Arterial injuries to the lower limb, such as from a shark bite or deep laceration, can lead to catastrophic bleeding and death. Current first aid measures involve trained personnel applying an arterial tourniquet. However, even a short delay in haemorrhage management can lead to significant blood loss, brain injury or death. There is growing evidence that the simple technique of applying pressure to the groin can effectively occlude blood flow through the femoral artery, buying time for medically trained personnel to attend.

One potential application of this technique is the treatment of shark attack victims with lower limb injuries, where beachgoers without medical training who have only seen a sign on a beach could apply life saving first aid. There is plethora of other potential applications outside marine encounters where this technique could be critical in reducing blood loss such as limb trauma from motor vehicle accidents, workplace injuries or military settings. The benefits are the simplicity of the technique which may be both easily and effectively performed by bystanders with no medical training. Using a non-clinical environment, we intend on performing a randomised trial to evaluate the efficacy of non-medically trained beachgoers performing pressure points compared with the application of a commercial arterial tourniquet after reading an infographic. We will measure the reduction in arterial blood flow using doppler ultrasound. The project aims to generate translatable research with the goal of influencing local, national, and international first aid guidelines.

Syndesmosis injuries, also known as a high ankle sprain, due to ligamentous injury are relatively uncommon but can have devastating outcomes when missed. This includes chronic pain, instability and osteoarthritis. Early surgical fixation of these injuries is recommended in some cases. Magnetic Resonance Imaging (MRI) is the most accurate way to diagnose these, but not ordered in the emergency department (ED) due to its cost and poor availability. Although clinical tests can help to narrow down who needs an MRI, they are often inaccurate in the acute phase. Ultrasound performed by sonographers can visualise ligament to components of the syndesmosis complex to streamline MRI referrals but is under demand during the day and not available afterhours. Point of Care Ultrasound (POCUS) performed by clinicians is an alternative option for imaging.

Emergency physiotherapy practitioners (EPP) typically manage patients with musculoskeletal injuries in the ED and are well placed to perform musculoskeletal POCUS. This study will evaluate the feasibility and accuracy of ED physiotherapist-performed POCUS for the diagnosis of ligament injury in the ED, indicative of a syndesmosis injury, against radiology-performed ultrasound. This could guide MRI patient selection to allow for earlier detection of unstable ankle injuries and expedite outpatient orthopaedic expert review and management. If POCUS by ED physiotherapists is demonstrated to be feasible and accurate for these syndesmosis injuries, the results of this study could inform the development of a diagnostic pathway that could be implemented in EDs locally and throughout Australia.