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blood pressure changes. Combined with the short application 3. King DR, van der Wilden G, Kragh JF Jr, et al. Forward as-
duration, these factors should optimize the maintenance of oc- sessment of 79 prehospital battlefield tourniquets used in the
clusion compared with what might be encountered in field use. current war. J Spec Oper Med. 2012;12:33–38.
4. Kragh JF Jr, Littrel ML, Jones JA, et al. Battle casualty sur-
Major strengths of this study were the use of human subjects, vival with emergency tourniquet use to stop limb bleeding. J
of a randomized block design, and of all tourniquet locations Emerg Med. 2011;4:590–597.
on each subject. The randomized block design controlled for 5. Shlaifer A, Yitzhak A, Baruch EN, et al. Point of injury tour-
niquet application during Operation Protective Edge – what
tourniquet application order effects, and the use of all tourni- do we learn? J Trauma Acute Care Surg. 2017;83:278–283.
quet locations on each subject factored out interrecipient vari- 6. Brodie S, Hodgetts TJ, Ollerton J, et al. Tourniquet use in
ations in systolic blood pressure and location circumferences. combat trauma: UK military experience. J R Army Med Corps.
2007;153:310–313.
7. Inaba K, Siboni S, Resnick S, et al. Tourniquet use for civil-
Conclusions ian extremity trauma. J Trauma Acute Care Surg. 2015;79:
Tourniquet occlusion pressures are lower for paired tourniquets 232–237.
than single tourniquets with no loss of this advantage with in- 8. Zietlow JM, Zietlow SP, Morris DS, et al. Prehospital use of
creased intertourniquet distances. Very proximal placement hemostatic bandages and tourniquets: translation from mili-
has a pressure advantage; however, pairs and very proximal tary experience to implementation in civilian trauma care. J
Spec Oper Med. 2015;15:48–53.
locations may be less likely to maintain occlusion. Increasingly 9. Scerbo MH, Mumm JP, Gates K, et al. Safety and appropri-
proximal placements also increase tissue at risk. Therefore, dis- ateness of tourniquets in 105 civilians. Prehosp Emerg Care.
tal placements and, when a second tourniquet is used, minimal 2016;20:712–722.
intertourniquet distances should still be recommended. 10. Swan KG Jr, Wright DS, Barbagiovanni SS, et al. Tourniquets
revisited. J Trauma. 2009;66:672–675.
Acknowledgments 11. Gordon CC, Churchill T, Clauser CE, et al. (1988). Anthro-
We thank the undergraduates of the Drake University Trauma pometric survey of U.S. Army personnel: methods and sum-
Research Team for all their help carrying out the experiments mary statistics. Natick, MA: U.S. Army Natick Research,
and James Hopkins, MD, for his project help and advice. Development, and Engineering Center; 1989:225, 279.
12. Hargens AR, McClure AG, Skyhar MJ, et al. Local compres-
sion patterns beneath pneumatic tourniquets applied to arms
Disclosures and thighs of human cadaver. J Orthop Res. 1987;5:247–252.
None of the authors have any financial relationships relevant 13. Wall PL, Coughlin O, Rometti M, et al. Tourniquet pressures:
to this article to disclose, and there was no outside funding. strap width and tensioning system widths. J Spec Oper Med.
2014;14:19–29.
Author Contributions 14. Wall PL, Sahr SM, Buising CM. Different width and tighten-
P.W., C.B, D.N, L.G., and S.S. contributed to conception and ing system emergency tourniquets on distal limb segments. J
design. P.W., C.B., D.N., and L.G. contributed to acquisition Spec Oper Med. 2015;15:28–38.
of data. All authors contributed to the analysis and interpreta- 15. Kragh JF Jr, O’Neill ML, Walters TJ, et al. The military emer-
tion of data. All authors contributed to drafting or revising the gency tourniquet program’s lessons learned with devices and
designs. Mil Med. 2011;176:1144–1152.
article, and all authors had final approval of the manuscript. 16. Slaven SE, Wall PL, Rinker JH, et al. Initial tourniquet pres-
sure does not affect tourniquet arterial occlusion pressure. J
References Spec Oper Med. 2015;15:39–49.
1. Graham B, Breault MJ, McEwen JA, et al. Occlusion of arte- 17. Polston RW, Clumpner BR, Kragh JF Jr, et al. No slackers
rial flow in the extremities at subsystolic pressures through the in tourniquet use to stop bleeding. J Spec Oper Med. 2013;
use of wide tourniquet cuffs. Clin Orthop. 1993;286:257–261. 13:12–19.
2. Tactical Combat Casualty Care Guidelines. 9 February 2015. J
Spec Oper Med. 2015;15:161–167.

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