Page 45 - Journal of Special Operations Medicine - Spring 2016

Preliminary Comparison of New and Established Tactical
Tourniquets in a Manikin Hemorrhage Model

Ruby Gibson; Greggory J. Housler, MS, MBA; Stephen Rush, MD;
James K. Aden 3rd, PhD; John F. Kragh Jr, MD; Michael A. Dubick, PhD

ABSTRACT

Background: Emergency tourniquet use has been asso- support a recommended strategy of early hemorrhage
ciated with hemorrhage control and improved survival control in out-of-hospital care, especially at or near
during the wars since 2001. The purpose of the present the point of injury. A particularly warranted point-
7–9
study is to compare the differential performance of two of-injury setting for early hemorrhage control is that
new tactical tourniquets with the standard-issue tourni- of tactical care under fire (CUF). Under such circum-
quet to provide preliminary evidence to guide decisions stances, tourniquet use not only improves survival of the
on device development. Methods: A laboratory experi- casualty, but also lessens risk to rescuers attempting to
ment was designed to test the effectiveness of tourniquets control the hemorrhage. 10–13 Such desired improvements
on a manikin thigh. Three models of tourniquets were in survival have led to tourniquets being specifically de-
assessed. The Rapid Application Tourniquet System signed for tactical settings. 14–16
(RATS) and the Tactical Mechanical Tourniquet (TMT)
were compared with the standard-issue Combat Appli- Periodically, new designs of interest enter the tactical
cation Tourniquet (C-A-T). Two users conducted 30 tourniquet marketplace. Two recent models are the
®
tests each. Results: Percentages for effectiveness (hem- Rapid Application Tourniquet System (RATS; RATS
orrhage control, yes/no) and distal pulse cessation did Tourniquet; http://ratstourniquet.com) and the Tacti-
not differ significantly by model. When compared with cal Mechanical Tourniquet (TMT; Alphapointe). As
the RATS, the C-A-T performed better (p < .001) for these two tactical tourniquets are new, there is no public
time to hemorrhage control and fluid loss. The C-A-T evidence that distinguishes their relative merits or any
and TMT had comparable responses for most measures, knowledge concerning their appropriate methods of
but the C-A-T applied more pressure (p = .04) than did use. Currently, the standard-issue tactical tourniquet is
the TMT for hemorrhage control. Conclusion: All three the Combat Application Tourniquet (C-A-T; Compos-
®
tactical tourniquets showed substantial capacity for ite Resources; http://combattourniquet.com), for which
hemorrhage control. However, the two new tourniquet there is a large body of evidence regarding its mer-
models (RATS and TMT) did not offer any improvement its. 6,17,18 The purpose of the present study is to compare
over the C-A-T, which is currently issued to military ser- the performance of these two new tactical tourniquets
vices. Indeed, one of the new models, the RATS, was in- with the standard-issue tourniquet to provide prelimi-
ferior to the C-A-T in terms of speed of application and nary evidence to guide decisions on their development.
simulated loss of blood. Opportunities were detected for
refinements in design of the two new tourniquets that Methods
may offer future improvements in their performance.
This study was conducted under a protocol for a labo-
Keywords: first aid; damage control; hemorrhage; shock; ratory experiment designed to compare the function of
tourniquet; resuscitation tourniquets and was reviewed and approved by the Reg-
ulatory Compliance Division of the US Army Institute of
Surgical Research. The study group included two new
tactical tourniquets intended for out-of-hospital hemor-
Introduction
rhage control during CUF. The intended user in such a
Tourniquet use in the current war has changed from a tactical situation is a nonmedical Soldier, a law enforce-
procedure of last resort to one of first aid. Emergency ment officer, or a person in a similar position. The two
1–3
tourniquet use for limb wounds has been associated with new tourniquet models were the RATS and the TMT.
effective hemorrhage control, prevention of shock on- One device per tourniquet model was tested unless wear
set, and improved survival rates. These three findings and tear occurred, upon which another device of the
4–6

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