Intuitive Placement of Three Tourniquet Types by Laypersons: A Pilot Study

Introduction—The “Stop the Bleed” campaign in the United States advocates for nonmedical personnel to be trained in basic hemorrhage control and for “bleeding control kits” to be available in high-risk areas. However, it is not clear which tourniquets are most effective in the hands of laypersons. The objective of this pilot study was to determine which tourniquet type was the most intuitive for a layperson to apply correctly.

Methods—This project is a randomized study derived from a “Stop the Bleed” initiative conducted by the University of Texas Health San Antonio Emergency Medical Services Office of the Medical Director between September 2016 and March 2017. Novice tourniquet users were randomized to apply one of three commercially available tourniquets—Combat Action Tourniquet (CAT; North American Rescue), Ratcheting Medical Tourniquet (RMT; M2 Inc.); or Stretch Wrap and Tuck (SWAT-T; TEMS Solutions)—in a controlled setting. Subjects with formal medical certification, prior military service and/or prior training with tourniquets were excluded from participation. The primary outcome of this study was successful tourniquet placement.

Results—Of 236 possible participants, 198 (80.5%) met the eligibility criteria. Demographics were similar across groups. The rates of successful tourniquet application for the RMT, SWAT-T and CAT were 23.4%, 10.6%, and 16.9% respectively (p=0.149). The most common causes of application failure were: inadequate tightness (74.1% [120/162]); improper placement technique (44.4% [72/162]); and incorrect positioning (16.7% [27/162]). The speed of application was not associated with successful placement (p=0.522).

Conclusion—This pilot study on the intuitive nature of applying commercially available tourniquets found unacceptable high rates of failure. Manufacturers must improve their tourniquets’ usability by the lay public before the widespread dissemination of tourniquets will have a significant public health effect.