P2B014: Establishing the Age at Which Children Can Apply a Combat Application Tourniquet (CAT) for Hemorrhage Control

Background: Uncontrolled hemorrhage is the single most preventable cause of death following a traumatic injury, occurring in 20% of civilian traumatic deaths. Overall, 50% of these deaths are deemed potentially preventable with adequate hemorrhage control. Emergency response plans across the United States are being reviewed and calls have been made to teach hemorrhage control techniques to children. The age at which children are able to understand the need and apply hemorrhage control techniques, including tourniquet placement, is unknown. This information could inform national recommendations on the appropriate age at which to teach this content. We aimed to identify the youngest age at which children can identify when and how to use a tourniquet and have the motor strength to tighten a tourniquet adequately to achieve hemorrhage control.

Methods: We conducted a prospective cohort study of children 8 to 12 years old in local schools from January 2023 – March 2023. Didactic training on hemorrhage control and tourniquet application was given to classes of 25 to 50 students. A trained facilitator provided hands-on instruction and practice to groups of 4 to 6 children in placement of a combat application tourniquet (CAT) on medical training manikins. They were then individually assessed on their cognitive and motor abilities to manage hemorrhage and place the tourniquet correctly. Correct tourniquet placement was defined as placing it 2 inches above the wound (not on a joint) and turning the windlass at least once with instructor unable to slide a tongue depressor underneath the tourniquet after the windlass was secured. Results were summarized with descriptive statistics and analyzed using one-way ANOVA. We defined a minimum acceptable success rate of 60% in all domains.

Results: 315 children were enrolled, 183 were male and 132 were female. The age distributions were 8-years-old (n=33), 9-years-old (n=63), 10-years-old (n=76), 11-years-old (n=88), and 12-years-old (n=55). Table 1 lists results. All age groups met the minimum acceptable success rate in both cognitive and motor domains. The differences between groups were only significant in the assessment of ability to tighten the tourniquet adequately, but this was driven by differences between the 10 and 11-year-old age groups.

Conclusion: Children 8-years-old and above can cognitively understand the concept of hemorrhage control, including use of a CAT, and are physically able to correctly place and tighten the tourniquet adequately.