Error Identification in Tourniquet Use : Error analysis of tourniquet use in trained and untrained populations

Abstract: The number of prehospital deaths caused by large bleedings could be decreased if civilian people would act in time to help the injured patient. One way to help is to stop the bleeding with a tourniquet application. However, the tourniquet needs to be placed correctly in order to stop the bleeding. Therefore laypersons need to be educated in bleeding control to increase the rate of successful tourniquet application. This study used human error identification techniques such as Hierarchical Task Analysis and Systematic Human Error Reduction and Prediction Approach to identify possible errors of four commonly used tourniquet models: the CAT-7, Delfi-EMT, SAM-X and SWAT-T. The results show that many predicted errors are time-oriented and critical. Video analysis of tourniquet application was performed to map occurred use errors from the videos with the predicted ones. The goal was to identify problems that could be solved by training or redesigns of the tourniquets. The results show that the most common errors for all participants during tourniquet application were of six error types. The errors were to not check time or write down time of application, to take too much time to place the tourniquet around the limb, to place the tourniquet upside down, to place the tourniquet band over the securing mechanism instead of between and lastly to not secure the tourniquet correctly before transporting the patient. The untrained laypersons made more errors than the trained laypersons and professional emergency personnel group. The trained laypersons also made fewer errors in a calm setting than in a stressed setting, comparing to the professional group who did the same error types in both settings. The results indicate that untrained laypersons not only make more errors but also more critical errors than trained laypersons and professional emergency personnel. Future research should empirically test other tourniquet models than the CAT in the goal of finding use errors to be reduced. Overall the results are in line with previous studies that show the need for education of bleeding control techniques in the civilian population.