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As part of EU (Horizon 2020) HERoS program, UK-MED and PCPM compiled main operational difficulties faced by the two EMTs in 25 and seven COVID-19 deployments, respectively. In particular, the paper discusses the changing role of EMTs, as well as challenges faced in meeting high expectations of the respective Ministries of Health (MOH).
Objectives:
Documenting challenges faced by EMTs in COVID-19 response, lessons learned, and best practices.
Method/Description:
Review of mission reports; interviews with mission members; input from other EMTs (TBC).
Results/Outcomes:
The paper lists best practices of the two EMTs and recommendations to donors and EMT Secretariat, particularly linked to mission duration and collaboration with MOH.
Conclusion:
The paper lists best practices of the two EMTs and recommendations to donors and EMT Secretariat, particularly linked to mission duration and collaboration with MOH.
Field hospitals present an attractive solution for Emergency Medical Teams due to their portability and ease of assembly, yet are generally designed to be temporary, often leading to a gap until permanent facilities are restored after a sudden-onset disaster.
Objectives:
The objective of this paper is to understand the duration of field hospitals deployed to the 2010 Haiti Earthquake, identify the time taken to re-open permanent facilities, and propose approaches to better address this gap.
Method/Description:
Following a review of field hospital typologies and standards, a comparative study was conducted of five key field hospitals deployed to Haiti. Quantitative data from in-house reports, limited available studies, and mapping exercises were complemented with qualitative findings through interviews with key personnel. Additional data were collected for another 21 field hospitals, confirming the rough duration of 26 of the total 44 field hospitals deployed for Haiti. This was compared against information available on the re-opening of major permanent health care facilities.
Results/Outcomes:
The results indicated most field hospitals were decommissioned after two-to-six months. Some semi-permanent facilities opened in their wake, but not until 18-24 months. Permanent facilities started re-opening after approximately four years, however the main 500 bed hospital did not fully re-open until almost 10 years after the disaster.
Conclusion:
Provision of more durable, semi-permanent structures during early relief stages could better capture the initial funding impulse as well as reduce the gap of bed numbers as field hospitals reach the limit of their viable lifespan, lasting until more permanent facilities are re-opened often many years later.
The effectiveness of care provided by EMTs is directly linked to the ability to ensure a controlled, coordinated, and safe patient flow through the post, especially in case of MCIs or disease outbreak. Currently, there are neither frameworks nor tools to analyze such flow that is often visualized on paper using arrows or simply connected to the care pathway, thus missing the impact of people’s interactions with the facility.
Objectives:
This study aims at exploring the use of a behavioral-design-based approach in simulating patient flow through EMTs.1
Method/Description:
It provides a dynamic behavioral simulation model to assess the interactions between patients, staff members, and the related dynamic movements/interactions with the health care facility, each of them having specific features also in relation to the emergency condition faced.2 Data used in this study consist of literature-based information concerning patient characteristics (eg, age), the variation of expected medical conditions and severity in relation to the time and typology of the emergency,3 layouts of existing facilities (eg, UKMed T1), and experimental activities (eg, exercise).
Results/Outcomes:
The analysis of the results will allow to simulate different scenarios and improve the design of health care facilities layouts in order to prevent overcrowding situation, avoid disease spreading, estimate the optimal number of staff for each task, and investigate interactions between patients and staff.
Conclusion:
Optimizing patient flow encompasses quickly, efficiently, and effectively movement meeting the demand for care by moving patients through care pathways while improving coordination of care, patient safety, and health outcomes.
Health care delivery in refugee camps is challenging; the setting of a refugee camp is a unique context that presents barriers and one of the main problems is the fragmentation and difficulty in communication and information sharing among HCWs deployed in a camp, especially in contexts where communication networks are not always available and accessible.
Objectives:
The overall objective of this project is to facilitate health communications among health care workers in a refugee camp where the communication network is not always available or accessible.
Method/Description:
A mesh network communication system will be deployed, tested, and evaluated to assess and evaluate the usage, feasibility, and reliability of the system, testing the capacity of the message to reach different parts of the camp.
Results/Outcomes:
During the project’s initial phase, local health care workers (HCWs) will support the project in identifying instances when communication is challenging and will create injects/mock scenarios to use in the following phase. In the second phase, the application of the new technology is evaluated; experimental research will compare the “as is” of the system and the “to be” solution using the new technology measuring key performance indicators (KPIs) (eg, time needed to send/receive information).
