Stopping Haemorrhage by Application of Randomised Compression or Tourniquet (SHARC-TWO)

Inguinal Fist Compression (IFC) The provider will place the fist of their dominant hand at the midpoint of the recipient’s inguinal canal, midway between the anterior superior iliac spine and the pubic symphysis. The leg used (left or right) for each data collection session will be determined by the ergonomics of each testing space and will be recorded. Maximal pressure will then be applied over the compression point as per the technique reported by Taylor and Lamond for up to five minutes (see below for complete description of this technique from the original paper). Commercially manufactured windlass tourniquet (CWT) The CWT used will be the Combat Application Tourniquet manufactured by C-A-T Resources. The provider will apply the CWT to the upper thigh of the recipient and the windlass rotated to and locked at the maximum tolerable tightness for the recipient. Application of the CWT will be over clothing as to emulate real world ultilsation for up to five minutes. Infographics Separate infographics were developed for the IFC and CWT which outline step-by-step instructions on the application of each intervention. The IFC infographic was adapted from the that used in the study conducted by Taylor and Lamond. The CWT infographic was adapted from the manufacturer’s instructions. Both infographics were tested in an initial pilot study and further developed with input from a consumer advisory group with members of the general population. Providers in this study will be exposed to these infographics immediately prior to application of each technique and also be available for reference during their application. Members of the research team will be supervising each episode of technique application but will not interfere or coach providers unless there is a concern for participant safety. There will be a 2-3 minute washout period between application by each provide during which the room will be reset and the sonographer will ensure return of normal blood flow to the leg. The protocol for inguinal compression from Taylor and Lamond (The SHARC study) was as follows: One member of the pair wearing shorts lay down supine on a mattress on the floor. The other volunteer in the pair then placed their fist at the compression point (midpoint of the inguinal canal, midway between the anterior superior iliac spine [ASIS] and pubic symphysis). Compression was then performed by the volunteer, by applying full bodyweight pressure through their fist over the compression point.