Ulus Travma Acil Cerrahi Derg. 2018; 24(1): 9-15 | DOI: 10.5505/tjtes.2017.84899

Bir simülasyon taktik ortamýnda turnike uygulamasýnýn deðerlendirilmesi

Tomasz Sanak¹, Robert Brzozowski², Marek Dabrowski³, Magdalena Kozak², Agata Dabrowska³, Maciej Sip³, Katarzyna Naylor⁴, Kamil Torres^4
1Department of Disaster Medicine and Emergency, Faculty of Anesthesiology and Intensive Therapy, Collegium Medicum, Jagiellonian University, Krakow-Poland
²Department of Battlefield Medicine, Military Institute of Medicine In Warsav-Poland
³Department of Disaster and Emergency Medicine, Poznan University of Medical Science, Poznan-Poland
⁴Department of Didactics and Medical Simulation, Chair of Human Anatomy, Medical University of Lublin-Poland

AMAÇ: Taktiksel ortamda turnike uygulamasý iki þekilde yürütülmüþtür: “kendi kendine yardým” denilen yaralýnýn kendisine turnike uygulamasý ve “arkadaþ yardýmý” denilen bir yardýmcýnýn turnike uygulamasý. Bu çalýþmanýn amacý bir yakýn harp simülasyon ortamýnda turnike kullanýmýnýn kalitesini test etmekti.
GEREÇ VE YÖNTEM: Çalýþmaya 24 “yaralý” ve tüm simülasyon çalýþmasýnda 72 uygulayýcý, altýþarlý 12 bölüm þeklinde katýldý. Turnike uygulamalarýný valide etmek için Yaralýlarýn Taktiksel Savaþ Ortamýnda Tedavisi Komitesi’nin önerilerinden yararlanýlmýþ turnike uygulamasýnýn hemodinamik etkisini deðerlendirmek için Doppler ultrason kullanýldý.
BULGULAR: Sonuçlar 15 uygulayýcýda kan akýmý durdurulmuþ, üç hastada çok az kan akým ve altý kiþide kýsýtlamasýz kan akýmý olduðunu göstermiþtir. Kiþilerin kendine veya baþka biri tarafýndan uygulanan turnike prosedürlerinin kaliteleri arasýnda herhangi bir anlamlý farklýlýk yoktu. Turnike ile koltuk altý arasýndaki ortalama mesafe kendi kendine veya baþkasýnýn uyguladýðý turnikelerde 9.5 cm idi. On altý olguda turnikenin kol dýþýndan baðlandýðý, yalnýzca sekiz olguda doðru biçimde kol içinden baðlandýðý gözlenmiþtir. On sekiz olguda taktiksel ortamda turnike doðru yerleþtirilmemiþ, yalnýzca altý olguda doðru yerleþtirilmiþtir. Ultrasonda negatif akým görülen uygulayýcýlarýn çoðunda DOP de negatifti. Ultrasonda tam kesintisiz akýmýn görüldüðü uygulayýcýlarýn çoðunda pozitif DOP saptanmýþtýr.
TARTIÞMA: Turnikelerin uygulanmasý uzmanlaþmýþ birimlerde bile zorluk yarattýðýndan bu iþlemin uygulanmasýna yönelik düzenli eðitim verilmesi gerekir.

Anahtar Kelimeler: Ateþ altýnda týbbi bakým, kanama; taktiksel alan tedavisi; turnike.

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Evaluation of tourniquet application in a simulatedtactical environment

Tomasz Sanak¹, Robert Brzozowski², Marek Dabrowski³, Magdalena Kozak², Agata Dabrowska³, Maciej Sip³, Katarzyna Naylor⁴, Kamil Torres^4
1Department of Disaster Medicine and Emergency, Faculty of Anesthesiology and Intensive Therapy, Collegium Medicum, Jagiellonian University, Krakow-Poland
²Department of Battlefield Medicine, Military Institute of Medicine In Warsav-Poland
³Department of Disaster and Emergency Medicine, Poznan University of Medical Science, Poznan-Poland
⁴Department of Didactics and Medical Simulation, Chair of Human Anatomy, Medical University of Lublin-Poland

BACKGROUND: Application of a tourniquet in a tactical environment is implemented in two ways: the so-called self-aid, which is the application of a tourniquet by the injured, and the so-called buddy aid, which is the application of a tourniquet by the person provide aid. This study aimed to test the quality of tourniquet use in a simulated situation, close quarter battle.
METHODS: The study involved 24 injured operators and 72 operators in the whole simulation, implying 12 sections of six individuals. To validate the application of tourniquets, the recommendations of the Committee of Tactical Combat Care of the Injured were used, and ultrasound with Doppler function was employed to assess the hemodynamic effect of applying tourniquets.
RESULTS: Native flow was observed in 15 operators; in three people, a trace flow was noticed, whereas in six people, a full flow was observed. No significant difference was found between the qualities of tourniquet application by the operators themselves compared with those of tourniquet application by another person. The median distance of tourniquet application from the armpit was 9.5 cm for self-aid and buddy aid. In 16 participants the outer arrangement of tourniquets was observed, and in only eight participants tourniquets were correctly located on the internal part of the arm. In 18 participants, tourniquets were not correctly prepared for use in the tactical environment, whereas in only six participants, they were correctly prepared. Most operators with a negative ultrasound flow revealed negative distal observed pulse (DOP). Positive DOP occurred in the majority of operators with full ultrasound flow.
CONCLUSION: The application of tourniquets poses a challenge even in case of specialized units; therefore, there is a need to provide regular training for implementing that procedure.

Keywords: Care under fire, hemorrhage; tactical field care; tourniquet.

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