Page 150 - JSOM Summer 2018

Re: Tourniquet Effectiveness When Placed Over
the Joint Service Lightweight Integrated Suit Technology

Christopher Picard, CD, BSN, RN, ENC(C) *;
1
Matthew J. Douma, MN, RN, ACCN, ENC(C), CNCC(C), CCN(C) 2

To the Editor:

We thank Peponis et al. for their work evaluating the effec- the SOFTT and SOFTT-W (97% versus 72.7% and 73.8%,
1
tiveness of the Combat Application Tourniquet (C-A-T; C-A-T respectively). The C-A-T also was more quickly applied (37.0
Resources Inc.; http://combattourniquet.com/) over the Joint seconds) than the SOFTT (45.4 seconds) or SOFTT-W (38.1
Service Lightweight Integrated Suit Technology (Lanx Fabric seconds). The C-A-T received better ratings for perceived ease
Systems). Their work validated the training doctrine of apply- of use, but consistently was rated as more painful than the
ing the tourniquet over top of the protective clothing, it adds SOFTT or SOFTT-W. 2
to the body of evidence that assesses tourniquets outside of a
controlled laboratory setting, and provides an evidence base The findings of Savage et al. correlate well with the work of
for not removing protective clothing or delaying tourniquet Peponis et al. The data indicate that although the tourniquet
application. appliers were researchers, there is likely good external validity
in generalizing the findings to skilled providers. Both studies
The authors asserted that all tourniquet testing before their are important: They validate doctrine, they may bring into
study had been conducted over a single-layer standard uni- question whether protective clothing need be removed in hos-
form; however, we would like to draw their attention to a tile environments of any sort, and they suggest more work is
tourniquet trial conducted by the Canadian military. A 2013 required to assess the broad range of tourniquet devices used
study by Savage et al. assessed the C-A-T, as well as the Spe- atop the wide array of protective clothing.
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cial Operations Forces (SOF) tactical tourniquet (SOFTT) and
the SOF tactical tourniquet-wide (SOFTT-W; both Tactical References
Medical Solutions, https://www.tacmedsolutions.com) over a 1. Peponis T, Ramly E, Roth KA, et al. Tourniquet effectiveness when
double layer of fleece and insulated wind pants to simulate placed over the Joint Service Lightweight Integrated Suit Technol-
ogy. J Spec Oper Med. 2016;16(2):17–19.
tourniquet application in arctic environments. This was a 2. Savage E, Pannell D, Payne E, et al. Re-evaluating the field tourni-
three-arm study that used military medics as simulated pa- quet for the Canadian forces. Mil Med. 2013;178(6):669–675.
tients, as well as providers; it used both palpation and audible
Doppler occlusion as definition of success. Savage et al. calcu- Keywords: letter; tourniquets; Joint Service Lightweight In-
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lated a pooled tourniquet efficacy rate of 86.4% when applied tegrated Suit Technology
over winter clothing, with the C-A-T being more effective than

*Correspondence tox 15417 76 Ave NW, Edmonton, Alberta, Canada T5R 3A2; or picard.ct@gmail.com.
1 Mr Picard is a clinical nurse educator at the Misericordia Community Hospital Emergency Department, Alberta Health Services, Alberta, Can-
2
ada. Mr Douma is an assistant adjunct professor in the Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of
Alberta, Alberta, Canada.
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