Page 66 - Journal of Special Operations Medicine - Spring 2017

Two strengths of this study are the use of human sub- 12. Inaba K, Siboni S, Resnick S, et al. Tourniquet use for civil-
jects and several different pulse oximeters. Two addi- ian extremity trauma. J Trauma Acute Care Surg. 2015;79:
232–237.
tional strengths are the randomized block design, which 13. Zietlow JM, Zietlow SP, Morris DS, et al. Prehospital use of
ensured each pulse oximeter sensor was used an equiva- hemostatic bandages and tourniquets: translation from mili-
lent number of times on each digit, and the use of paired tary experience to implementation in civilian trauma care. J
raters, whose high level of agreement regarding the pres- Spec Oper Med. 2015;15:48–53.
ence or absence of a pulsatile waveform suggests eco-
logic validity concerning the likely waveform judgments
of other users.
Dr Wall is a researcher in the Surgery Education Department
of UnityPoint Health Iowa Methodist Medical Center, Des
Conclusion Moines, Iowa. E-mail: piperwall@q.com.
Current pulse oximetry can be thought of as a screening Dr Buising is a professor of biology and the director of the
technology for extremity tourniquet effectiveness. When Biochemistry, Cell and Molecular Biology Program at Drake
a pulsatile waveform is obtained from a location dis- University, Des Moines, Iowa.
tal to an extremity tourniquet, the tourniquet should be
tightened. When a pulsatile waveform is not detected, Ms Grulke is an emergency medical technician-paramedic
vigilance should be maintained. and a laboratory instructor in the Biology Department of
Drake University, Des Moines, Iowa.
Disclosures Mr Troester was an undergraduate research mentor in the
None of the authors have any financial relationships rel- Biochemistry, Cell and Molecular Biology Program at Drake
evant to this article to disclose, and there was no outside University, Des Moines, Iowa, and is now a medical student
funding. at the University of Iowa Carver College of Medicine, Iowa
City, Iowa.

References Mr Bianchina is an undergraduate research mentor in the
Biochemistry, Cell and Molecular Biology Program at Drake
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Trauma. 2008;64:S38–S50.
2. Kragh JF Jr, O’Neill ML, Walters TJ, et al. Minor morbidity Ms White was an undergraduate research mentor in the Bio-
with emergency tourniquet use to stop bleeding in severe limb chemistry, Cell and Molecular Biology Program at Drake Uni-
trauma: research, history, and reconciling advocates and abo- versity, Des Moines, Iowa, and is now a medical student at
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3. King DR, van der Wilden G, Kragh JF Jr, et al. Forward as-
sessment of 79 prehospital battlefield tourniquets used in the Ms Freymark was an undergraduate research mentor in the
current war. J Spec Oper Med. 2012;12:33–38. Biochemistry, Cell and Molecular Biology Program at Drake
4. Wall PL, Duevel DC, Hassan MB, et al. Tourniquets and oc- University, Des Moines, Iowa, and is now a medical student
clusion: the pressure of design. Mil Med. 2013;178:578–587. at the University of Iowa Carver College of Medicine, Iowa
5. Wall PL, Coughlin O, Rometti M, et al. Tourniquet pressures: City, Iowa.
strap width and tensioning system widths. J Spec Oper Med.
2014;14:19–29.
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ing system emergency tourniquets on distal limb segments. J Biochemistry, Cell and Molecular Biology Program at Drake
Spec Oper Med. 2015;15:28–38. University, Des Moines, Iowa, and is now a medical student at
7. Rometti MRP, Wall PL, Gildemaster YL, et al. Significant Des Moines University, Des Moines, Iowa.
pressure loss occurs under tourniquets within minutes of ap-
plication. J Spec Oper Med. 2016;16:15-26. Dr Hopkins is a retired pediatric surgeon who conducts re-
8. Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets search at UnityPoint Health Iowa Methodist Medical Center,
revisited. J Trauma. 2009;66:672–675. Des Moines, Iowa.
9. Leonard J, Zietlow J, Morris D, et al. A multi-institutional
study of hemostatic gauze and tourniquets in rural civilian Dr Renner is the director of the Office of Research at
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11. Ode G, Studnek J, Seymour R, et al. Emergency tourniquets Dr Sahr is a trauma surgeon at UnityPoint Health Iowa Meth-
for civilians: can military lessons in extremity hemorrhage be odist Medical Center, Des Moines, Iowa.
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44 Journal of Special Operations Medicine Volume 17, Edition 1/Spring 2017