The Windlass Tourniquet: Is It Taking the Wind Out of the "Stop the Bleed" Sails?

Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois. Electronic address: victoria.schlanser@cookcountyhhs.org. Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois; Department of Surgery, Rush University, Chicago, Illinois. Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Emergency Medicine, Northwestern University, Chicago, Illinois. Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois; Department of Surgery, Midwestern University, Downers Grove, Illinois. Institute for Healthcare Innovation, Midwestern University, Downers Grove, Illinois. Department of Trauma and Burn Surgery, Cook County Health, Chicago, Illinois.

The Journal of surgical research. 2021;271:91-97
Abstract
BACKGROUND Civilians are often first-line responders in hemorrhage control; however, windlass tourniquets are not intuitive. Untrained users reading enclosed instructions failed in 38.2% of tourniquet applications. This prospective follow-up study replicated testing following Stop the Bleed (STB) training. MATERIALS AND METHODS One and six months following STB, first-year medical students were randomly assigned a windlass tourniquet with enclosed instructions. Each was given one minute to read instructions and two minutes to apply the windlass tourniquet on the TraumaFX HEMO trainer. Demographics, time to read instructions and stop bleeding, blood loss, and simulation success were analyzed. RESULTS 100 students received STB training. 31 and 34 students completed tourniquet testing at one month and six months, respectively. At both intervals, 38% of students were unable to control hemorrhage (P = 0.97). When compared to the pilot study without STB training (median 48 sec, IQR 33-60 sec), the time taken to read the instructions was shorter one month following STB (P <0.001), but there was no difference at 6 months (P = 0.1). Incorrect placement was noted for 19.4% and 23.5% of attempts at 1 and 6 months. Male participants were more successful in effective placement at one month (93.3% versus 31.3%, P = 0.004) and at six months (77.8% versus 43.8%, p = 0.04). CONCLUSIONS Skills decay for tourniquet application was observed between 1 and 6 months following STB. Instruction review and STB produced the same hemorrhage control rates as reading enclosed instructions without prior training. Training efforts must continue; but an intuitive tourniquet relying less on mechanical advantage is needed.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine