. Am J Surg. 2019;217(2):368372.CrossRefGoogle ScholarPubMed
Martinez, T, Duron, S, Schaal, JV, et al. Tourniquet training program assessed by a new performance score. Prehosp Disaster Med. 2018;33(5):519525.CrossRefGoogle ScholarPubMed
Sidwell, RA, Spilman, SK, Huntsman, RS, Pelaez, CA. Efficient hemorrhage control skills training for healthcare employees. J Am Coll Surg. 2018;226(2):160164.CrossRefGoogle ScholarPubMed
Jacobs, LM, Burns, KJ. Tourniquet application training for individuals with and without a medical background in a hospital setting. J Trauma Acute Care Surg. 2015;78(2):442445.CrossRefGoogle ScholarPubMed
Pajuelo Castro, JJ, Meneses Pardo, JC, Salinas Casado, PL, et al. “Evita Una Muerte, Esta en Tus Manos” program: bystander first aid training for terrorist attacks. J Spec Oper Med. 2017;17(4):133137.Google ScholarPubMed
Tsur, AM, Binyamin, Y, Koren, L, Ohayon, S, Thompson, P, Glassberg, E. High tourniquet failure rates among non-medical personnel do not improve with tourniquet training, including combat stress inoculation: a randomized controlled trial. Prehosp Disaster Med. 2019;34(3):282287.CrossRefGoogle Scholar
Andrade, EG, Hayes, JM, Punch, LJ. Stop the bleed: the impact of trauma first aid kits on post-training confidence among community members and medical professionals. Am J Surg. 2020;220(1):245248.CrossRefGoogle ScholarPubMed
Schreckengaust, R, Littlejohn, L, Zarow, GJ. Effects of training and simulated combat stress on leg tourniquet application accuracy, time, and effectiveness. Mil Med. 2014;179(2):114120.CrossRefGoogle ScholarPubMed
Schroll, R, Smith, A, Martin, MS, et al. Stop the bleed training: rescuer skills, knowledge, and attitudes of hemorrhage control techniques. J Surg Res. 2020;245:636642.CrossRefGoogle ScholarPubMed
Jacobs, LM, Burns, KJ, Langer, G, Kiewiet de Jonge, C. The Hartford Consensus: a national survey of the public regarding bleeding control. J Am Coll Surg. 2016;222(5):948955.CrossRefGoogle ScholarPubMed
Silverplats, K, Jonsson, A, Lundberg, L. A hybrid simulator model for the control of catastrophic external junctional hemorrhage in the military environment. Adv Simul (Lond). 2016;1:5.CrossRefGoogle ScholarPubMed