The effect of cold hands on immediate responder's tourniquet application ability: A within-group trial

Abstract

Introduction

Cold exposure generally has a negative effect on tasks that rely on finger dexterity. It is not known if cold exposure will affect immediate responder's ability to perform first aid for life-threatening bleedings, specifically tourniquet application.

Study objective

This study investigates the effect of cold exposure on immediate responder's tourniquet application ability and their experienced stress.

Methods

29 adult participants completed a tourniquet application test in a baseline condition and three partial cold immersion conditions where their hands were immersed in near 0 °C water. The three conditions lowered the participant's hand-skin temperature to 16 °C, 12 °C and 8 °C, respectively. Tourniquet application was conducted on the leg of a rescue manikin and was measured using a procedural checklist. Time until bleeding control and total application time was also measured. Stress was measured using the Short Stress State Questionnaire.

Results

The results show that cold exposure, specifically lowering hand-skin temperature to 8 °C, significantly increases the time to bleeding control (Baseline: M 65.5 s, SD 17.0 s; 8 °C: M 76.9 s, SD 19.6 s) and total application time (Baseline: M 77.1 s, SD 18.0 s; 8 °C: M 89.6 s, SD 21.3 s). No effect was found on application quality in any of the cold exposure conditions. The experience of stress regarding the application of tourniquets in cold conditions showed an increase in task engagement (Normalized change score 0.87, 95% CI [0.55, 1.19]), a decrease in worry (Normalized change score -1.01, 95% CI [-1.35, -0.67]) and no change in distress (Normalized change score -0.02, 95% CI [-0.45, 0.41]).

Conclusion

Cold exposure can decrease the chance of survival for the injured person when an immediate responder provides first aid for a massive bleed. Future research should be aimed at finding suitable mitigation strategies for the effect and testing their viability in the presence of additional stressors.