Examining the Effects of Stress on Tourniquet Application in a Layperson and Professional Civilian Population

Sammanfattning: Every year, approximately 3000 people die as the result of physical trauma in Sweden (Gedeborg, Chen, Thiblin, & Byberg, 2012). Many of these deaths occurs outside of the hospital and are preventable, including some caused by hemorrhage. One hemorrhage control device is the tourniquet which can be used in a civilian pre-hospital setting. The effects of stress on a laypersons tourniquet application ability is unknown and to date only one study have examined the effects of stress on tourniquet application in a military population (Schreckengaust, Littlejohn, & Zarow, 2014). The purpose of this study was to investigate how the performance of two first aid interventions, tourniquet application and cardiopulmonary resuscitation (CPR), is affected by stress in immediate (layperson) and first (professional) responders. A total of 55 participants followed a brief educational program about hemorrhage control. Their ability to apply a tourniquet and perform CPR was tested in a calm classroom scenario and a stressful scenario, which consisted of paintball fire and an obstacle course. Stress was assessed through subjective reports of stress, physiological heart rate and heart rate variability measurements, and subjective workload and with a secondary task. The results showed differences of elicited stress reaction between the conditions and groups. Tourniquet and CPR performance was moderately affected by stress. Participants across all groups experienced more stress reactions during the stressful scenario, and laypersons did experience more stress reactions than professional first responders. In conclusion, the method did make participants experience more stress reactions in terms of psychological, physiological and performance adaptations in the stressful scenario. However, the results need to be replicated and a list of suggested improvements are given, such as: examining the fidelity of the scenarios, validating the tourniquet application assessment method, and examining the relationship between tourniquet application performance and self-assessed performance.