Page 35 - Journal of Special Operations Medicine - Summer 2016

Preliminary Comparison of Pneumatic Models

of Tourniquet for Prehospital Control of
Limb Bleeding in a Manikin Model

Ruby Gibson; James K. Aden 3rd, PhD; Michael A. Dubick, PhD; John F. Kragh Jr, MD

ABSTRACT

Background: Emergency tourniquet use has been asso- however, in a minority of cases, such bleeding can cause
ciated with hemorrhage control and improved survival death from hemorrhagic shock. Such deaths are po-
1–4
during the wars since 2001, but little is known of the tentially preventable because limb hemorrhage is con-
5–8
differential performance of pneumatic tourniquet mod- trollable with out-of-hospital tourniquet use. During
els. The purpose of this study was to compare the per- the recent wars in Afghanistan and Iraq, military ser-
formance of three models of pneumatic tourniquets in a vices have compiled evidence associating tourniquet use
laboratory setting to aid a possible decision to field test with improved survival of casualties, although the level
suitable models for medic preference. Methods: A labora- of improvement remains unclear. 9–12 Much of the field
tory experiment was designed to test the effectiveness of evidence gained has been with the common strap-and-
tourniquets on a manikin thigh. Three models (one Emer- stick tourniquet that is standard issue in military first
gency and Military Tourniquet [EMT] and two Tactical aid kits for individual Soldiers. 13–16
Pneumatic Tourniquets differing in width: 2 in. and 3 in.
[TPT3]) were compared with the standard-issue Combat Despite the success of Soldiers using strap-and-stick tour-
Application Tourniquet of a strap-and-windlass design. niquets, military medics have different caregiving prac-
Two users conducted 40 tests each on a right-thigh mani- tices and access to different types of tourniquets than do
Lifesaving. Combat Ready. kin (HapMed Leg Tourniquet Trainer) with a simulated regular Soldiers such as infantrymen. For example, medics
above-knee amputation injury. Measurements included
often assess the bleeding control status of strap-and-stick
™
Arrow EZ-IO T.A.L.O.N. IO Needle T.A.L.O.N. IO Needle effectiveness in hemorrhage control, pulse stoppage distal tourniquets placed by nonmedical Soldiers for possible
™
®
exchange of that tourniquet for a pneumatic tourniquet,
to the tourniquet, time to stop bleeding, blood loss, and
®
NSN 6515-01-626-6395 pressure. Results: All four models were 100% effective in which is safer, more comfortable, and more effective. 13,17,18
both hemorrhage control and pulse stoppage distal to the Although pneumatic tourniquets have been recommended
• VERSATILE: 7-site IO device tourniquet. The TPT3 had the slowest mean time to stop for issue to military medics since 2004, a knowledge gap
(sternum, proximal humerus, proximal & distal tibia) bleeding and the highest mean blood loss. The EMT had remains in a performance assessment of currently avail-
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the least mean pressure. An interuser difference was found able models. The purpose of the present study is to
• LIFE-SAVING: Delivers fluids and medications rapidly EZ-Connect ® only for mean pressure. Conclusions: All models of tour- compare the performance of three models of pneumatic
Extension Set
and accurately for casualty resuscitation niquet performed equally well for both the critical out- tourniquets in a laboratory setting to aid a possible deci-
come of effectiveness and the important outcome of pulse sion to field test suitable models for medic preference.
• CONVENIENT: No need for additional gear, multiple needles
or special removal tools Sternal stoppage, whereas results for secondary outcomes (time,
Locator pressure, and blood loss) differed by model. The EMT had Materials and Methods
• SIMPLE: Designed for any level responder best performance for every type of measurement.
This study, involving a laboratory experiment designed
Keywords: first aid; damage control; hemorrhage, preven- to compare the function of tourniquets, was conducted
tion and control; shock; tourniquet; resuscitation; emer- under a protocol reviewed and approved by the Regula-
teleflex.com/military gency medical services tory Compliance Division of the US Army Institute of
Surgical Research. The study group included use of the
three pneumatic tourniquets intended for out-of-hospital
hemorrhage control during military combat or emer-
Rx Only - Caution: Federal law (USA) restricts this device to sale by or on the order of a physician.See Instructions For Use for detailed information regarding the Instructions For Use, Introduction
Contraindications, Potential Adverse Events, Warnings, and Cautions.The T.A.L.O.N Needle Set is manufactured in the USA. Potential complications may include local or systemic infection, gency medicine. The intended user in such a prehospital
hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. Uncontrolled hemorrhage from limb wounds is a common situation is a military medic, a civilian paramedic, or a
Teleflex, the Teleflex logo, Arrow, EZ-Connect, EZ-IO and T.A.L.O.N are trademarks or registered trademarks of Teleflex Incorporated or its affiliates, in the U.S. and/or other countries.
Information in this document is not a substitute for the product Instructions for Use. The products in this document may not be available in all countries. Please contact your local representative. phenomenon both on civilian streets and in battlefields; person in an analogous position.
© 2016 Teleflex Incorporated. All rights reserved. MC-002362

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