Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-05T14:12:51.471Z Has data issue: false hasContentIssue false
  • English
  • Français

Developing “Herd Immunity” in a Civilian Community Through Incorporation of “Just-In-Time” Tourniquet Application Training

Published online by Cambridge University Press:  28 August 2019

Cameron Marcus ,
Josef Pontasch ,
Joseph Duff ,
Trisha Khambadkone ,
Brian Fink ,
Corion Jones ,
Kristopher Brickman  and
Paul Rega
Cameron Marcus*
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Josef Pontasch
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Joseph Duff
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Trisha Khambadkone
Affiliation:
MS3 Medical Student, University of Toledo, Toledo, OhioUSA
Brian Fink
Affiliation:
Professor, School of Population Health, University of Toledo, Toledo, OhioUSA
Corion Jones
Affiliation:
Research Coordinator, University of Toledo, Toledo, OhioUSA
Kristopher Brickman
Affiliation:
Associate Dean of Innovation, University of Toledo, Toledo, OhioUSA
Paul Rega
Affiliation:
Assistant Professor, Director of EM Simulation Education & UTMC Medical Advisor for Disaster Preparedness, University of Toledo, Toledo, OhioUSA
*
Correspondence: Cameron Marcus, BS University of Toledo, Emergency Medicine 3000 Arlington Ave MS#1088 Toledo, Ohio USA 43614 E-mail: Cameron.marcus@rockets.utoledo.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Herd immunity, a concept normally applied in vaccinated populations, is a preventative measure to determine if a significant portion of a population can protect vulnerable individuals against a certain disease. Like vaccines, tourniquet education can be a form of herd immunity to protect vulnerable individuals in a population and prevent the loss of life from a peripheral hemorrhage. The authors have identified a deficiency in simple, quick, and effective hemorrhage control education. Therefore, to maximize herd immunity, the novel educational platform evaluates the efficacy of “Just-in-Time” (JiT) tourniquet application training.

Hypothesis/Problem:

The authors hypothesize that the utilization of JiT training will be effective in promoting both competence and confidence for individuals to utilize tourniquets in response to a disaster environment.

Methods:

This Institutional Review Board-approved study recruited medical students who were trained in hemorrhage control measures at a Level 1 Trauma Center. Tourniquet training sessions were held, and naïve civilians received tourniquet education. The subjects received a five- to ten-minute lesson on indications, contraindications, and application techniques of commercial and improvisational tourniquets. Participants subsequently applied a tourniquet to an instructor’s arm to demonstrate proper tourniquet application for a brachial artery hemorrhage. Pre- and post-educational surveys were completed to test participant competency and confidence.

Results:

Of the 104 subjects who completed the course, 97 had no prior training in hemorrhage control techniques, including commercial and improvisational tourniquet application. The mean pre-test score was 2.27/5.00 and the mean post-test score was 4.38/5.00, P <.001 (n = 97). When queried “How competent would you feel applying a tourniquet (commercial or improvisational) on an individual with a bleeding wound?” 92/97 felt confident (95%), one felt less confident, and four felt no difference in confidence levels (P <.001).

Conclusion:

Just-in-Time training is an effective method in teaching naïve civilians proper tourniquet application. This platform could serve as an alternative to more extensive training programs and requires less time, costs, and resources. If a significant number of individuals in a local community can effectively apply a tourniquet in a disaster scenario, a “herd immunity” effect could be achieved to control peripheral hemorrhages.

Keywords

disasterseducationherd immunitytourniquets
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 34 , Issue 5 , October 2019 , pp. 481 - 485
Copyright
© World Association for Disaster and Emergency Medicine 2019 

