Page 56 - JSOM Summer 2019

For thigh applications, the highest peak strap pressures hap- TABLE 3 Associations Between Strength or Experience and Secured
pened with the hold below and pull down technique (p < Strap Pressure
.0001 for technique and for tourniquet, with p = .2999 for Spearman r Value p Value
interaction when including the pulling outward only tech- Above tangential
niques, and p < .0001 for technique and for tourniquet, with Applier strength versus secured pressure
p = .1280 for interaction when excluding the pulling outward C-A-T7 0.33 .15
only techniques; Figure 4A). However, this technique also had Tac RMT 0.59 .0064*
the greatest difference between the peak pressures and the
secured-strap pressures (p < .0001 for technique, p = .4523 TMT 0.52 .020*
for tourniquet, and p = .2491 for interaction when including Parabelt 0.79 <.0001*
the pulling outward only techniques; and p < .0001 for tech- SOFTTW 0.13 .58
nique, p = .2442 for tourniquet, and p = .0924 for interaction Applier experience versus secured pressure
when excluding the pulling outward only techniques; Figure C-A-T7 0.16 .49
4C). This coincides with feelings of appliers that significant Tac RMT 0.31 .19
strap-pressure loss occurred while getting the two fingers out TMT 0.26 .26
from between the tourniquet strap and the thigh. We were un- Parabelt 0.087 .71
able to do this strap hold with the hanging weight gel appli- SOFTTW 0.24 .30
cations, because the tackiness of the gel precluded removal of
the two fingers involved in strap holding from between the Below tangential
strap and the gel. Applier strength versus secured pressure
C-A-T7 –0.037 .88
For gel applications, techniques involving an outward pulling Tac RMT –0.17 .47
direction (Figure 3), with all of the hanging weight supported TMT –0.074 .76
by the portion of the strap directly over the No. 1 neonatal Parabelt 0.0023 .99
blood pressure cuff on the opposite side of the gel from the SOFTTW 0.31 .18
weights, resulted in the highest peak strap pressures (p < .0001 Applier experience versus secured pressure
for technique, tourniquet, and interaction; Figure 4B). As ex- C-A-T7 0.14 .55
pected, the best capture of strap pressure (i.e., least difference Tac RMT 0.47 .035*
between peak and secured strap pressure) occurred with the
tangential pulling direction (p < .0001 for technique, tourni- TMT 0.41 .073
quet, and interaction; Figure 4D). Parabelt 0.54 .014*
SOFTTW 0.36 .12
Applier Strength or Experience Above out then tangential
and Secured-Strap Pressures Applier strength versus secured pressure
Statistically significant correlations between applier strength C-A-T7 0.28 .23
or experience and secured-strap pressure were only sometimes Tac RMT 0.66 .0017*
present (Table 3). Therefore, one cannot count on either strong TMT 0.69 .0007*
or experienced appliers achieving desirable secured pressures Parabelt 0.51 .0209*
without knowledge of results while applying.
SOFTTW 0.48 .034*
Applier experience versus secured pressure
Strap-Securing Issues
One complete novice applier unintentionally demonstrated C-A-T7 0.22 .34
the difference between non–self-securing and self-securing Tac RMT 0.11 .63
tourniquets when he pulled the C-A-T7 strap tight but failed TMT 0.028 .91
to move the strap into a hook-and-loop to hook-and-loop po- Parabelt 0.10 .67
sition. This resulted in a complete failure to capture the strap SOFTTW 0.16 .50
tightness achieved with the pull. The applier was reminded of Buckle out then tangential
the need to move the portion of the strap pulled through the Applier strength versus secured pressure
redirect buckle into contact with the strap encircling the leg
and redid the application successfully. C-A-T7 0.36 .12
Tac RMT 0.48 .033*
Many appliers chose to wrap the free end of the strap around TMT 0.52 .018*
the pulling hand. In three applications with the C-A-T7, a Parabelt 0.51 .023*
problem occurred because in the process of unwrapping and SOFTTW 0.33 .15
freeing the pulling hand, the secured hook-and-loop to hook- Applier experience versus secured pressure
and-loop was inadvertently pulled completely or partially out C-A-T7 0.46 .042*
of contact. This occurred during the first C-A-T7 application Tac RMT -0.025 .92
for one complete novice (complete hook-and-loop pull out of TMT 0.081 .73
contact) and during two C-A-T7 applications for one expe- Parabelt 0.085 .72
rienced applier (partial hook-and-loop pulls out of contact).
SOFTTW 0.30 .19
With the TMT, the forced proximity of the two hook-and- *p < .05, text also bolded.
C-A-T7, Generation 7 Combat Application Tourniquet; Tac RMT, Tactical Ratch-
loop strap surfaces created by the non–self-securing, triglide eting Medical Tourniquet; TMT, Tactical Mechanical Tourniquet; SOFTTW, Gen-
redirect buckle often created some difficulty for appliers. It eration 3 Special Operations Forces Tactical Tourniquet–Wide.

54 | JSOM Volume 19, Edition 2 / Summer 2019