Conclusion:
The use of an available, affordable, and usable mobile and internet connectivity system in a context where communication networks are not always available or accessible will facilitate the communication among agencies, improve the coordination of health services, and improve the quality and timing of information sharing.
The World Health Organization (WHO) declared climate change a defining issue in the 21st century with more intense heatwaves, higher risks of flooding and damaging storms, and a changing pattern of emerging infectious diseases. In this scenario, the response of Emergency Medical Teams (EMTs) to disasters represents a fundamental resource.
Objectives:
To expand EMT2-ITA-Regione Piemonte operational independence and to minimize its environmental footprint.
Method/Description:
A multiphasic and prospective project is planned in order to:
(1) Reduce water consumption: use of a sterilizer designed with a set of high-efficiency heat exchangers enabling a substantial saving in water consumption by the vacuum pump and a significant reduction of total water usage through a recirculation system.
(2) Reduce demand for diesel: photovoltaic (PV) system to integrate the current energy production system based on diesel generators.
(3) Reduce paper consumption: use of sterilization management and traceability system and computerized medical record in order to be paperless.
(4) Improve staff awareness and education on greening practices: educational program for the staff focused on waste segregation/management and energy and water saving both in the hospital and in the Base of Operation (BoO).
Results/Outcomes:
EMT2-ITA-Regione Piemonte aims to reduce energy and water consumption by 30% and to become paperless.
Conclusion:
Advances in greening initiatives offer to EMT2-ITA-Regione Piemonte the potential to improve its disaster medical response capabilities and to reduce its ecological footprint.
Many Pacific governments have committed to establishing deployable, self-sufficient national EMTs following recent tropical cyclones, measles outbreaks, and the COVID-19 pandemic. However, for much of the COVD-19 pandemic, PICs have closed international borders limiting in-person team member training.
Objectives:
To develop a remote, interactive EMT training series to engage current and prospective EMT team members in the PICs during the COVID-19 pandemic.
Method/Description:
From July through September 2021, WHO hosted a weekly webinar series to introduce the concepts of the EMT Initiative to current and prospective EMT team members in the PICs. The sessions utilized Pacific deployment experience using faculty from EMTs in Australia, Fiji, New Zealand, Papua New Guinea, Solomon Islands, Tonga, and Vanuatu.
Results/Outcomes:
Attendees from over 23 countries from across the Pacific and other areas of the world participated in the 11 sessions, with a total of over 300 individual participants. The average number of participants per sessions was 85. Feedback was sought after every session. The most significant adaptation of the sessions from the feedback was incorporating the Pacific tradition of talanoa, or storytelling, into the sessions.
Conclusion:
Adapting the session plans to incorporate the talanoa style of communication in the Pacific created an environment of learning from colleagues throughout the Pacific and increased participant engagement in the virtual setting. The webinar series provided knowledge of EMT basics and increased engagement and excitement in the establishment and continued growth of EMTs in the Pacific.
As natural disasters continue to cause human suffering and contribute to health inequalities, Mobile Health Units (MHU) provide medical aid to people deprived of health care. However, the service modality has received criticism related to logistical difficulties, irregular service provision, and adaptability. Although MHUs may be of value, there is a significant knowledge gap regarding their usefulness on addressing health needs in natural disasters.
Objectives:
To elucidate the use of MHUs in natural disasters in adherence to WHO Classification for Emergency Medical Teams.
Method/Description:
A scoping review was conducted following the framework by Arksey and O’Malley. Twenty-six bibliographic databases and websites were screened for white and grey literature published from 2000-2021 reporting on the use of MHUs in natural disasters.
Results/Outcomes:
Thirteen publications were included in the final analysis, highlighting seven themes: key characteristics, services, staff, benchmark indicator, operational availability, self-sufficiency, and pre-deployment preparedness. All documents described the mobile approach to increase access to health services in the absence of regular health care. MHUs were mostly reported to provide out-patient care with medical needs primarily related to non-communicable diseases. Basic trauma care was less reported on. The main challenges concerned transportation, coordination, and communication.
Conclusion:
Data on the use of MHUs in natural disasters are scarce with inconsistent reporting of key aspects. The literature adhered to previous research and WHO guidelines to some extent. Further research is deemed necessary to evaluate the interventions and outcomes of MHUs following natural disasters.
