Page 44 - Journal of Special Operations Medicine - Summer 2016

Tourniquet Recipients multiple comparison test for thigh Occlusion Pressures,
Tourniquet recipients were volunteers familiar with the thigh Completion Pressures, arm Completion Pressures,
tourniquet study through a research course. They were thigh pressure gain from Occlusion to Completion, and
a convenience sample of undergraduate students and in- thigh and arm 60-Second and 120-Second pressure drops;
structors. Recipient inclusion criteria were participation one-way ANOVA with Tukey multiple comparison test for
in a previous tourniquet study or participation in the arm Occlusion Pressures, arm pressure gain from Occlu-
related research course, ability to lie down and remain sion to Completion, and pressure increases from Occlusion
relaxed for 30 minutes, and age 18 years or older. Recip- to Completion for thigh Proximal of Pair and Distal of Pair
ient exclusion criteria were self-reported blood clotting according to which had the final tooth advance; paired
or circulation irregularities, connective tissue disorders, t-tests for pressure increases from Occlusion to Completion
implants in relevant locations, systolic blood pressure for arm Proximal of Pair final tooth advance versus Distal
higher than 140mmHg, pain syndromes, or peripheral of Pair without the final tooth advance and for the 60-Sec-
neuropathies. Recipients completed an informed con- ond versus 120-Second pressure drop for each tourniquet
sent and were able to have a tourniquet removed or to on each limb. Contingency data were analyzed as follows:
stop participating at any time. Fisher’s exact test for thigh versus arm occlusion loss and
chi-square test for occlusion loss according to tourniquet
Single Tactical versus Wide versus and for thigh versus arm discomfort (with Moderate and
Paired Tactical RMT Protocol Severe discomfort ratings combined). Graphing and statis-
1. Recipient age, limb circumference, and blood pres- tical analyses were performed with GraphPad Prism ver-
sure information was collected. sion 5.02 for Windows (GraphPad Software Inc., www.
2. Recipients lay down throughout each application, graphpad.com). In tables and text, medians are shown with
with foam support and mid-range flexion of the rel- minimums and maximums. In graphs, medians are shown
evant limb. with scatter plots. Statistical significance was set at p ≤ .05.
3. Recipients were directed to maintain the relevant
limb in a completely relaxed state.
4. The order of tourniquet use was random and was Results
determined by drawing labeled slips of paper from Tourniquets were applied to eight men and eight women.
a box. None requested any early tourniquet removals. Their
5. Tourniquets were applied directly on skin with the ages ranged from 20 to 55 years; the median age was 21
friction buckle on the lateral aspect of each limb years. Their arm systolic blood pressures ranged from
and the free end of the strap pulled downward 108mmHg to 138mmHg on the left and 100mmHg to
through the friction buckle. 138mmHg on the right, with a shared median for each
6. The first RMT was applied on top of the mark on of 119mmHg. Their diastolic blood pressures ranged
the left mid-thigh (thigh) followed by application from 54mmHg to 87mmHg on the left and 58mmHg to
on top of the mark on the left mid-upper arm (arm). 84mmHg on the right, with medians of 72mmHg and
7. The next RMT was applied on the mark on the 69mmHg. Their mid-thigh circumferences ranged from
right thigh followed by application on the mark on 46.5cm to 57.4cm on the left and 47.3cm to 59.7cm on
the right arm. the right, with medians of 54.5cm and 53.6cm. Their
8. The remaining RMT was applied on the mark on mid-brachium circumferences ranged from 26.1cm to
the left thigh followed by application on the mark 32.9cm on the left and 26.0cm to 34.1cm on the right,
on the left arm. These second left limb applications with medians of 28.7cm and 29.5cm.
occurred approximately 20 minutes after the first
left limb applications. The order of tourniquet applications was as follows: the
9. Pressures and times were recorded. Single was applied first seven times; the Wide was ap-
10. The number of ladder teeth advanced to Comple- plied first six times, and the Paired were applied first
tion was recorded. three times. The Single was applied second four times;
11. Recipients verbally rated discomfort as None, Lit- the Wide was applied second four times, and the Paired
tle, Moderate, or Severe. 7 were applied second eight times. The Single was applied
12. Any comments relating to the application were third five times; the Wide was applied third six times,
recorded. and the Paired were applied third five times.

Statistical Analysis Excluded Pressure Data
Numeric pressure data were organized in Microsoft Of- Nine arm applications reached Occlusion at Friction
®
fice Excel 2003 (Microsoft Corp., www.microsoft.com). (one Single, two Wide, and six Paired). This left the
Pressure data were analyzed as follows: one-way repeated Occlusion Pressures of those applications unknown
measures analysis of variance (ANOVA) with the Tukey (simply some pressure lower than that reached during

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