Page 53 - JSOM Winter 2019

Interoperable Readiness to Use Tourniquets by
One’s Familiarity With Different Models

John F. Kragh Jr, MD *;
1
James K. Aden 3rd, PhD ; Michael A. Dubick, PhD 3
2

ABSTRACT
Background: We investigated interoperability for a first aid services school for students in the US Army, Navy, Air Force,
provider to perform simulated use of three tourniquet mod- or Marines was to help them better understand one another.
els of maximal, moderate, and minimal familiarity. Methods: Working together can be easy when things are familiar, espe-
The experiment was focused on the tourniquets used by an cially if people are experienced and ready. Otherwise, operat-
expert who rendered aid on a manikin by using three mod- ing together can be challenging. For this work-together trait,
els of tourniquet with different extents of familiarity: The fa- the term ‘interoperability’ was coined in 1965 to mean the
miliarity with Combat Application Tourniquet (C-A-T) was ability of an equipment system to work with another system,
2
maximal; that for Special Operations Forces Tactical Tourni- such as comprising hi-fi components. However, interoperabil-
quet (SOFTT) was moderate, and that for Military Emergency ity is also applicable between people within a team or people
Tourniquet (MET) was minimal. Each model had a band-and- in different teams. Businesses, military alliances, and govern-
3
rod design. Interoperability changes as intermodel differences ments seek to develop an ability to work synergistically in the
were beneficial or costly in that performances were improved execution of their tasks. By and large, they aim to act together
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or impaired in units of time, ease, blood, and pressure. Each coherently, effectively, and efficiently to achieve their goals. In
model had 10 tests, and test order was randomized by model. 2019, Special Operations Forces (SOF) plan to participate in
The HapMed Leg Tourniquet Trainer simulated a limb am- 19 rotations at US combat training centers with an emphasis
putation. Results: In comparison of interoperability burdens, on interoperability among conventional forces and SOF. 5
sums of 10 test durations by model for C-A-T, SOFTT, and
MET were 38, 77, and 64 minutes, respectively; C-A-T was Although many reports examine emergency preparedness
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fastest (p ≤ .002, both). The sums of times to stop bleeding for across multiple industries, few have focused on the interop-
C-A-T, SOFTT, and MET were 334, 953, and 826 seconds, erability of an individual caregiver. When disasters strike or
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respectively; C-A-T was fastest (p ≤ .0013, both). The sums of accidents occur, a caregiver may have to work with unfamiliar
blood losses for C-A-T, SOFTT, and MET were 2105, 3287, tools or people. A 2019 study found that trainee performance
and 4256mL, respectively; that for C-A-T was least (p ≤ .0005, differed by model of tourniquet, suggesting that if bleed-
both). The mean ease of use differed, with C-A-T being easiest ing-control providers are unfamiliar with the model available,
(p ≤ .0046, both). The mean pressure differed, with C-A-T they may not be prepared to care for bleeding patients. In
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being higher than SOFTT (p = .0073). Conclusions: Time- seeing performances of first aid providers by their degree of
saving strongly favored the model with which the user had familiarity with the equipment at hand, interoperability mea-
maximal familiarity. In theory and simulation, interoperability sures may indicate a readiness level of an individual. Mea-
bears costs in successfully attaining it, in maintaining it, and sures may also show benefits or costs resulting from current
in failing either. The user’s familiarity with tourniquet model interoperability goals, potential changes in plans or practices,
was associated with improved interoperability as seen by im- or an onset of new needs. In this study, we investigated a first
proved performances. If multiple models are fielded, then or- aid provider’s interoperability to perform simulated tourni-
ganizations may plan on extra spending, supplying, training, quet use with three models of maximal, moderate, or minimal
and managing. familiarity.

Keywords: tourniquet model; Combat Application Tourni- Methods
quet (C-A-T); Special Operations Forces Tactical Tourniquet
(SOFTT); Military Emergency Tourniquet (MET); interopera- This study was conducted in April 2019 within the limits of
bility; manikin; emergency; first aid protocol guidelines at the US Army Institute of Surgical Re-
search. The design was a laboratory experiment of tourniquets
used by an expert. The study was designed and implemented
rapidly to mimic a sudden challenge for a caregiver to demon-
Introduction
strate interoperability in first aid. The challenge was scaled for
1
We are to “work together for the common goo.” The purpose the use of a medical device with which the user had different
of this 1980s typo recorded in a new staff manual at a joint degrees of familiarity. Specifically, a caregiver rendered aid on
*Correspondence to 3698 Chambers Pass, Joint Base San Antonio Fort Sam Houston, TX; or john.f.kragh.civ@mail.mil
1 Dr Kragh is a researcher of bleeding control at the Institute of Surgical Research (ISR), Fort Sam Houston, TX, and an associate professor in
the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr Aden is a statistician at the Brooke Army
2
Medical Center, Fort Sam Houston, TX. Dr Dubick is a researcher and the chairperson of the Department of Hemorrhage Control and Resus-
3
citation at the ISR.
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