PDF(Pubmed)
Abstract：
BACKGROUND: Bleeding remains the leading cause of potentially preventable deaths both in military and civilian pre-hospital trauma settings. Conventional extremity tourniquets do not control bleeding if an iliac artery or a common femoral artery is injured. Stopping junctional bleeding is particularly challenging and requires the use of specifically designed junctional tourniquets. SAM® Junctional Tourniquet (SJT®, United States of America) and Tactical Abdominal Junctional Tourniquet (T-AJT®, Fora Group Türkiye) have been actively used by Turkish security forces. This study questioned the effect of training on combat medics\' successful junctional tourniquet applications and application times (AT).
METHODS: Our research on two different junctional tourniquet models was designed as a prospective randomized, crossover, single-blinded study. All 40 participants in the study were attendees of a 12-week combat medic training course with updated medical approvals, which were used as an eligibility criterion. Randomization was performed by drawing T-AJT®-SJT cards. The study consisted of pretraining and after-training tourniquet application phases. In each study phase, all participants\' AT and the presence or absence of arterial flow were recorded for each group. Finally, the combat medics were presented with a 6-question survey.
RESULTS: Although training increased successful T-AJT® application rates, training was not statistically significantly associated with successful applications for any tourniquet types (p>0.05). The pretraining phase ATs for SJT® and T-AJT® were 55±11.8 and 93.8±2.9 seconds, respectively, and the difference was statistically significantly different (p<0.001). Likewise, after-training phase ATs for SJT® and T-AJT® were 49±22.6 and 79.2±17.5 seconds, respectively, and participants\' SJT® ATs were significantly shorter (p<0.001). Overall, when participants\' applied any of the tourniquet unsuccessfully, the odds of participants\' lower Visual Analogue Scale scores were 0.2 (95% CI [0.08, 0.49]. p<0.001).
CONCLUSIONS: Our study basically investigates the effects of training on effective tourniquet application. Unfortunately, our after-training success rates remained unsatisfactory when compared to other studies. This is also the first study on T-AJT® tourniquet application, and further studies on its efficacy are also required.
METHODS: Our research on two different junctional tourniquet models was designed as a prospective randomized, crossover, single-blinded study. All 40 participants in the study were attendees of a 12-week combat medic training course with updated medical approvals, which were used as an eligibility criterion. Randomization was performed by drawing T-AJT®-SJT cards. The study consisted of pretraining and after-training tourniquet application phases. In each study phase, all participants\' AT and the presence or absence of arterial flow were recorded for each group. Finally, the combat medics were presented with a 6-question survey.
RESULTS: Although training increased successful T-AJT® application rates, training was not statistically significantly associated with successful applications for any tourniquet types (p>0.05). The pretraining phase ATs for SJT® and T-AJT® were 55±11.8 and 93.8±2.9 seconds, respectively, and the difference was statistically significantly different (p<0.001). Likewise, after-training phase ATs for SJT® and T-AJT® were 49±22.6 and 79.2±17.5 seconds, respectively, and participants\' SJT® ATs were significantly shorter (p<0.001). Overall, when participants\' applied any of the tourniquet unsuccessfully, the odds of participants\' lower Visual Analogue Scale scores were 0.2 (95% CI [0.08, 0.49]. p<0.001).
CONCLUSIONS: Our study basically investigates the effects of training on effective tourniquet application. Unfortunately, our after-training success rates remained unsatisfactory when compared to other studies. This is also the first study on T-AJT® tourniquet application, and further studies on its efficacy are also required.
摘要：
背景：在军事和民用院前创伤环境中，出血仍然是潜在可预防死亡的主要原因。如果髂动脉或总股动脉受伤，常规的四肢止血带不能控制出血。停止交界性出血特别具有挑战性，需要使用专门设计的交界性止血带。SAM®连接止血带(SJT®,美利坚合众国）和战术腹部连接止血带（T-AJT®，Fora集团Türkiye）已被土耳其安全部队积极使用。这项研究质疑了训练对战斗医务人员成功应用和应用时间（AT）的影响。
方法：我们对两种不同交界性止血带模型的研究被设计为前瞻性随机，交叉，单盲研究。研究中的所有40名参与者都参加了为期12周的战斗军医培训课程，并获得了最新的医学批准。这被用作资格标准。通过绘制T-AJT®-SJT卡进行随机化。该研究包括训练前和训练后止血带应用阶段。在每个研究阶段,记录每组所有参与者的AT和有无动脉血流.最后,向战斗医务人员提交了一份6个问题的调查。
结果：尽管培训提高了T-AJT®的成功率，训练与任何类型止血带的成功应用均无统计学意义(p>0.05).SJT®和T-AJT®的预训练阶段AT分别为55±11.8和93.8±2.9秒，分别,差异有统计学意义(p<0.001)。同样，SJT®和T-AJT®的训练后阶段ATs分别为49±22.6和79.2±17.5秒，分别,参与者的SJT®ATs显著缩短（p<0.001）。总的来说,当参与者应用任何止血带失败时，参与者较低视觉模拟评分的几率为0.2(95%CI[0.08,0.49]。p<0.001)。
结论：我们的研究基本上调查了训练对有效使用止血带的影响。不幸的是,与其他研究相比,我们的训练后成功率仍不能令人满意.这也是T-AJT®止血带应用的第一项研究，还需要进一步研究其功效。
方法：我们对两种不同交界性止血带模型的研究被设计为前瞻性随机，交叉，单盲研究。研究中的所有40名参与者都参加了为期12周的战斗军医培训课程，并获得了最新的医学批准。这被用作资格标准。通过绘制T-AJT®-SJT卡进行随机化。该研究包括训练前和训练后止血带应用阶段。在每个研究阶段,记录每组所有参与者的AT和有无动脉血流.最后,向战斗医务人员提交了一份6个问题的调查。
结果：尽管培训提高了T-AJT®的成功率，训练与任何类型止血带的成功应用均无统计学意义(p>0.05).SJT®和T-AJT®的预训练阶段AT分别为55±11.8和93.8±2.9秒，分别,差异有统计学意义(p<0.001)。同样，SJT®和T-AJT®的训练后阶段ATs分别为49±22.6和79.2±17.5秒，分别,参与者的SJT®ATs显著缩短（p<0.001）。总的来说,当参与者应用任何止血带失败时，参与者较低视觉模拟评分的几率为0.2(95%CI[0.08,0.49]。p<0.001)。
结论：我们的研究基本上调查了训练对有效使用止血带的影响。不幸的是,与其他研究相比,我们的训练后成功率仍不能令人满意.这也是T-AJT®止血带应用的第一项研究，还需要进一步研究其功效。