Natural and man-made catastrophes have caused significant destruction and loss of lives throughout human history. Disasters accompany various events with multiple causes and consequences, often leading to a cascade of health-related events. Ethiopia, amongst the developing countries in the horn of Africa, is vulnerable to natural and man-made disasters. Over the last few years, Ethiopia learned the hardest way to transform its disaster management from a mere apparatus of response and recovery to preparedness and mitigation.
Objectives:
Review the challenges and opportunities for establishing the Ethiopian EMT and its disaster response experience.
Method/Description:
This was a mixed-methods, cross-sectional Intra-Action Review of activities of country EMT. It included a review of documents and key informant interviews. All data were analyzed thematically.
Results/Outcomes:
In May 2022, the Ethiopian Federal MOH, in collaboration with WHO, adapted the WHO EMT initiative to tackle the identified challenges. Ethiopia’s EMT implementation plan was created, which included ten steps and 50 detailed activities. This initiative aims to have a classified Type I fixed EMT in the coming six months. Based on the objective evaluation of the last four months’ performance toward plan implementation, activities show that 65% of the overall plan has been completed.
Conclusion:
Implementing the EMT initiative in Ethiopia has positively impacted the clinical quality of care, enhanced coordination, and improved health outcomes for the population served at times of great need. However, the implementation requires collaboration in support, guidance, and experience sharing from stakeholders and partners, including twinning with other organizations.
Papua New Guinea (PNG) is a Pacific nation of over nine million. It is one of the world’s most diverse nations, with over 800 languages and geographic diversity that includes both tropical islands and highland mountains. Located on the Pacific “ring of fire,” PNG is regularly struck by disasters and outbreaks. The COVID-19 pandemic triggered multiple deployments of international EMTs to PNG, which were coordinated through a national EMT Coordination Cell. To strengthen rapid, national response to future emergencies, the PNG Government through its National Department of Health is now developing the “PNG EMT.”
Objectives:
To describe the development of the PNG EMT.
Method/Description:
PNG’s national EMT development was inspired by multiple international EMT deployments, including the 2018 Highlands earthquake and multiple COVID-19 deployments. With support from WHO, PNG’s National Department of Health led EMT coordination efforts in those responses, and recognized the need for similar capabilities to be developed for national response.
Results/Outcomes:
To develop the PNG EMT, a focal point was appointed, a national technical working group was formed, and SOPs have been drafted with support from WHO and partners. In consultation with PNG and other Pacific EMTs, WHO is procuring a tailored Pacific EMT cache, including items specifically selected for PNG’s diverse geographic and climactic environments. PNG plans to train team members and be ready for self-sufficient national deployments by late 2022.
Conclusion:
PNG is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to challenging and austere post-disaster environments.
Tropical Cyclone Yasa made landfall on Fiji’s main islands as a Category 5 cyclone on December 17, 2020 causing an immense impact on the health system with damages to health infrastructure amounting to 1.2 million USD.1 FEMAT was activated to assess and assist with disaster response in the greatly impacted Northern and Eastern Divisions of Fiji.
Objectives:
To describe FEMAT’s response to Tropical Cyclone Yasa.
Method/Description:
FEMAT’s response to TC Yasa included community assessments, provision of medical supplies and temporary tents for health facilities, and coordinating the distribution of WASH kits. FEMAT’s Health Emergency Response Team (HERT) was mobilized and provided surveillance support and medical care in Evacuation Centers (EC) treating the injured and sick. Health inspectors were deployed with FEMAT to provide food safety surveillance and management of dead animals near and in water sources.
Results/Outcomes:
Four mobile FEMAT teams were deployed during the TC Yasa response for 17 days over the Christmas and New Year holidays. Teams were composed of physicians, nurses, and health inspectors, and were provided with vehicles stocked with medications, medical supplies, food, and tents. 354 different communities were visited by FEMAT HERT teams, including five islands, 170 villages, 167 settlements, four estates, and eight evacuation centers. 1,172 out-patient medical encounters were recorded. Over 110 sites were treated for potential vectors by spraying and disinfection.
Conclusion:
FEMAT operationalized a small, mobile medical teams approach to respond to Category 5 tropical cyclone that impacted Fiji in December of 2020.
Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments. Whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSE).
