Page 162 - JSOM Spring 2020

3. Simplicity of application 3. Feedback from the field
4. Pressure 4. Suggestion box
a. Optimal: 180–500mmHg a. Not anonymous – to keep vendors from submitting
i. Optimal pressure depended on size of thigh and b. Should be from a .mil email
arm
5. Specifications (minimum) This topic created a lot of discussion within the meeting
where multiple people stated their frustration that we do
a. 1.5 inches – width (critical requirement) not have a real mechanism for feedback and suggestions.
b. 37.5 inches – length (critical requirement) Additionally, the majority of members felt the CoTCCC
c. Weight: <8.0 ounces (critical requirement) should get away from naming a product but rather come
d. Did it have a locking mechanism?
6. Complications and safety up with a “Preferred Features.”
a. Lots of hearsay but we only looked at actual doc-
umented cases. 12. TCCC Curricula
7. User preference Harold Montgomery, JTS contractor, began with stan-
8. Real-world cases use(s) dard disclaimers. Mr Montgomery went over some of the
9. Logistics issues we (CoTCCC) need to overcome to move forward
a. Did they have an NSN? and realize our target population is the Service members
b. Cost per tourniquet that were born on or after 9-11.
i. GSA cost 1. How do they learn?
ii. Commercial cost a. Online
10. Pain was not included b. They figure it out on their own
a. A lot of studies did use this as a criterion i. YouTube
b. Pain is subjective c. They don’t know what life was like before mobile
c. When a tourniquet is applied, it is going to hurt devices and computers
Way ahead for the CoTCCC and tourniquets was discussed Reviewed why there is a push for change:
because between the time the tourniquet change was voted 2. FY 17 National Defense Authorization Act
on in late May – early June there have been changes to the a. Public law 114-328, Section 708 (b)(6) (OPR: DHA)
approved tourniquets and there are new tourniquets on the b. Develop standardized combat casualty care instruc-
market. For example: There is the new SOFT-W Gen 4, tion for all members of the Armed Forces, including
TX3 added indication for pelvic binder and junctional. The the use of standardized trauma training platforms
issue is we just finished this review and recommendation 3. DoDI 1322.24 (16 March 2018)
and there is a need for a relook already. There was a brief 4. Assistant Secretary of Defense – Health Affairs
question and answer session after this section. memorandum
a. Target Date: April 2020
Q1: Is the tourniquet review our (CoTCCC) responsibility? i. Standardize Joint curriculum delivered to Services
A1: No, but all military look to the CoTCCC for guidance; b. Implementation: NLT 2023
All civilians look to the Military for what works. Example: i. 85% of all Forces should be trained at this point
Stop the Bleed program. c. Four TIERs or levels of care for TCCC
Q2: Should we set the standards and criteria for tourni- i. Tier 1 = All Service Members (ASM)
quets rather than recommending one? 1. Nonmedical personnel
A2: Yes, because all the studies we reviewed were not con- 2. Student population: ALL Service members
sistent and used lots of confusing criteria. We have done 3. On deployed medicine: as of June 2019
this in the past with different products and industry reacted ii. Tier 2 = Combat Life Savers (CLS)
quickly and well. We should generate a “Preferred Fea- 1. Nonmedical personnel
tures” document as part of the way ahead. 2. Student population: combatants
3. Deployed medicine after 31 December 2019
Q: Should 60-seconds be the minimum or maximum? iii. Tier 3 = Combat Medic
A: Yes, 60 seconds is the maximum. 1. Medical personnel
2. Student population: Medic/Corpsman – Junior
Q: Why don’t we endorse just one tourniquet? Medics/Corpsman
A: That was not the purpose of this study but rather to look 3. Deployed medicine after 31 March 2020
at what we recommended in the past and what has been iv. Tier 4 = Combat Paramedic
used from 2012 to now. The services can now use this scru- 1. Medical personnel
tinized list of tourniquets and decide what they want to 2. Student population: SOF Medics, Flight Med-
purchase and outfit their people with. However, with this ics, Physicians/PAs/Providers at Role 1 (and II)
approach there will be tourniquets on the battlefield that 3. Deployed medicine after June 2020
service men and women will not be familiar with and this
could lead to deadly results.
Mr Montgomery also discussed the need for “user feed-
back” so that we are truly looking at what the end users
want and use. Some suggested user feedback forums are:
1. DD Form 1380 – casualty documentation
2. JTS after action review

156 | JSOM Volume 20, Edition 1 / Spring 2020