Page 33 - JSOM Winter 2023

Effects of Tourniquet Features on
Application Processes Times

Piper Wall, DVM, PhD *; Charisse Buising, PhD ; Alex White ;
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JaNiese Jensen ; Justin Davis, MD ; Catherine Hackett Renner, PhD 6

ABSTRACT
Background: We investigated emergency-use limb tourniquet arterially occlusive, secure applications and the speed of achiev-
design features effects on application processes (companion ing tourniquet-sustainable arterial occlusion. Using scoring
paper) and times to complete those processes (this paper). and time, we investigated the effects of different tourniquet
Methods: Sixty-four appliers watched training videos then design features on appliers’ ability to correctly and quickly ap-
each applied all eight tourniquets: Combat Application Tour- ply emergency-use limb tourniquets. The hypothesis was that
niquet Generation 7 (CAT7), SOF Tactical Tourniquet-Wide different features would have different effects on the successes
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Generation 3 (SOFTTW3), SOF Tactical Tourniquet-Wide and times of application processes. This paper discusses the
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Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet times for application processes. The companion paper earlier
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(TMT), OMNA Marine Tourniquet (OMT), X8T-Tourni- in this journal discussed the success of application processes. 1
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quet (X8T), Tactical Ratcheting Medical Tourniquet (Tac
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RMT), and RapidStop Tourniquet (RST). Application pro- Methods
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cesses times were captured from videos. Results: From “Go”
to “touch tightening system” was fastest with clips and self- The Drake University Institutional Review Board approved
securing redirect buckles and without strap/redirect applica- this study. The companion paper details all the methods ex-
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tion process problems (n, median seconds: CAT7 n=23, 26.89; cept those for application timing. In brief, eight tourniquet
SOFTTW3 n=11, 20.95; SOFTTW5 n=16, 20.53; TMT n=5, designs were applied in randomized order. Tourniquet parts
26.61; OMT n=12, 25.94; X8T n=3, 18.44; Tac RMT n=15, and activities were divided into the strap and redirect buckle
30.59; RST n=7, 22.80). From “touch tightening system” to (“strap/redirect system”) and the tightening system. Major
“last occlusion” was fastest with windlass rod systems when design feature differences among tourniquets are shown and
there were no tightening system understanding or mechanical described in Figure 1 and Table 1 of the companion paper. The
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problems (seconds: CAT7 n=48, 4.21; SOFTTW3 n=47, 5.99; major design feature differences were the presence or absence
SOFTTW5 n=44, 4.65; TMT n=38, 6.21; OMT n=51, 6.22; of a strap/redirect system clip (no clip: CAT7, OMT, Tac RMT;
X8T n=48, 7.59; Tac RMT n=52, 8.44; RST n=40, 8.02). For clip: SOFTTW3, SOFTTW5, TMT, X8T, RST), whether or not
occluded, tightening system secure applications, from “touch strap/redirect systems were self-securing (strap/redirect not
tightening system” to “Done” was fastest with self-securing self-securing: CAT7, TMT, OMT; strap/redirect self- securing:
tightening systems tightening from a tight strap (occluded, se- SOFTTW3, SOFTTW5, X8T, Tac RMT, RST), whether or not
cure time in seconds from a tight strap: CAT7 n=17, 14.47; tightening systems were self-securing (tightening system not
SOFTTW3 n=22, 10.91; SOFTTW5 n=38, 9.19; TMT n=14, self-securing: CAT7, SOFTTW3, SOFTTW5, TMT; tighten-
11.42; OMT n=44, 7.01; X8T n=12 9.82; Tac RMT n=20, ing system self-securing: OMT, X8T, Tac RMT, RST) and the
6.45; RST n=23, 8.64). Conclusions: Suboptimal processes in- plane of rotation of the tightening system (parallel to the limb:
crease application times. Optimal design features for fast, oc- CAT7, SOFTTW3, SOFTTW5, TMT, X8T; perpendicular to
clusive, secure tourniquet applications are self-securing strap/ the limb: OMT, Tac RMT, RST).
redirect systems with an easily identified and easily used clip
and self-securing tightening systems. FIGURE 1 Timeline.

Touch
Keywords: tourniquet; hemorrhage; first aid; emergency Strap Tightening 1 st Last
treatment Events: "Go" Secured System Occlusion Occlusion "Done"
Timed Go to Strap Secured Touch Tightening System 1 Occlusion
st
Segments: to 1 Occlusion to Done
st
Go to Touch Tightening System
Introduction Touch Tightening System Last Occlusion
to Done
to Last Occlusion
The key to lifesaving use of emergency-use limb tourniquets is The times involved in applying each tourniquet are shown. Of 512
quickly stopping severe bleeding via arterial occlusion. Differ- tourniquet applications, 35 never reached occlusion, and 36 had sepa-
ent tourniquet design features affect appliers’ ability to achieve rate first and last occlusions.
*Correspondence to piperwall@q.com
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1 Dr Piper Wall is a researcher in the Department of Research, UnityPoint Health Iowa Methodist Medical Center, Des Moines, IA. Dr Charisse
Buising is a professor of biology at Drake University, Des Moines, IA. Alex White was an undergraduate researcher at Drake University and is
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now a medical student at Des Moines University, Des Moines, IA. JaNiese Jensen was an undergraduate researcher at Drake University and is
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now a medical student at the Carver College of Medicine, University of Iowa, Iowa City, IA. Dr Justin Davis is a surgery resident physician at
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UnityPoint Health Iowa Methodist Medical Center, Des Moines, IA. Dr Catherine Hackett Renner is a volunteer researcher at UnityPoint Health
Iowa Methodist Medical Center, Des Moines, IA.
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