Assessing Hemorrhage Control and Tourniquet Skills in School-Aged Children.

Objectives: Uncontrolled hemorrhage is the most preventable cause of death following traumatic injury; children may be called to act as bystanders when hemorrhage control is necessary. The earliest age that children can learn hemorrhage control remains undetermined. We aimed to identify whether children aged 8 to 12 years can identify when and how to use a combat application tourniquet (CAT) and can appropriately place and tighten it to achieve hemorrhage control. Methods: We conducted a prospective study of children aged 8 to 12 years old. A trained facilitator taught hemorrhage control and CAT placement on manikins in small group sessions. After each session, we assessed the comprehension and application skills of each participant using a standardized 4-question tool. If at least 60% of children within each age group correctly performed both comprehension (cognitive) and skills (psychomotor) assessments, the group was considered successful. We compared success rates between age groups and analyzed the association between performance and participant age, sex, and body mass index (BMI). Results: Of 326 eligible children, 322 completed the training and assessment (99%). Overall, 70% (225/322) of participants completed all 4 assessment questions correctly, 88% (284/322) of participants were able to answer both comprehension (cognitive) questions correctly, and 76% (246/322) of participants were able to accurately demonstrate both CAT placement skills (psychomotor) correctly. All age groups exceeded the 60% success rate in both assessments. Age, sex, and BMI were not significantly associated with assessment performance. Conclusion: Children as young as 8 years old can successfully learn hemorrhage control techniques and combat application tourniquet application, suggesting this training can begin as early as third grade.