1
|
Barcala Furelos R, Schmidt A, Manteiga Urbón J, Aranda García S, Otero-Agra M, di Tullio N, de Oliveira J, Martínez Isasi S, Fernández-Méndez F. Aquatic Feasibility of Limbs Application of Tourniquets (AFLAT) during a Lifeguard Water Rescue: A Simulation Pilot Study. Prehosp Disaster Med 2024; 39:52-58. [PMID: 38328881 DOI: 10.1017/s1049023x24000050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Control of massive hemorrhage (MH) is a life-saving intervention. The use of tourniquets has been studied in prehospital and battlefield settings but not in aquatic environments. OBJECTIVE The aim of this research is to assess the control of MH in an aquatic environment by analyzing the usability of two tourniquet models with different adjustment mechanisms: windlass rod versus ratchet. METHODOLOGY A pilot simulation study was conducted using a randomized crossover design to assess the control of MH resulting from an upper extremity arterial perforation in an aquatic setting. A sample of 24 trained lifeguards performed two randomized tests: one using a windlass-based Combat Application Tourniquet 7 Gen (T-CAT) and the other using a ratchet-based OMNA Marine Tourniquet (T-OMNA) specifically designed for aquatic use on a training arm for hemorrhage control. The tests were conducted after swimming an approximate distance of 100 meters and the tourniquets were applied while in the water. The following parameters were recorded: time of rescue (rescue phases and tourniquet application), perceived fatigue, and technical actions related to tourniquet skills. RESULTS With the T-OMNA, 46% of the lifeguards successfully stopped the MH compared to 21% with the T-CAT (P = .015). The approach swim time was 135 seconds with the T-OMNA and 131 seconds with the T-CAT (P = .42). The total time (swim time plus tourniquet placement) was 174 seconds with the T-OMNA and 177 seconds with the T-CAT (P = .55). The adjustment time (from securing the Velcro to completing the manipulation of the windlass or ratchet) for the T-OMNA was faster than with the T-CAT (six seconds versus 19 seconds; P < .001; effect size [ES] = 0.83). The perceived fatigue was high, with a score of seven out of ten in both tests (P = .46). CONCLUSIONS Lifeguards in this study demonstrated the ability to use both tourniquets during aquatic rescues under conditions of fatigue. The tourniquet with the ratcheting-fixation system controlled hemorrhage in less time than the windlass rod-based tourniquet, although achieving complete bleeding control had a low success rate.
Collapse
Affiliation(s)
- Roberto Barcala Furelos
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
| | - Andrew Schmidt
- Department of Emergency Medicine, University of Florida-Jacksonville, Jacksonville, FloridaUSA
| | - José Manteiga Urbón
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
| | - Silvia Aranda García
- GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), University of Barcelona, Barcelona, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Martín Otero-Agra
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- School of Nursing, Universidade de Vigo, Pontevedra, Spain
| | - Nicolò di Tullio
- Sant'Anna School of Advanced Studies, Institute of Management, Piazza Martiri della Libertà, Pisa, Italy
| | - Joel de Oliveira
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- Surfing Medicine International, the Netherlands
| | - Santiago Martínez Isasi
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela-CHUS, Santiago de Compostela, Spain
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, Santiago de Compostela, Spain, University of Santiago de Compostela, Santiago de Compostela, Spain
- Faculty of Nursing, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Felipe Fernández-Méndez
- REMOSS Research Group, Facultade de CC. da Educación e do Deporte, Universidade de Vigo, Pontevedra, Spain
- School of Nursing, Universidade de Vigo, Pontevedra, Spain
| |
Collapse
|