Page 39 - Journal of Special Operations Medicine - Fall 2016

Evaluation of Models of Pneumatic Tourniquet

in Simulated Out-of-Hospital Use

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

ABSTRACT

Background: Pneumatic field tourniquets have been rec- a tool of public health. The medical literature has of-
1,2
ommended for Military medics to stop bleeding from fered evidence of safety and effectiveness in emergency
limb wounds, but no comparison of commercially avail- use of such tourniquets. Most used or studied emer-
3–5
able pneumatic models of tourniquet has been reported. gency tourniquets are of either a windlass-and-band
6–8
The purpose of this study is to provide laboratory data design or a ratchet design, and such nonpneumatic
on the differential performance of models of pneumatic designs are intended for use by any lay civilians and by
tourniquets to inform decision-making of potential field military Servicemembers irrespective of medic training
assessment by military users. Methods: Models included (i.e., by all Servicemembers, of whom only a minority
the Emergency and Military Tourniquet (EMT), Tacti- are medics). However, the skillset and caregiving capac-
cal Pneumatic Tourniquet 2-inch (TPT2), and Tactical ity differ between medics and nonmedics because the
Pneumatic Tourniquet 3-inch (TPT3). One user tested former focus on providing a higher level of care than
the three tourniquet models 30 times each on a mani- the latter, who focus on self-aid, buddy aid, and combat
kin to collect data on effectiveness (yes-no bleeding con- lifesaver aid. 9–11
trol), pulse cessation, time to stop bleeding, total time
of application, after time (after bleeding was stopped), The field tourniquet design that is most effective has
Lifesaving. Combat Ready. pressure applied, blood loss volume, composite outcome a pneumatic design, and pneumatic tourniquets are
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(whether all individual outcomes were good or not),
suited well to the skillset and capabilities of medics,
™
Arrow EZ-IO T.A.L.O.N. IO Needle T.A.L.O.N. IO Needle and pump count of the bulb used to inflate the tourni- whereas the windlass-and-band tourniquets are suited
®
™
quet. Results: Neither tourniquet effectiveness nor pulse
6,13
Further-
to the skillset and capabilities of nonmedics.
®
NSN 6515-01-626-6395 cessation (p = 1; likelihood ratio, 0 for both) differed more, in 2004, a pneumatic tourniquet was tested and
among tourniquet models: all three models had 100% recommended for issue to US Army medics; however,
• VERSATILE: 7-site IO device (30 of 30 tests) for both outcomes. The EMT had the such issue was not doctrinally enacted. Later medi-
13
(sternum, proximal humerus, proximal & distal tibia) best or tied for best performance in time to stop bleed- cal research confirmed better efficacy of the pneumatic
ing, total time, after time, pressure blood loss, compos- tourniquet compared with the standard-issue windlass-
• LIFE-SAVING: Delivers fluids and medications rapidly EZ-Connect ® ite outcome, and pump count. Conclusion: Each of the and-band tourniquet, and such confirmation eventually
14
Extension Set
and accurately for casualty resuscitation three models of pneumatic field tourniquet was 100% led to a request in 2015 to compare pneumatic tourni-
effective in stopping simulated bleeding. Among the quet models suitable for out-of-hospital use by medics.
• CONVENIENT: No need for additional gear, multiple needles The purpose of this study is to assess and provide labora-
or special removal tools Sternal three models, the EMT showed the best or tied for best
Locator performance in time to stop bleeding, blood loss, and tory data on the differential performance of models of
• SIMPLE: Designed for any level responder composite outcomes. All models are suitable for future pneumatic field tourniquets to gain information for de-
field assessment among military users. cision-making by possible future field assessment among
military users.
Keywords: first aid; damage control; hemorrhage; shock;
teleflex.com/military tourniquet; resuscitation
Materials and Methods
This study was conducted under a protocol reviewed
and approved by the Regulatory Compliance Division
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, of the US Army Institute of Surgical Research. The
hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. In the United States in 2015, out-of-hospital use of tour- study involved a laboratory experiment designed to
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. niquets to control bleeding from limb wounds became compare the function of tourniquets. The comparisons
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21
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