Evaluation of Makeshift Tourniquet Efficacy on a Simulated Model of an Exsanguinating Limb
Publication Date
July 2019
Location
LSU Health Medical Education Building
Document Type
Abstract
Start Date
26-7-2019 9:00 AM
End Date
26-7-2019 12:00 PM
Description
Background: Tourniquets are a device used in emergency situations to stop profuse bleeding. Tourniquets have been used for centuries using various techniques to achieve circumferential compression of the limb tissue in order to occlude the arterial flow upstream from the bleeding site. This simple technique is part of the Stop the Bleed (STB) campaign curriculum to educate the lay public as well as medical professionals in basic intervention skills to mitigate lifethreatening exsanguination. Although many different commercial tourniquets exist, these are often not available in emergency situations before professional first responders (EMS, Fire, Police) arrive. Creating a makeshift tourniquet from available material is theoretically easy and could help prevent further blood loss until that happens. However, it is unclear if a makeshift tourniquet might work as effectively or if the basic technique for making a tourniquet is able to be taught effectively to lay persons taking STB courses. The purpose of this study was to test whether a makeshift tourniquet is as effective and easy to use as the commercial army grade Combat Application Tourniquet (CAT). Methods: A simulated model of a thigh was designed and developed to test the effectiveness of makeshift tourniquets. The thigh model was built using materials with similar densities, size and consistencies of human limb tissue. Different types of commercially available material were used to construct the thigh model. The flow pressure through the simulated vessel was set to 150 mm/Hg, the systolic blood pressure of an average adult. The model was validated by professional emergency medical providers with experience treating patients with exsanguinating limb injuries (two Trauma surgeons and one Navy special operations medic with combat experience). Subjects were asked to apply each tourniquet type on the leg model to achieve cessation of flow (COF) through the simulated vessel in the model emptying into a reservoir that was visible. Each application was timed from the moment of picking up the material/tourniquet to cessation of flow of water into the reservoir. Pressure within the proximal vessel was maintained at 150mmHg using an IV pressure bag with a manometer. Each application was timed and recorded and the participants were given a five point questionnaire to fill out. First the CAT was tested in this manner. Next, a brief video was shown demonstrating the technique for making and applying a tourniquet from household materials and the participants were asked to perform the maneuver in a timed fashion on the ELS. Eight trained surgeons with trauma experience were tested in this manner. Data was collected on the time to COF and amount of fluid lost; basic comparative statistics were performed.
Recommended Citation
Beaulieu, Sara I., "Evaluation of Makeshift Tourniquet Efficacy on a Simulated Model of an Exsanguinating
Limb" (2019). Summer Research Internship Program. 3.
https://digitalscholar.lsuhsc.edu/srip/2019/undergrad/3
Evaluation of Makeshift Tourniquet Efficacy on a Simulated Model of an Exsanguinating Limb
LSU Health Medical Education Building
Background: Tourniquets are a device used in emergency situations to stop profuse bleeding. Tourniquets have been used for centuries using various techniques to achieve circumferential compression of the limb tissue in order to occlude the arterial flow upstream from the bleeding site. This simple technique is part of the Stop the Bleed (STB) campaign curriculum to educate the lay public as well as medical professionals in basic intervention skills to mitigate lifethreatening exsanguination. Although many different commercial tourniquets exist, these are often not available in emergency situations before professional first responders (EMS, Fire, Police) arrive. Creating a makeshift tourniquet from available material is theoretically easy and could help prevent further blood loss until that happens. However, it is unclear if a makeshift tourniquet might work as effectively or if the basic technique for making a tourniquet is able to be taught effectively to lay persons taking STB courses. The purpose of this study was to test whether a makeshift tourniquet is as effective and easy to use as the commercial army grade Combat Application Tourniquet (CAT). Methods: A simulated model of a thigh was designed and developed to test the effectiveness of makeshift tourniquets. The thigh model was built using materials with similar densities, size and consistencies of human limb tissue. Different types of commercially available material were used to construct the thigh model. The flow pressure through the simulated vessel was set to 150 mm/Hg, the systolic blood pressure of an average adult. The model was validated by professional emergency medical providers with experience treating patients with exsanguinating limb injuries (two Trauma surgeons and one Navy special operations medic with combat experience). Subjects were asked to apply each tourniquet type on the leg model to achieve cessation of flow (COF) through the simulated vessel in the model emptying into a reservoir that was visible. Each application was timed from the moment of picking up the material/tourniquet to cessation of flow of water into the reservoir. Pressure within the proximal vessel was maintained at 150mmHg using an IV pressure bag with a manometer. Each application was timed and recorded and the participants were given a five point questionnaire to fill out. First the CAT was tested in this manner. Next, a brief video was shown demonstrating the technique for making and applying a tourniquet from household materials and the participants were asked to perform the maneuver in a timed fashion on the ELS. Eight trained surgeons with trauma experience were tested in this manner. Data was collected on the time to COF and amount of fluid lost; basic comparative statistics were performed.
Comments
Mentor: Patrick Greiffenstein (MD), UMC, Department of Trauma Surgery