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blood loss would have include two high values, which 7. Fox N, Rajani RR, Bokhari F, et al. Evaluation and man-
would have increased the mean value and, perhaps, the agement of penetrating lower extremity arterial trauma: an
statistical results. Although this complexity is an experi- Eastern Association for the Surgery of Trauma practice man-
agement guideline. J Trauma Acute Care Surg. 2012;73(5
mental limitation, such a determination is made when a Suppl 4):S315–320.
medic switches to a different hemorrhage control inter- 8. Bulger EM, Snyder D, Schoelles K, et al. An evidence-based
vention, such as wound packing. Two models, C-A-T prehospital guideline for external hemorrhage control: Amer-
and RATS, were commercially developed, while TMT ican College of Surgeons Committee on Trauma. Prehosp
Emerg Care. 2014;18:163–173.
was developed primarily by the US Army. However, the 9. Jacobs LM Jr. Joint Committee to create a national policy
C-A-T is most familiar to many users, since it has had to enhance survivability from mass casualty shooting events:
widespread sales, including to the military. Hartford Consensus II. J Am Coll Surg. 2014;218:476–478e1.
10. Butler FK Jr, Hagmann J, and Butler EG. Tactical combat ca-
Given the present study, which introduced RATS and sualty care in special operations. Mil Med. 1996;161(Suppl):
3–16.
TMT to preliminary assessment, future directions for 11. Butler FK Jr. Tactical medicine training for SEAL mission
further research include assessment with more users, commanders. Mil Med. 2001;166:625–631.
and in a field setting or with tactical situations. 12. Butler FK Jr, Holcomb JB, Giebner SD, et al. Tactical combat
casualty care 2007: evolving concepts and battlefield experi-
ence. Mil Med. 2007;172(11 Suppl):1–19.
Funding 13. National Association of Emergency Medical Technicians.
PHTLS: Prehospital trauma life support. St. Louis, MO:
This project was funded with internal US Army Insti- Mosby; 2007:501–519.
tute of Surgical Research funds and the Defense Health 14. Kragh JF Jr, O’Neill ML, Walters TJ, et al. The military emer-
Program (Proposal 201105: Operational system man- gency tourniquet program’s lessons learned with devices and
agement and post-market surveillance of hemorrhage designs. Mil Med. 2011;176:1144–1152.
control devices used in medical care of US Serviceper- 15. Kragh JF Jr, Burrows S, Wasner C, et al. Analysis of recovered
tourniquets from casualties of Operation Enduring Freedom
sons in the current war). and Operation New Dawn. Mil Med. 2013;178:806–810.
16. Kragh JF Jr. Use of tourniquets and their effects on limb func-
tion in the modern combat environment. Foot Ankle Clin.
Disclaimers 2010;15: 23–40.
The opinions or assertions contained herein are the pri- 17. Walters TJ, Wenke JC, Kauvar DS, et al. Effectiveness of self-
applied tourniquets in human volunteers. Prehosp Emerg
vate views of the authors and are not to be construed Care. 2005;9:416–422.
as official or reflecting the views of the Department of 18. Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emer-
Defense or US Government. The authors are employees gency tourniquets to stop bleeding in major limb trauma. J
of the US Government. This work was prepared as part Trauma. 2008;64(2 Suppl):S38–49.
of their official duties and, as such, there is no copyright 19. Clumpner BR, Polston RW, Kragh JF Jr, et al. Single versus
double routing of the band in the Combat Application Tour-
to be transferred. niquet. J Spec Oper Med. 2013;13:34–41.
20. Polston RW, Clumpner BR, Kragh JF Jr, et al. No slack-
ers in tourniquet use to stop bleeding. J Spec Oper Med.
Disclosure 2013;13:12–19.
The authors declare no conflicts of interest.

References
Ms Gibson is an undergraduate student at both the Univer-
1. Andersen RC, Shawen SB, Kragh JF Jr, et al. Special topics. J sity of Texas at San Antonio and University of Texas Health
Am Acad Orthop Surg. 2012;20(Suppl 1):S94–98.
2. Kragh JF Jr, Walters TJ, Westmoreland T, et al. Tragedy into Science Center at San Antonio, Texas. She also works at the
drama: an American history of tourniquet use in the current US Army Institute of Surgical Research (USAISR).
war. J Spec Oper Med. 2013;13:5–25.
3. Kragh JF Jr, Beebe DF, O’Neill ML, et al. Performance im- Mr Housler is a biomedical engineer working as a program
provement in emergency tourniquet use during the Baghdad manager for the US Army Medical Materiel Agency, Fort De-
surge. Am J Emerg Med. 2013;31:873–875. trick, Maryland.
4. Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital
tourniquet use in Operation Iraqi Freedom: effect on hemor- Lt Col Rush, USAF, MC is a US Army Air Force radiation
rhage control and outcomes. J Trauma. 2008;64(2 Suppl): oncologist and flight surgeon who serves as medical director of
S28–37.
5. Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emer- the 103rd Rescue Squadron, Westhampton Beach, New York.
gency tourniquet use to stop bleeding in major limb trauma. He has been involved in operational medicine and the Special
Ann Surg. 2009;249:1–7. Operations Medical Association for over a decade. He is affili-
6. Kotwal RS, Montgomery HR, Kotwal BM, et al. Eliminating ated with the Departments of Radiation Oncology and Neuro-
preventable death on the battlefield. Arch Surg. 2011;146: surgery, NYU Langone Medical Center, New York, New York.
1350–1358.

34 Journal of Special Operations Medicine Volume 16, Edition 1/Spring 2016