Page 33 - Journal of Special Operations Medicine - Winter 2015

Testing Tourniquet Use in a Manikin Model
Two Improvised Techniques

William E. Lyles III, BA; John F. Kragh Jr, MD;
James K. Aden 3d, PhD; Michael A. Dubick, PhD

ABSTRACT
Background: Improvised tourniquets may be used to including the Committee on Trauma for the American
treat limb wound hemorrhage, but there is little evi- College of Surgeons and the Joint Committee to Create
dence for best techniques of use. The purpose of the a National Policy to Enhance Survivability from Mass
present study is to compare use of two techniques of Casualty Shooting Events, have advocated early hemor-
improvised tourniquet application and use of a common rhage control by use of out-of-hospital tourniquets. 11–14
commercial tourniquet that is nonimprovised. Methods:
A laboratory experiment was conducted to assess three Commercial, off-the-shelf tourniquets are available in the
groups of strap-and-windlass tourniquet designs on a marketplace, but they may not be available every time, ev-
manikin to test for differences in performance. Groups erywhere, for everyone. Although commercial tourniquets
included two types of improvised tourniquets (bandage may be more effective than improvised tourniquets, 15–19
and bandana) and a third group that served as a con- few quality datasets are available for review upon which
trol, the commercial Combat Application Tourniquet. to decide the merits of these two types of tourniquets. 16,19–22
Two users performed 10 tests of each group. Results: Moreover, tourniquets are often necessarily improvised
The commercial CAT had 100% effectiveness, but both on the spot when hemorrhage is to be controlled and com-
improvised tourniquets had poor effectiveness (40% mercial tourniquets are unavailable. 16,19–22 Given a possi-
and 10% for the bandage and bandana groups, respec- ble need to control hemorrhage wherever and whenever
tively). The commercial CAT performed fastest; the two it may occur, such as at the 2009 Fort Hood shooting,
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improvised tourniquet groups were slower than the and the 2013 Boston Marathon bombing, 23–25 a better un-
commercial group (p < .0001, both) but were not statis- derstanding of improvising tourniquets may help inform
tically different from each other. All time-of-application development of best tourniquet practices. Few empirical
results in the commercial group were less than the mini- biomechanical or biomedical data are available to provide
mums of either improvised group. The commercial CAT guidelines for such practices that involve specific tech-
had the highest mean pressures, and all such pressures niques of improvisation. The purpose of the present study
were within safe and effective ranges. Low pressures is to compare a common commercial tourniquet and two
generated by both improvised tourniquet groups were techniques of improvised tourniquet use.
ineffective. All results of simulated blood loss with the
commercial CAT group were less than the minimums Methods
of either improvised tourniquet group. Conclusion: In
the present experiment, the commercial CAT performed A US Army Institute of Surgical Research (USAISR) lab-
better than either improvised tourniquet. oratory protocol was approved by USAISR’s Regulatory
Compliance Division. The study was a biomechanical
Keywords: first aid; hemorrhage; resuscitation; groin; ingui­ experiment on a manikin using two types of improvised
nal; medical device; injuries; wounds; tourniquet tourniquets compared with a commercial tourniquet
as a control: each of the three groups had a strap-and-
windlass design.
Introduction
The first improvised technique involved use of an es-
In an emergency, the ability to stop bleeding from a limb tablished method of the US Army that has been taught
wound may be lifesaving. Additionally, traumatic limb to Soldiers and medics. This technique included a
1,2
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hemorrhage is common, disabling, and costly. Out- folded triangular bandage made of cotton muslin (El-
3–5
of-hospital hemorrhage control by tourniquet use has wyn Inc, http://www.elwyn.org) that served as the strap.
been advocated, shown to be effective, and associ- This bandage is a common item in civilian and military
6,7
8,9
ated with lifesaving benefits. 1,2,10 Trauma care stewards, first aid classes (Federal Logistic Information System:
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