Page 42 - JSOM Spring 2026

Summary of X8T Advantages/Disadvantages Over acquisition, analysis, and interpretation of data and the draft-
Currently Deployed Windlass-Rod-Based Tourniquets ing or revising of the article. All authors had final approval of
Among arterially occlusive emergency-use limb tourniquets, the manuscript.
the X8T has several design advantages for skilled and un-
skilled tourniquet appliers as compared to current windlass- Disclosures
rod-based tourniquets. The self-securing strap/redirect system None of the authors have any financial relationships relevant
precludes applier strap/redirect securing errors (unlike hook- to this article to disclose, and there was no outside funding. As
and-loop-dependent systems). The self-securing strap/redirect indicated in the methods, the X8Ts were requested from and
1
system is long enough that all securing aspects are engaged donated by the manufacturer. PW and CB are paid by their re-
even on thighs larger than 56cm in circumference (unlike spective institutions, and MJ was a volunteer researcher. None
the currently available hook-and-loop-dependent systems). of the authors owns stock in any tourniquet companies nor do
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The self-securing tightening system precludes applier tight- any paid consulting with them. The authors talk to and share
ening-system-securing errors. The self-securing tightening data with any and all companies and individuals who are in-
1
system avoids loss of all tightening progress if the applier’s terested and do not keep any tourniquet-related secrets. PW
hand slips. The self-securing tightening system allows better and CB are volunteer members of an ASTM Committee E54
1
maintenance of situational awareness during tightening and on Homeland Security Applications task group working on a
does not require any separate, attention requiring, securing performance standard for non-pneumatic emergency-use limb
steps. The tightening increment resolution of the self- securing tourniquets. The lab equipment belongs to Drake University
tightening system is considerably finer than that of current and UnityPoint Health Iowa Methodist Medical Center.
windlass-rod-based systems, which allows the applier to choose
lower completion pressures without preventing the applier Funding
from choosing higher completion pressures. The need for ap- No funding was received for this work.
plier fine motor control is less because the tightening system is
self-securing. The speed and ease of increasing pressure after References
an initial completion of application is much better than with 1. Wall PL, Buising CM, Jensen J, White A, Davis J, Renner CH. Ef-
a windlass-rod-based system and avoids the potential for acci- fects of tourniquet features on application processes. J Spec Oper
dental release that accompanies unsecuring and tightening and Med. 2023;23(4):11–30. doi:10.55460/8FFG-1Q48
resecuring a windlass-rod-based system. 2. Wall PL, Buising CM, White A, Jensen J, Davis J, Renner CH. Ef-
fects of tourniquet features on application processes times. J Spec
Oper Med. 2023;23(4):31–42. doi:10.55460/RPO1-CB79
The X8T has a few design features that may be disadvantages 3. Wall P. X8T-T2G tourniquet description. Vimeo. 2024. Accessed
in some settings. The X8T requires more hand strength to 25 September 2024. https://vimeo.com/1005938346
release than do most current bracket-secured windlass-rod- 4. Hingtgen E, Wall PL, Buising CM. Characterizing a system for
based systems. The length of the base area of the X8T does measuring limb tourniquet pressures. J Spec Oper Med. 2020;20
(1):47–54. doi:10.55460/KRT6-FUKJ
not allow pressure application around cylinders quite as small 5. Wall PL, Buising CM, Donovan S, McCarthy C, Smith K, Renner
as some windlass-rod-based tourniquets. The initial release of CH. Best tourniquet holding and strap pulling technique. J Spec
pressure of the X8T is not as easily limited as is the unwinding Oper Med. 2019;19(2):48–56. doi:10.55460/H9GT-Q602
of a windlass rod (presuming one does not lose one’s grip on 6. Graham B, Breault MJ, McEwen JA, McGraw RW. Occlusion of
the rod). arterial flow in the extremities at subsystolic pressures through
the use of wide tourniquet cuffs. Clin Orthop Rel Res. 1993;286:
257–261.
Conclusion 7. Tuncali B, Karci A, Tuncali BE, et al. A new method for estimat-
ing arterial occlusion pressure in optimizing pneumatic tourni-
Every X8T application reached arterial occlusion and main- quet inflation pressure. Anesth Analg. 2006;102(6):1752–1757.
tained arterial occlusion with limited, simple tightening-sys- doi:10.1213/01.ane.0000209018.00998.24
tem advances. As compared to 3.8cm-wide tourniquets with 8. Loenneke JP, Allen KM, Mouser JG, et al. Blood flow restriction in
windlass-rod tightening systems, initial and final completion the upper and lower limbs is predicted by limb circumference and
pressures and total tightening-system use were lower and com- systolic blood pressure. Eur J Appl Physiol. 2015;115(2):397–
405. doi:10.1007/s00421-014-3030-7
pletion of any tightening-system use after initial completion 9. Wall PL, Buising CM, Hingtgen E, Smith H, Renner CH. Clothing
was faster. The X8T’s self-securing tightening system pre- effects on limb tourniquet application. J Spec Oper Med. 2020;
10
vented the possibility of applier securing struggles or acciden- 20(2):83–94. doi:10.55460/2CXR-1UVJ
tal release during tightening. 10. Wall PL, Buising CM, Jonas M. Lab evaluation of four Ukrainian-
manufactured tourniquets. J Spec Oper Med. 2025;25(3):11–24.
Acknowledgments doi:10.55460/E5KA-QHKF
We thank the Drake University undergraduates of the Trauma 11. Mann FC, Herrick JF, Essex HE, Baldes EJ. The effect on the
blood flow of decreasing the lumen of a blood vessel. Surgery.
Research Team for their help carrying out the experiments: 1938;4(2):249–252.
Nia Eberhard-Mattes, Adrianna Clark, Adaire MacSwain, Ella 12. Griffin LV, Kragh JF Jr, Dubick MA. Laboratory model of a col-
Kocina, Maya Jean Elting, Cing Mang, McKenna Nelson, Hal- lapsible tube to develop bleeding control interventions: effects of
lie Peak, Paige Ransdell, Sarah Foley, Hannah Moseley, and compression on flow. J Spec Oper Med. 2018;18(1):47–52. doi:
Soren Olsen. 10.55460/E3Z7-1LUV

Author Contributions PMID: 41861466;
PW and CB contributed to concept development. All authors DOI: 10.55460/J.Spec.Oper.Med.2026.EB59-1U75
contributed to project design. All authors contributed to the

40 | JSOM Volume 26, Edition 1 / Spring 2026