Objectives:
What is appropriate SMR in RSE?
Method/Description:
The first round of this Modified Delphi (mD) study was a structured focus group. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the 20 mD statements presented to the experts.
Experts rated their agreement with each statement on a scale from one to seven. Consensus amongst experts was defined as SD≤1.0. Statements that were in agreement reaching consensus were included in the final report. Those not reaching consensus advanced to the next mD round.
For these subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement.
Results/Outcomes:
Twenty-two experts completed the first mD round, 19 completed the second mD round, and 16 completed the third mD round. Eleven statements reached consensus (Table 1). Nine statements did not reach consensus (Table 2).
Conclusion:
Experts reached consensus offering 11 statements to be incorporated into the creation of SMR clinical guidelines in RSE.
The country’s location makes it vulnerable to natural disasters, hence, the PEMAT’s potential was tested during local disaster response for Taal Volcano Eruption in Batangas last January 2020 and during the aftermath of Super Typhoon Odette in Dinagat Islands last December 2021, amidst COVID-19 surge.
Objectives:
The primary objective of the deployment was to augment the DOH in the provision of safe, effective, and efficient quality health care services appropriate to the victims’ needs, timely, and coordinated mobilization of DJNRMHS PEMAT, and to evaluate the knowledge and skills acquired in the EMT Basic induction course in disaster response.
Method/Description:
As per WHO standards, disaster responses conducted by the DJNRMHS PEMAT followed three important phases: pre-mobilization, mobilization, and post-mobilization. The methods used during these phases in Taal and Dinagat missions were the simulation of drills and application of didactics learnt from the EMT Basic Induction Course for Disaster Response conducted by the DOH in collaboration with WHO in 2019.
Results/Outcomes:
The essential services rendered by DJNRMHS PEMAT, ensuring patient and responder safety despite being at the height of COVID-19 surge, were out-patient, acute emergency, trauma and basic obstetric care, basic laboratory, social welfare, public health, and pharmaceutical to 1,124 victims in the Taal Eruption and 1,089 victims of Typhoon Odette.
Conclusion:
Safe and effective delivery of quality health care services by PEMAT, a team equipped with knowledge and skills acquired through mentorship, can be achieved with thorough planning, setting of mission objectives, and most importantly, having full support from the management and all stakeholders.
UK-Med, as part of our UK EMT project, deployed a team to respond to the overwhelming surge in COVID-19 cases in Papua New Guinea in late 2021. Such deployment was associated with several risks, including natural hazards; earthquakes; societal crisis; tribal fighting and civil unrest; and health risks such as extreme temperatures and poor sanitation infrastructure presented further hazards to personnel safety.
Objectives:
To share lessons learned on enhancing the well-being of an EMT in a challenging context such as PNG.
Method/Description:
Satisfaction survey, bilateral meetings, in addition to weekly meetings with the headquarters held throughout the deployment.
Results/Outcomes:
All deployed team members felt exhausted early in the deployment, including an early lack of clarity on the deployment location which eventually ended up being Mount Hagen, a very risky area only accessible by plane. Utilizing emotional and social support, diversity acceptance within the team, and coherent coordination between team members the deployment delivered upon all agreed objectives. Local staff were integrated and a successful workplan was well-received and evaluated as making a real difference to the staff and patients, with a request for an extension of activities received from the Provincial Health Authority.
Conclusion:
Considerations for staff well-being need to counter-balance the need for strict security protocols. Solid feedback mechanisms should be designed and implemented at an early stage of deployments to avoid any adverse effect on the team’s well-being. Deployment of an assessment team should strengthen coordination, ensuring required needs are being responded to and operational planning is location/context specific.
Japan DMAT and US DMAT have been collaborating in the past to prepare for expected and unexpected disasters in Japan. Japan is predicting overwhelming disasters on Japanese soil soon, which needs efficient and optimum use of resources in medical assistance, including additional support from overseas, particularly from the US. The Japanese government established a large-scale Earthquake/Tsunami Disaster Emergency Response protocol in 2020. However, this protocol does not include any standard operation procedure (SOP) to receive an international medical team.
Objectives:
Establishing the SOP of receiving medical assistance from US-DMAT based on the WHO International Emergency Team (EMT) initiative.
