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Skill decay or maintenance between tourniquet uses among first aid caregivers: Exploration in a manikin model

      From 2013 to 2015, the number of civilian reports of emergency tourniquet use in the medical literature has increased [
      • Alpert EA
      • Lipsky AM
      • Elie ND
      • Jaffe E
      The contribution of on-call, volunteer first responders to mass-casualty terrorist attacks in Israel.
      ,
      • Meizoso JP
      • Valle EJ
      • Allen CJ
      • Ray JJ
      • Jouria JM
      • Teisch LF
      • et al.
      Decreased mortality after prehospital interventions in severely injured trauma patients.
      ,
      • Ode G
      • Studnek J
      • Seymour R
      • Bosse MJ
      • Hsu JR
      Emergency tourniquets for civilians: can military lessons in extremity hemorrhage be translated?.
      ,
      • Caterson EJ
      • Carty MJ
      • Weaver MJ
      • Holt EF
      Boston bombings: a surgical view of lessons learned from combat casualty care and the applicability to Boston's terrorist attack.
      ,
      • Eikermann M
      • Velmahos G
      • Abbara S
      • Huang PL
      • Fagan SP
      • Hirschberg RE
      • et al.
      Case records of the Massachusetts General Hospital. Case 11–2014. A man with traumatic injuries after a bomb explosion at the Boston Marathon.
      ,
      • Gates JD
      • Arabian S
      • Biddinger P
      • Blansfield J
      • Burke P
      • Chung S
      • et al.
      The initial response to the Boston marathon bombing: lessons learned to prepare for the next disaster.
      ,
      • Inaba K
      • Siboni S
      • Resnick S
      • Zhu J
      • Wong MD
      • Haltmeier T
      • et al.
      Tourniquet use for civilian extremity trauma.
      ,
      • Schroll R
      • Smith A
      • McSwain Jr., NE
      • Myers J
      • Rocchi K
      • Inaba K
      • et al.
      A multi-institutional analysis of prehospital tourniquet use.
      ,
      • Malo C
      • Bernardin B
      • Nemeth J
      • Khwaja K
      Prolonged prehospital tourniquet placement associated with severe complications: a case report.
      ,
      • Jacobs LM
      • Burns KJ
      • Priest HS
      • Muskett W
      Use of a tourniquet by LIFE STAR air medical crew: a case report.
      ,
      • Passos E
      • Dingley B
      • Smith A
      • Engels PT
      • Ball CG
      • Faidi S
      • et al.
      Canadian trauma trials collaborative. Tourniquet use for peripheral vascular injuries in the civilian setting.
      ,
      • King DR
      • Butler F
      • Kragh JF
      Re: tourniquet use at the Boston Marathon bombing.
      ,
      • King DR
      • Larentzakis A
      • Ramly EP
      Boston Trauma Collaborative
      Tourniquet use at the Boston Marathon bombing: lost in translation.
      ,
      • Kue RC
      • Temin ES
      • Weiner SG
      • Gates J
      • Coleman MH
      • Fisher J
      • et al.
      Tourniquet use in a civilian emergency medical services setting: a descriptive analysis of the Boston EMS experience.
      ,
      • Zietlow JM
      • Zietlow SP
      • Morris DS
      • Berns KS
      • Jenkins DH
      Prehospital use of hemostatic bandages and tourniquets: translation from military experience to implementation in civilian trauma care.
      ]. Civilian law enforcement reports have also occurred during this time [
      • Robertson J
      • McCahill P
      • Riddle A
      • Callaway D
      Another civilian life saved by law enforcement-applied tourniquets.
      ,
      • Callaway DW
      • Robertson J
      • Sztajnkrycer MD
      Law enforcement-applied tourniquets: a case series of life-saving interventions.
      ]. Although expert reviewers of first aid science note that tourniquet data are weak, first aid use of limb tourniquets has become a consensus internationally as a skill recommended to be taught to everyone; such recommenders are the leading authorities including the American Heart Association, the American Red Cross, the International Liaison Committee on Resuscitation, and President Obama's Administration (18, 19, https://www.whitehouse.gov/the-press-office/2015/10/06/fact-sheet-bystander-stop-bleed-broad-private-sector-support-effort-save, accessed Feb. 1, 2016; http://www.dhs.gov/stopthebleed, accessed Feb. 1, 2016). In 2014 and 2015, preliminary reports of tourniquet training started addressing relevant issues, but much remains unknown or unclear, such as whether skill of tourniquet users may decay over time [
      • Singletary EM
      • Charlton NP
      • Epstein JL
      • Ferguson JD
      • Jensen JL
      • MacPherson AI
      • et al.
      Part 15: first aid: 2015 American Heart Association and American Red Cross guidelines update for first aid.
      ,
      • Zideman DA
      • Singletary EM
      • De Buck ED
      • Chang WT
      • Jensen JL
      • Swain JM
      • et al.
      Part 9: first aid: 2015 international consensus on first aid science with treatment recommendations.
      ,
      • Schreckengaust R
      • Littlejohn L
      • Zarow GJ
      Effects of training and simulated combat stress on leg tourniquet application accuracy, time, and effectiveness.
      ,
      • Jacobs LM
      • Burns KJ
      Tourniquet application training for individuals with and without a medical background in a hospital setting.
      ]. The purpose of the present study is to explore skill decay in tourniquet use in order to provide 1) initial information on a technique of measurement, and 2) preliminary guidance for instruction of users.
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