Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use performance.
BACKGROUND
Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel.


METHODS
Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed. The educational intervention was to allocate the participants into a monthly tourniquet practice program: either a single-application practice (SAP) group or a triple-application practice (TAP) group. Each group practiced according to its program. After 3 months, the participants' tourniquet use performance was reassessed. Assessments were conducted using the HapMed Leg Tourniquet Trainer (CHI Systems, Fort Washington, PA), a mannequin which measures time and pressure.


RESULTS
A total of 151 participants dropped out, leaving 87 in the TAP group and 69 in the SAP group. On initial assessment, the TAP group and the SAP group performed similarly. Both groups improved their performance from the initial to the final assessment. The TAP group improved more than the SAP group in mean application time (faster by 18 vs 8 seconds, respectively; P = .023) and in reducing the proportion of participants who were unable to apply any pressure to the mannequin (less by 18% vs 8%, respectively; P = .009).


CONCLUSIONS
Three applications per monthly practice session were superior to one. This is the first prospective validation of a tourniquet practice program based on objective measurements.
Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: erez_br@yahoo.com.
Erez N
EN
Baruch
Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Surgery "A," Meir Medical Center, Kfar Saba, Israel. Electronic address: avi.benov@gmail.com.
Avi
A
Benov
Israel Defense Forces Medical Corps, Ramat Gan, Israel; Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel. Electronic address: avishina@yahoo.com.
Avi
A
Shina
Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: amylaurenberg@hotmail.com.
Amy L
AL
Berg
Israel Defense Forces Medical Corps, Ramat Gan, Israel; Orthopedic Division, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel. Electronic address: shlaifer.md@gmail.com.
Amir
A
Shlaifer
Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: elon.glassberg@gmail.com.
Elon
E
Glassberg
Damage Control Resuscitation, US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX, 78234. Electronic address: james.k.aden2.civ@mail.mil.
James K
JK
Aden
Israel Defense Forces Medical Corps, Ramat Gan, Israel; Department of Military Medicine, Hebrew University, Jerusalem, Israel. Electronic address: drtarifb@gmail.com.
Tarif
T
Bader
Damage Control Resuscitation, US Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX, 78234. Electronic address: john.f.kragh.civ@mail.mil.
John F
JF
Kragh
Israel Defense Forces Medical Corps, Ramat Gan, Israel. Electronic address: ayitzhak@gmail.com.
Avraham
A
Yitzhak
D000293:Adolescent; D004505:Education, Nonprofessional / Q000379:methods*; D005392:First Aid; D006801:Humans; D007557:Israel; D008297:Male; D008348:Manikins; D008889:Military Personnel / Q000193:education*; D011214:Practice, Psychological; D011312:Pressure; D011446:Prospective Studies; D000066908:Simulation Training; D013647:Task Performance and Analysis; D013997:Time Factors; D014111:Tourniquets; D055815:Young Adult