Method/Description:
Collaborated with the Office of the Assistant Secretary for Preparedness and Response (ASPR) of the United States Health and Human Services, tabletop exercises assuming that a large-scale earthquake occurred during hosting the 2025 Osaka Expo was conducted online meeting system.
Results/Outcomes:
Provisional SOP was formed by the Japan research team and ASPR representatives. Even though Japan had several disaster medical assistance collaborations with US DMAT and is well-familiarized with the Classification and Minimum Standards for Emergency Medical Teams, many issues need to be prepared to accept US DMAT.
Conclusion:
Numerous procedures need to be conducted to receive US DMAT assistance during a large-scale earthquake in Japan. With this SOP, receiving US medical team assistance will be conducted promptly, eventually saving many lives. This SOP can be modified for other international teams’ acceptance in Japan. It could reference other countries seeking to have SOPs for receiving international medical team assistance in the near future.
Among all health care workers, EMTs have played a notable role during COVID-19; working as a frontline, they faced many challenges, including working overload and an extremely cautious environment that requires a rapid and precise response, which led to experiencing higher severity of mental health symptoms.
Objectives:
To explore the association between stress and burnout among EMTs while working during the COVID-19 pandemic.
Method/Description:
A cross-sectional quantitative study with a descriptive design. It was conducted from March-April 2021 on 280 Spanish EMTs, using an online survey of 42 items about workload and working conditions during COVID-19 and other variables specific to COVID-19. The Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and Pearson’s correlation coefficient were used to determine the relationships between the variables.
Results/Outcomes:
The study revealed a moderate positive correlation between the perceived level of stress and burnout among the EMTs. Specifically, findings showed a strong positive correlation between stress and EE (0.62) and a moderate positive correlation with DP (0.48). However, it found a moderate negative correlation between the level of stress and the third subdimension of burnout, PA (0.45), where the increase in the stress level correlated with a decrease in PA of the EMTs.
Conclusion:
Burnout might be related to the persistent stress of the EMTs working during the COVID-19 pandemic, considering their work conditions and the socio-demographic variables. The mental health of the first responders is crucial, as it influences their achievement and works satisfaction, and it might affect the quality of the service they provide.
Tables and Figures (optional)
Table 1.
Pearson Correlation: Correlation between the Stress and Burnout among the Emergency Medical Technicians (n = 280)
The Induction Team Member (ITM) course is compulsory training for teams setting up an EMT. It encapsulates elements around safety and security, protocols and procedures, and familiarization with equipment and should happen in countries that have undergone the awareness session.1 Tailoring the ITM course to fit different countries settings and professional backgrounds is imperative, particularly in Africa, because countries have heterogeneous characteristics.
Objectives:
To describe the changes to the ITM Course curriculum adapted to the different professional backgrounds and technical scopes of potential team members (TM) and African countries.
Method/Description:
This is an After-Action Review (AAR) of in-depth feedback (n = 10) received from participants in the five trainings that have been conducted at the WHO African Regional EMT Training Center (TC) since 2021 to date. All analyses were done thematically.
Results/Outcomes:
The training experiences in the region have shown the need for three imperative modifications to the ITM course based on the type of EMTs and the background of the participants. These include ITM courses focusing on health workers (Doctors and Nurses); team leads, security, and logistics officials; and support staff that can work during deployment and pre-deployment tasks. An interactive ten steps to building an operational national EMTs initiative developed to fit the context has been shown as significant.
Conclusion:
Conceptualizing ITM course training for EMTs based on teams’ backgrounds, cultural circumstances, and political will is imperative for enhancing the capacity of regional countries’ EMTs. A pragmatic modification to the training to fit the context that captures the countries’ needs is key.
Administration of epinephrine has been associated with worse neurological outcomes for survivors of out-of-hospital cardiac arrest. The publication of the 2018 PARAMEDIC-2 trial, a randomized and double-blind study of epinephrine in out-of-hospital cardiac arrest, provides the strongest evidence to date that epinephrine increases return of spontaneous circulation (ROSC) but not neurologically intact survival. This study aims to determine if Emergency Medical Services (EMS) cardiac arrest protocols have changed since the publication of PARAMEDIC-2.
Methods:
States in the US utilizing mandatory or model state-wide EMS protocols, including Washington DC, were included in this study. The nontraumatic cardiac arrest protocol as of January 1, 2018 was compared to the protocol in effect on January 1, 2021 to determine if there was a change in the administration of epinephrine. Protocols were downloaded from the relevant state EMS website. If a protocol could not be obtained, the state medical director was contacted.
