Page 34 - Journal of Special Operations Medicine - Fall 2017

Figure 8 Results of time versus thickness regression. Table 8 Training Tips Gathered from Experience During This Study
Start novices in tourniquet use with bare hands first before they
graduate to using examination gloves.
Advanced beginners may practice primarily with the glove type
most needed in their setting.
Competent tourniquet users should strive for familiarity with use of
a few types of gloves.
Proficient tourniquet users should strive for familiarity with use of
several types of glove.
Experts should gain experience in use of all glove types relevant to
themselves and their clients.
Environmental exposure for 3 months can damage tourniquets and
wrappers.
The chart depicts the plotted results of time to unwrap a packaged Commanders and leaders should be informed about proper
tourniquet by thickness of glove group. Each median is a dot repre- tourniquet stowage in first aid kits.
senting a glove group. Thickness and time were positively associated
to a moderate degree (R = 0.6096) in that time to unwrap was mod- Leaders may be unaware of the risk in using tourniquets previously
2
erately and positively associated with glove thickness. In other words, exposed outside of aid kits.
speed of use was negatively associated with thickness of gloves. Of Stewards (e.g., physicians, physician assistants, or senior medics)
note, the median for glove liners is fourth highest, whereas its mean are to inform leaders.
was second highest, and such skewing of the mean was commented Training directors may check their lessons for the recommendation
on by users as due to unpredictable performance with liners because to stow tourniquets in kits.
the loops in the liner fabric occasionally got caught up by inadver-
tent contact and connection with the Velcro hooks of the tourniquet, Medical directors to law enforcement or military services should

thereby impairing manual dexterity and speed. Skewing can be seen as check tourniquet practices.
a degree of separation between a mean and its related median, and the Authors of first aid lessons, curricula, and books should consider
most skewed glove group in the vertical box plots was of glove liners, tourniquet stowage guidance.
as presented in Figure 5. Instructors should use ‘unwrapping’ referring to the wrapper and
‘unrouting’ referring to removal of the band from around a limb
Table 7 Comments of Users on Points Learned about Unwrapping or from the buckle so that students are not needlessly forced to
Tourniquets disambiguate usage.
Users often thought the gloves impaired manual dexterity and Excerpt of Ranger Creed: “My . . . care of equipment shall set the
tactile sensation. example for others to follow.”
Users commonly noted that impairment worsened as glove types
became thicker or layered. Figure 9 Image of tourniquets after photodegradation by
Users sometimes noted that a problem occurred at one of the hand- environmental exposure.
glove-tourniquet interfaces.
Users occasionally noted slippage, gapping (bagginess), or folding
of gloves between interfaces.
An interface had specific trouble when glove liner fabric caught on
the Velcro hooks occasionally.
Sale prices for tourniquets online were less if unwrapped than if
wrapped.
Online tourniquets were sometimes packaged differently than how
the manufacturer does.
Repackaged tourniquets may not be unwrapped as fast as those
originally packaged.
Unwrapped tourniquets worn on gear may act as contaminated
fomites to make wounds dirty.
First-aid kit developers may redesign quick-draw pouches to
protect tourniquets from sunlight. The image depicts the environmentally exposed tourniquets after re-
covery as laid out in the laboratory. The unrouted four tourniquets
End-users of tourniquets may query advice, local practices, or the
absence of either. lengthwise laid out at the top of the image are two generation 3 de-
vices in an up-down pair above and a generation 6 up-down pair be-
Tourniquet users may ask about local practices from instructors, low. At the bottom left, four generation 6 devices are laid out. At the
course directors, or leaders. bottom right, four generation 3 devices are laid out. The instructions
for use and wrappers are laid out in the middle.
gray and appeared to be cracked, brittle, and fragmented, as The degradation of the wrapper was similar to that already
degradation was progressively more severe toward the sun- described. For the four devices laid out flat and unrouted, even
ward side and progressively less severe toward the roof-ward for the two that had been flipped over, the rest of the evidence
side. The wrapper also fractured incompletely along its seam was similar to that of devices already described, except that
where the heat-shrink process sealed the wrapper. All four de- more of the components were exposed when laid flat, so deg-
vices, routed and configured with Omni-tape fasteners down, radation was then more widespread. The paper instructions
showed the same evidence as the other devices described thus for use were faded, abraded, and degraded to the point that
far, except the specific sites of protected Omni-tape fasteners portions were illegible. Some of the paper damage appeared
differed because of locally differing protection from sunlight to be from photodegradation (fading alone), whereas other
due to the shift in the orientation of the tourniquet. Again, damage appeared to be from a combination of photodegrada-
degradation of both wrapped and unwrapped counterparts of tion (fading) and rainwater damage (abrasion of surface and
both generations was similar. portions worn away, forming small holes in the paper).

32 | JSOM Volume 17, Edition 3/Fall 2017