Stopping Haemorrhage by Application of Rope tourniquet or inguinal Compression (SHARC study)

Objective: There are increasing numbers of shark attacks in Australasian waters, with death commonly resulting from uncontrolled lower limb bleeding. The present study aims to determine the most effective first aid method using immediately available resources for controlling lower limb haemorrhage, which could be provided by single unsupported rescuer. Methods: The present study was a clinical trial performed at a single tertiary referral hospital. Healthy volunteers who completed a screening questionnaire, a baseline popliteal velocity measurement and then consented were eligible. The present study used Doppler ultrasound to record the reduction in popliteal artery peak systolic velocity created by surfboard leg rope tourniquet and by inguinal region external compression in healthy volunteer subjects with and without a wetsuit. Leg circumference and sex data were also collected. Results: Pooled data from each intervention without and with a wetsuit showed that inguinal compression resulted in a mean reduction of popliteal artery peak systolic velocity of 89.7% (95% CI 83.9%, 95.5%) compared to leg rope application 43.8% (95% CI 34.5%, 53.1%; P ≤ 0.001). There was no significant influence by the wetsuit on effectiveness of either intervention technique. Conclusion: The present study has shown that manual inguinal compression, an easily taught first aid technique, can reliably completely stop or substantially reduce blood loss in the setting of a lower limb injury and is superior to an improvised tourniquet.