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Invited Commentary
July 24, 2019

Prehospital Hemorrhage Control—Leveraging Successes From Cardiac Arrest to Optimize Population-Level Effectiveness

Author Affiliations
  • 1Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado
  • 2School of Medicine, Department of Emergency Medicine, University of Colorado, Aurora
  • 3Department of Epidemiology, Colorado School of Public Health, Aurora
  • 4Department of Community and Behavioral Health, Colorado School of Public Health, Aurora
  • 5American Heart Association, Dallas, Texas
JAMA Surg. Published online July 24, 2019. doi:10.1001/jamasurg.2019.2276

In this issue of JAMA Surgery, McCarty et al1 report results from a well-done crossover randomized clinical trial of tourniquet application using a high-fidelity mannequin to simulate lower-extremity hemorrhage, specifically evaluating the effectiveness of the Bleeding Control Basic (B-Con) course and the ability of individuals to use 4 commercial tourniquets (ie, 2 windlass-based tourniquets, the Combat Application Tourniquet [CAT], and the Special Operations Forces Tactical Tourniquet [SOFT-T]), and 2 elastic tourniquets (Stretch-Wrap-and-Tuck Tourniquet and Rapid Application Tourniquet System), and an improvised tourniquet (ie, from gauze, a shoestring, a leather belt, and a piece of wood).1 A total of 102 participants were recruited immediately following completion of a B-Con course, where CAT was the only tourniquet specifically taught, and randomized to different sequences of tourniquet application, with correct placement (defined as a composite of adequate pressure, positioning, and timing) as the primary outcome and pressure, time, estimated blood loss, and understanding of the device as secondary outcomes. The CAT was correctly applied by 92% of participants, followed by the SOFT-T (69% of participants), the improvised tourniquet (32% of participants), and both elastic tourniquets (12% of participants each). Additionally, the CAT resulted in the highest obtained pressure, shortest time to placement, and least amount of blood loss. Participants demonstrated best understanding of both windlass-based tourniquets, followed by the improvised tourniquet.

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