Page 46 - Journal of Special Operations Medicine - Summer 2016

Table 1 Ladder and Strap Pressures During Tourniquet Applications
Ladder–Strap at Occlusion Ladder–Strap at Completion Ladder–Strap at 120-seconds
Tourniquet (mmHg) (mmHg) (mmHg)
Thigh
Single 126, 70–178 140, 86–197 125, 74–182
Wide 133, 78–186 144, 105–202 137, 92–189
Proximal of Pair 75, 17–92 83, 37–103 75, 30–96
Distal of Pair 98, 31–156 110, 42–150 97, 38–127
Arm
Single 56, 2–100 82, 28–133 72, 28–107
Wide 72, 5–101 105, 46–132 94, 41–116
Proximal of Pair 7, –34–47 16, –45–72 8, –36–64
Distal of Pair 58, –5–101 60, 15–96 54, 12–86
Data given as median pressure difference, minimum difference–maximum difference. Ladder pressures were generally higher than Strap pressures.
rather than 2.5 teeth/cm of the Tactical RMTs. The thigh to Completion. The tourniquet in the pair with the final
application pressure gains from Occlusion to Comple- one-tooth advance had the greater pressure increase from
tion, given as median mmHg, minimum– maximum Occlusion to Completion (Table 2). That pressure increase
mmHg, were as follows: Single Tactical RMT 40, 33- was still lower than the increase that occurred with Single
49; Wide RMT 51, 37-65; Proximal of Pair 15, 0-30; and Wide tourniquet applications. The tourniquet with-
and Distal of Pair 13, 1-35 (p < .05 for each comparison out the final one-tooth advance also had a pressure in-
except Proximal versus Distal, which did not signifi- crease but of a much lower amount.
cantly differ). The arm application pressure gains from
Occlusion to Completion were as follows: Single Tacti- Pressure Decreases Over Time
cal RMT 49, 41-71, Wide RMT 63, 48-77, Proximal Following Completion, pressures decrease under non-
of Pair 23, 2-35, and Distal of Pair 3, 0-14 (p < .05 for elastic strap-based tourniquets. The rate of decline is
5,8
each comparison except Single versus Wide, which did affected by the Completion Pressure, limb circumference,
not significantly differ). and limb composition and may be affected by tourniquet
width. The pressure decreases following Completion are
For Paired tourniquet applications, either tourniquet in shown in the panels of Figure 2. For each tourniquet ap-
the pair could have the one-tooth advance from Occlusion plication, greater decline occurred in the first 60 seconds

Table 2 Pressure Gain from Occlusion to Completion Under Paired Tourniquet Straps
Gain from Occlusion to Completion
Tourniquet (mmHg) p value
Thigh
Proximals that had the one-tooth advance to Completion, 22, 9–30
n = 9
Proximals that did not have the one-tooth advance to 8, 0–17 <.05 for those that
Completion, n = 7 advanced versus
Distals that had the one-tooth advance to Completion, 26, 18–35 those that did not
n = 7 advance
Distals that did not have the one-tooth advance to 2, 1–21
Completion, n = 9
Arm*
Proximals that had the one-tooth advance to Completion, 23, 2–35
n = 9
.0020
Distals that did not have the one-tooth advance to 3, 0–14
Completion, n = 9
Data given as median pressure gains, minimum gains–maximum gains.
*Seven of the Paired arm applications had excluded data because they either reached Occlusion at Friction or had an alternate Strap cuff location
because of small arm circumferences.

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