Page 40 - Journal of Special Operations Medicine - Summer 2016

tourniquet itself. Since 2001, when tourniquet research Funding
accelerated, the tourniquet materiel has improved. To- This project was funded by the Defense Health Program
day, the weakest link is the user; skill acquisition and (Proposal 201105: Operational system management
maintenance are examples of current research topics to and post-market surveillance of hemorrhage control de-
be explored more to gain insights about ways to im- vices used in medical care of US Servicepersons in the
prove the overall process.
current war).
The clinical context of the present study findings is noted
because in the US Army, one military medic is routinely Disclaimer
assigned at the fundamental level to a platoon, such as in The opinions or assertions contained herein are the pri-
the infantry branch where there are about 36 to 41 Sol- vate views of the authors and are not to be construed
diers. In war-related hemorrhage situations, after Soldiers as official or reflecting the views of the Department of
provide self-care to their own wounds or buddy care to Defense or US Government. The authors are employees
the wounds of another Soldier, later casualty caregiving of the US Government. This work was prepared as part
is typically by the assigned military medic before possible of their official duties and, as such, there is no copyright
transportation of the casualty to a higher level of care, to be transferred.
such as a hospital. In casualties, the body segment most
often in need of tourniquet use is the thigh; the thigh of-
ten requires side-by-side strap-and-stick tourniquet use Disclosures
because the thigh’s girth is often too much for a single The authors declare no conflicts of interest.
strap-and-stick tourniquet’s narrow width. 13,16 Because
wide straps will not wind well within the windlass, which
has an aperture for the strap, strap-and-windlass designs References
are limited to a narrow width. Pneumatic tourniquet de- 1. Sauaia A, Moore FA, Moore EE, et al. Epidemiology of
signs, however, are not width limited and, therefore, may trauma deaths: a reassessment. J Trauma. 1995;38:185–193.
be used singly on a thigh. 13,14,26 In these ways, the medic’s 2. Dorlac WC, DeBakey ME, Holcomb JB, et al. Mortality from
skill sets and clinical requirements differ substantially isolated civilian penetrating extremity injury. J Trauma. 2005;
from those of common Soldiers; medic skills and require- 59:217–222.
ments match well with pneumatic tourniquets, and fur- 3. Kalish J, Burke P, Feldman J, et al. The return of tourniquets.
Original research evaluates the effectiveness of prehospital
ther consideration of allowing doctrinal use of pneumatic tourniquets for civilian penetrating extremity injuries. JEMS.
tourniquets by medics is ongoing. 2008;33:44–46, 49–50, 52, 54.
4. Kragh JF Jr, Littrel ML, Jones JA, et al. Battle casualty sur-
Limitations of the present study are rooted in its design vival with emergency tourniquet use to stop limb bleeding. J
Emerg Med. 2011;41:590–597.
as a laboratory experiment. The study is of a simulation, 5. Beekley AC, Sebesta JA, Blackbourne LH, et al. Prehospital
not actual care. The preliminary nature of the investiga- tourniquet use in Operation Iraqi Freedom: effect on hemor-
tion does not allow for broad conclusions but only nar- rhage control and outcomes. J Trauma. 2008;64:S28–37.
row findings of focused interest. 6. Gruen RL, Brohi K, Schreiber M, et al. Haemorrhage control
in severely injured patients. Lancet. 2012;380:1099–1108.
Future directions for further study include investigation 7. Bulger EM, Snyder D, Schoelles K, et al. An evidence-based
prehospital guideline for external hemorrhage control: Amer-
among other people more representative of the intended ican College of Surgeons Committee on Trauma. Prehosp
user set, field assessments instead of laboratory assess- Emerg Care. 2014;18:163–173.
ments, and a detailed analysis to complement the cur- 8. Jacobs LM Jr. Joint Committee to create a national policy
rent preliminary analysis. to enhance survivability from mass casualty shooting events:
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78 e1.
In summary, all four models of tourniquet performed 9. Brodie S, Hodgetts TJ, Ollerton J, et al. Tourniquet use in
equally well in the present study for both the critical combat trauma: UK military experience. J R Army Med
outcome of effectiveness and the important outcome of Corps. 2007;153:310–313.
pulse stoppage distal to the tourniquet. Secondary out- 10. Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emer-
comes (time, pressure, and blood loss) differed by tour- gency tourniquet use to stop bleeding in major limb trauma.
Ann Surg. 2009;249:1–7.
niquet model, and the EMT had the best performance 11. Kragh JF Jr, Nam JJ, Berry KA, et al. Transfusion for shock in
for every type of measurement. US Military war casualties with and without tourniquet use.
Ann Emerg Med. 2015;65:290–296.
12. Kragh JF Jr, Aden JK 3rd, Walters TJ, et al. In reply. Ann
Acknowledgments Emerg Med. 2015;66:340–341.
13. Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emer-
Lingamanaidu V. Ravichandran of the US Institute of gency tourniquets to stop bleeding in major limb trauma. J
Surgical Research aided in manuscript preparation. Trauma. 2008;64:S38–49; discussion S49–50.

26 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016