Page 27 - Journal of Special Operations Medicine - Fall 2017

Unwrapping a First Aid Tourniquet From Its Plastic Wrapper
With and Without Gloves Worn

A Preliminary Study

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John F. Kragh Jr, MD *; James K. Aden 3d, PhD ; Connor D. Lambert ;
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Virgil K. Moore III, BBA ; Michael A. Dubick, PhD 5
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ABSTRACT
Background: The purpose of this study was to gather data Introduction
about unwrapping a packaged limb tourniquet from its plas-
tic wrapper while wearing different types of gloves. Because The use of a limb tourniquet in first aid has emerged as a more
already unwrapped tourniquets require no time to unwrap, common practice since 2006, when military lessons learned
unwrapping data may provide insights into the issue of hav- in recent wars started to be more effectively translated into
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ing tourniquets unwrapped when stowed in a first aid kit of civilian care. In general, the tourniquet devices are routinely
a Serviceperson at war. Materials and Methods: In a labora- stowed in first aid kits Servicepersons attach to the outside of
tory setting, 36 tests of nine glove groups were performed in their torso body armor. Like many other commercial goods,
which four people, gloved and ungloved, unwrapped tour- the tourniquet supplied in such kits is packaged in a plastic
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niquets. Other tourniquets were environmentally exposed wrapper. Different advisors offer different advice about un-
for 3 months. Results: All the users successfully unwrapped wrapping the tourniquet. On one hand, one group of advisors
each tourniquet. Mean times to unwrap by glove group were suggests that tourniquets should be unwrapped before actual
not significantly different (p = .0961). When mean values of deployment for combat because such preparation speeds ap-
eight experimental groups were compared with that of one plication. On the other hand, other advisors suggest not un-
control group (i.e., bare hands), results showed no significant wrapping beforehand, based on the belief that the wrapper
difference (p > .07). Mean time was least for bare hands (12 protects the tourniquet from environmental exposure, which
degrades the tourniquet. In general, advice is routinely given
seconds) and most for cold gloves layered under mittens (22
Lifesaving. Combat Ready. seconds). Among the 36 pairwise comparisons of difference by an individual (e.g., an instructor), but occasionally an or-
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ganizational authority may also offer such advice. Based on
between glove group means, after adjustment for multiple
™
on for making a decision, a preliminary study was designed to
Arrow EZ-IO T.A.L.O.N. IO Needle T.A.L.O.N. IO Needle comparisons, no comparison was noted to be statistically sig- both contradictory advice and the lack of available data to rely
®
™
nificant (p > .052, all 36 pairs). Glove thickness ranged from
®
explore whether to unwrap a tourniquet.
NSN 6515-01-626-6395 0 mm for bare hands to 2.5 mm for cold gloves layered un-
der mittens. By glove group, the thickness–time association Caregivers routinely take precautions while rendering first aid,
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• VERSATILE: 7-site IO device was moderate, as tested by linear regression (R = 0.6096). such as using examination gloves to protect their hands from
(sternum, proximal humerus, proximal & distal tibia) The tourniquets exposed to the environment had evidence of blood. Military caregivers in combat are often gloved, so we
rapid photodegradation due to direct exposure to sunlight. made glove type a topic of study in the step of unwrapping a
• LIFE-SAVING: Delivers fluids and medications rapidly EZ-Connect ® Such exposure also destroyed the wrappers. Conclusion: In a tourniquet.
Extension Set
and accurately for casualty resuscitation preliminary study, different gloves performed similarly when
wearers unwrapped a tourniquet from its wrapper. The tour- In a nutshell, the purpose of this study was to gather prelimi-
• CONVENIENT: No need for additional gear, multiple needles niquet wrappers gave no visible protection from sunlight, and nary data about unwrapping a limb tourniquet from its pack-
or special removal tools Sternal environmental exposure destroyed the wrappers. aging material so a conclusion could be reached as to whether
Locator
such tourniquets should be unwrapped when stowed in a first
• SIMPLE: Designed for any level responder Keywords: tourniquet; first aid methods/device; hemor- aid kit of a Serviceperson at war.
rhage/prevention and control; shock; emergency medical
services; military medicine; material science; environment;
exposure Materials and Methods
teleflex.com/military This study was conducted by the guidelines of an approved
protocol involving a mechanical experiment designed to assess
*Correspondence to 3698 Chambers Pass, Joint Base San Antonio Fort Sam Houston, TX 78234-7767; or john.f.kragh.civ@mail.mil.
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, 1 Dr Kragh is a researcher of bleeding control at the ISR. He is an orthopedic surgeon who was the 3d Ranger Battalion Surgeon from 1990 to

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, 1993. He is an associate professor in the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
hematoma, extravasations or other complications associated with percutaneous insertion of sterile devices. 2 Dr Aden is a statistician at the Brooke Army Medical Center. He has published many papers in operational medicine. Cadet Lambert is a U.S.
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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. Military Academy cadet at West Point, New York, where he studies mechanical engineering. He had advanced individual academic development
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.
experience conducting research in bleeding control at the ISR in 2016. Mr Moore is a research associate in bleeding control at the ISR. He is
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© 2016 Teleflex Incorporated. All rights reserved. MC-002362 5
a former U.S. Army Noncommissioned Officer as a laboratory technician at ISR. Dr Dubick is a resuscitation researcher at the ISR. He is the
manager of the Damage Control Resuscitation task area. He has published many articles in operational medicine.
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