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

Kragh, JF, Swan, KG, Smith, DC, Mabry, RL, Blackbourne, LH. Historical review of emergency tourniquet use to stop bleeding. Am J Surg. 2012;203(2):242–252.CrossRefGoogle ScholarPubMed
Holcomb, JB, Butler, FK, Rhee, P. Hemorrhage control devices: tourniquets and hemostatic dressings. Bull Am Coll Surg. 2015;100(Suppl 1):66–71.Google ScholarPubMed
Butler, FK. The US Military experience with tourniquets and hemostatic dressings in the Afghanistan and Iraq conflicts. Bull Am Coll Surg. 2015;100(Suppl 1):60–65.Google Scholar
Kelly, JF, Ritenhour, AE, McLaughlin, DF, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003–2004 vs 2006. J Trauma. 2008;64(Suppl 2):S21–26.Google Scholar
Beekley, AC, Sebesta, JA, Blackbourne, LH, et al; 31st Combat Support Hospital Research Group.Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes.” J Trauma. 2008;64(2 Suppl):S28–37.CrossRefGoogle ScholarPubMed
Beekley, AC, Sebesta, JA, Blackbournbe, LH, et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect of hemorrhage control and outcomes. J Trauma. 2008;64(2 Suppl):S28–S37.CrossRefGoogle ScholarPubMed
Kragh, JF Jr., Walters, TJ, Westmoreland, T, et al. Tragedy into drama: a history of tourniquet use in the current war. J Spec Ops Med. 2013;13(3):5–25.Google ScholarPubMed
Teixeira, PG, Brown, CV, Emigh, B, et al. Civilian prehospital tourniquet use is associated with improved survival in patients with peripheral vascular injuries. J Am Coll Surg. 2018;226(5):769–776.CrossRefGoogle Scholar
Active Shooter Incidents in the United States from 2000–2017. US Department of Justice Federal Bureau of Investigation web site. https://www.fbi.gov/file-repository/active-shooter-incidents-2000-2017.pdf/view. Accessed April 5, 2019.Google Scholar
Levenson, E, Baldacci, M, Hanna, J. Doctor, pharmacy resident, and a police officer were the victims of the Chicago hospital shooting. CNN web site. https://www.cnn.com/2018/11/20/us/chicago-hospital-shooting-victims/index.html. Accessed April 5, 2019.Google Scholar
King, DR, Larentzakis, A, Ramly, EP; The Boston Trauma Collaborative. Tourniquet use at the Boston Marathon bombing: lost in translation. J Trauma Acute Care Surg. 2015;78(3):594Y599.CrossRefGoogle ScholarPubMed
McCarty, JC, Caterson, EJ, Chaudhary, MA, et al. Can they stop the bleed? Evaluation of tourniquet application by individuals with varying levels of prior self-reported training. Injury. 2019;50(1):10–15.CrossRefGoogle ScholarPubMed
Goolsby, C, Branting, A, Chen, E, et al. Just-in-time to save lives: a pilot study of layperson tourniquet application. Acad Emerg Med. 2015;22(9):1113–1117.CrossRefGoogle ScholarPubMed
Goralnick, E, Chaudhary, MA, McCarty, JC, et al. Effectiveness of instructional interventions for hemorrhage control readiness for laypersons in the public access and tourniquet training study (PATTS): a randomized clinical trial. JAMA Surg. 2018;153(9):791–799.CrossRefGoogle ScholarPubMed
Ross, EM, Redman, TT, Mapp, JG, et al. Stop the bleed: the effect of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehosp Disaster Med. 2018;33(2):127–132.CrossRefGoogle ScholarPubMed
Fine, P, Eames, K, Heymann, DL. “Herd Immunity:” a rough guide. Clin Infect Dis. 2011;52(7):911–916.CrossRefGoogle ScholarPubMed
Smith, PG. Concepts of herd protection and immunity. Procedia in Vaccinology. 2010;134–139.CrossRefGoogle Scholar
Hamasu, S, Morimoto, T, Kuramoto, N, et al. Effects of BLS training on factors associated with attitude toward CPR in college students. Resuscitation. 2009;80(3):359–364.CrossRefGoogle ScholarPubMed
Malta Hansen, C, Rosenkranz, SM, Folke, F, et al. Lay bystanders’ perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests. J Am Heart Asso. 2017:6(3):5.Google 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):442–445.CrossRefGoogle Scholar
Jacobs, LM, Burns, KJ, Langer, G, Kiewiet de, Jonge C. The Hartford Consensus: a national survey of the public regarding Bleeding control. J Am Col Surg. 2016;222(5):948–955.CrossRefGoogle ScholarPubMed
Ross, EM, Redman, TT, Mapp, JG, et al. Stop the bleed: the effect of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehosp Disaster Med. 2018;33(2):127–132.CrossRefGoogle ScholarPubMed
Rega, P, Bork, C, Chen, Y, Woodson, D, Hogue, P, Batten, S. Using an H1N1 vaccination drive-through to introduce healthcare students and their faculty to disaster medicine. Am J Disaster Med. 2010;5(2):129–136.CrossRefGoogle ScholarPubMed
Kaiser, HE, Barnett, DJ, Hayanga, AJ, Brown, ME, Filak, AT. Medical students’ participation in the 2009 novel H1N1 influenza vaccination administration: policy alternatives for effective student utilization to enhance surge capacity in disasters. Disaster Med Public Health Prep. 2011;5(2):150–153.CrossRefGoogle ScholarPubMed
Fitzgerald, TJ, Moulia, DL, Graitcer, SB, Vagi, SJ, Dopson, SA. 2015 pandemic influenza readiness assessment among US public health emergency preparedness awardees. Am J Public Health. 2017;107(S2):S177–S179.CrossRefGoogle ScholarPubMed
Chung, CA. Use of geographical information system data for emergency management points of distribution analysis with POD Locator 2.0. J Emerg Manag. 2017;15(2):99–105.CrossRefGoogle ScholarPubMed