Page 40 - Journal of Special Operations Medicine - Fall 2016

of outcomes were made to provide evidence of differen- the other is outward, facing away from the limb. The
tial performance by model of tourniquet. The models pattern of the welds allows pumped air to flow unim-
of pneumatic tourniquet were intended for temporary peded through the bladder until the closed clamp is
control of bleeding from limb wounds in out-of-hospital reached. The welds keep the bladder nearly flat as it is
settings during both Care Under Fire and Tactical Field inflated. The flatness of the inflated bladder helps keep
Care, situations similar to civilian care when aid is not it in place; if the bladder was torus-shaped, like an in-
in the midst of active gunfire or similar dangers. The ner tube or donut, it would tend to roll down the limb
intended user in such a tactical situation is a Military distally, because a limb segment (e.g., thigh) is a cone-
medic, a fire department paramedic, a paramedical law like section that is narrower distally. A bulb is attached
enforcement officer, a flight paramedic, or a person with by a tube to the bladder in a configuration like a blood
similar medical experience as a field caregiver of emer- pressure cuff. The bulb is squeezed by hand to pump air
gency aid. Data were collected from 18 June 2015 to 10 through the tube to inflate the bladder. The bulb has a
August 2015. one-way inlet for air intake. The bulb-tube connector
has a plastic twist cap that has a one-way valve as an
The models of tourniquet included the Emergency and outlet for air to escape. The EMT was designed by clini-
Military Tourniquet (EMT; Delfi Medical Innovations, cal engineers with extensive experience with field and
http://www.delfimedical.com; Figure 1A), the Tacti- surgical tourniquets.
cal Pneumatic Tourniquet 2-inch (TPT2; Alphapointe,
https://www.alphapointe.org), and the Tactical Pneu- The EMT is made in Canada, weighs about 215g, and
matic Tourniquet 3-inch (TPT3, Alphapointe; Figure costs about $300 (USD). The EMT is registered with the
1B). The development of the latter two tourniquet mod- FDA as a pneumatic tourniquet, and is not limited to sin-
els was led by two senior US Army medics; the mod- gle use. The device used in this study was uniquely iden-
els were introduced recently into the marketplace. The tified as EMT (serial number 7259 was etched into the
EMT has been in the marketplace for more than a de- metal handle). The EMT was delivered in a clear plastic
cade. All three tourniquet models are registered with the wrapper bearing a label with corporate and device-spe-
US Food and Drug Administration (FDA). For testing, cific information. In the EMT wrapper was a paper copy
tourniquet models of the current version were acquired of the 13-page Instructions for Use (IFU). Abbreviated
in mid-2015. Devices assessed were unused before the instructions were indelibly printed on the bladder, and
experiment. corporate information and guidance on use were etched
on the clamp. A large white arrow at the end of the band
Figure 1 Two tourniquets used in this study. (A) Emergency pointed in the direction for the band to enter the clamp.
and Military Tourniquet. Image is used with permission of In the actual field application, the user is instructed to
Delfi Medical Innovations. (B) Tactical Pneumatic Tourniquet record the time of initial application on the arrow, which
3-inch (TPT3). The TPT2 is similar to TPT3, except it is has enough space for times and dates of multiple uses.
2 inches wide.
A B The TPT2 is a militarily developed and commercially
made tourniquet model also intended for out-of-hospi-
tal use. TPT2 has a pneumatic design with an inner and
outer cover. Overall, the two covers act as bands joined
in a Y-shape as viewed from the side edge of the covers.
The brown inner cover constitutes the base of the Y and
one of the Y’s arms. The base of the Y is a nonpneumatic
The EMT is a commercially developed tourniquet model extension of the inner cover. The rest of the inner cover
intended for out-of-hospital use; it has a pneumatic de- is a pneumatic bladder that acts as a 69cm band to en-
sign with an air bladder that acts as a band to circumfer- velope the limb. Compared with the arms of the Y, the
entially envelope the limb. It is designed to allow either nonpneumatic extension of the inner cover is shorter,
one-handed or two-handed use. The black band is 96cm at 15cm. The inner cover has black Velcro (http://www
long, which includes the 93cm-long bladder and a 3cm .velcro.com) on its two ends so that, after slack is re-
pull-tab. The tab is threaded through a clamp that al- moved, the cover can be secured to itself when the two
lows slack removal from the band in tightening before Velcro surfaces contact and adhere to each other. The
clamp closure upon the bladder. The aluminum clamp Velcro on the bladder end is on top and faces away from
has two handles that act as levers to close the open slit the limb; the Velcro on the extension end is on bottom
through which the uninflated bladder is threaded. The and faces the underlying Velcro of the bladder end. With
bladder is of a thin fabric that is impervious to air, and these two segments of Velcro, almost half of the inner
the bladder has ultrasonic spot welds that join the two cover has a Velcro surface: Velcro is absent on the 43cm
layers of the bladder: one layer is toward the limb and surface in contact with the limb and is absent on the

22 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2016