Results:
A 2021 state-wide protocol was found for 32/51 (62.7%) states. Data from 2018 were available for 21/51 (41.2%) states. Of the 11 states without data from 2018, all follow Advanced Cardiac Life Support (ACLS) guidelines in the 2021 protocol. Five (15.6%) of the states with a state-wide protocol made a change in the cardiac arrest protocols. Maximum cumulative epinephrine dose was limited to 4mg in Maryland and 3mg in Vermont. Rhode Island changed epinephrine in shockable rhythms to be administered after three cycles of cardiopulmonary resuscitation (CPR) and an anti-arrhythmic. Rhode Island also added an epinephrine infusion as an option. No states removed epinephrine administration from their cardiac arrest protocol. Simple statistical analysis was performed with Microsoft Excel.
Conclusion:
Several states have adjusted cardiac arrest protocols since 2018. The most frequent change was limiting the maximum cumulative dosage of epinephrine. One state changed timing of epinephrine dosing depending on the rhythm and also provided an option of an epinephrine infusion in place of bolus dosing. While the sample size is small, these changes may reflect the future direction of prehospital cardiac arrest protocols. Significant limitations apply, including the exclusion of local and regional protocols which are more capable of quickly adjusting to new research. Additionally, this study is only focused on EMS in the United States.
Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibility of trauma care from national parks by calculating the travel time by ground and air from each park to its nearest trauma center. Using these calculations, the percentage of parks by census region with timely access to a trauma center was determined.
Methods:
This was a cross-sectional study analyzing travel times by ground and air transport between national parks and their closest adult advanced trauma center (ATC) in 2018. A list of parks was compiled from the National Parks Service (NPS) website, and the location of trauma centers from the 2018 National Emergency Department Inventory (NEDI)-USA database. Ground and air transport times were calculated using Google Maps and ArcGIS, with medians and interquartile ranges reported by US census region. Percentage of parks by region with timely trauma center access—defined as access within 60 minutes of travel time—were determined based on these calculated travel times.
Results:
In 2018, 83% of national parks had access to an adult ATC within 60 minutes of air travel, while only 26% had timely access by ground. Trauma center access varied by region, with median travel times highest in the West for both air and ground transport. At a national level, national parks were unequally distributed, with the West housing the most parks of all regions.
Conclusion:
While most national parks had timely access to a trauma center by air travel, significant gaps in access remain for ground, the extent of which varies greatly by region. To improve the accessibility of trauma center expertise from national parks, the study highlights the potential that increased implementation of trauma telehealth in emergency departments (EDs) may have in bridging these gaps.
Hemorrhage control prior to shock onset is increasingly recognized as a time-critical intervention. Although tourniquets (TQs) have been demonstrated to save lives, less is known about the physiologic parameters underlying successful TQ application beyond palpation of distal pulses. The current study directly visualized distal arterial occlusion via ultrasonography and measured associated pressure and contact force.
Methods:
Fifteen tactical officers participated as live models for the study. Arterial occlusion was performed using a standard adult blood pressure (BP) cuff and a Combat Application Tourniquet Generation 7 (CAT7) TQ, applied sequentially to the left mid-bicep. Arterial flow cessation was determined by radial artery palpation and brachial artery pulsed wave doppler ultrasound (US) evaluation. Steady state maximal generated force was measured using a thin-film force sensor.
Results:
The mean (95% CI) systolic blood pressure (SBP) required to occlude palpable distal pulse was 112.9mmHg (109-117); contact force was 23.8N [Newton] (22.0-25.6). Arterial flow was visible via US in 100% of subjects despite lack of palpable pulse. The mean (95% CI) SBP and contact force to eliminate US flow were 132mmHg (127-137) and 27.7N (25.1-30.3). The mean (95% CI) number of windlass turns to eliminate a palpable pulse was 1.3 (1.0-1.6) while 1.6 (1.2-1.9) turns were required to eliminate US flow.
Conclusions:
Loss of distal radial pulse does not indicate lack of arterial flow distal to upper extremity TQ. On average, an additional one-quarter windlass turn was required to eliminate distal flow. Blood pressure and force measurements derived in this study may provide data to guide future TQ designs and inexpensive, physiologically accurate TQ training models.