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

Abstract

Civilians are often first-line respondersin 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. 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 TraumaFXHEMO trainer. Demographics, time to read instructions andstop bleeding, blood loss, and simulation success were analyzed. 100students received STB training. 31and 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 shorterone 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 placementat one month (93.3% versus 31.3%, P=0.004) and at six months (77.8% versus 43.8%, p=0.04). Skills decay for tourniquet application was observed between 1 and 6 months following STB. Instruction review and STBproduced 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.