Page 20 - JSOM Summer 2020

2018;18(2):58–62 along the band, and having the strap fastened to its clip of
origin. When used, tourniquets had normal, small elongations
Old Tricks for New Dogs? John Caddy and the Victorian Or- in part due to band flattening. This tourniquet study showed
igins of TCCC Reynolds PS
the importance of optimal configuration to first-aid readiness
ABSTRACT The success of Tactical Combat Casualty Care practices.
(TCCC) in reducing potentially preventable combat deaths
may rely on both specific interventions (such as tourniquets) 2019;19(1):44–46
and the systematized application of immediate care. Essential
elements of a combat care system include clear specification Masimo Perfusion Index Versus Doppler for Tourniquet Ef-
of immediate care priorities, standardized methodology, and fectiveness Monitoring Wall PL, Buising CM, Nelms D, et al.
inclusion and training of all nonmedical personnel in early re- ABSTRACT Conclusion: The PI available on Masimo pulse
sponse. Although TCCC is fairly recent, the construct is sim- oximeters is not appropriate for monitoring limb tourniquet
ilar to that first suggested during the mid-nineteenth century effectiveness.
by John Turner Caddy (1822–1902), a British Royal Navy
staff surgeon. Although naval warfare engagements at the 2019;19(2):48–56
time were relatively infrequent, casualties could be numerous
and severe and often overwhelmed the small medical staff on Best Tourniquet Holding and Strap Pulling Technique Wall
board. Caddy recognized that nonmedical personnel properly PL, Buising CM, Donovan S, et al.
trained in the fundamentals of combat injury management ABSTRACT Conclusions: The default for best tourniquet
would result in lives saved and greatly improved morale. The strap-application technique is to hold above the buckle and
novelty was in his attempt to make procedures simple enough pull the strap tangential to the limb at the buckle. Addition-
to be performed by nonmedical personnel under stress. How- ally, neither strength nor experience guarantees desirable strap
ever, Caddy’s guidelines were completely overlooked for nearly pressures in the absence of pressure knowledge.
two centuries. The principles of best practice for managing
combat trauma injuries learned in previous wars have often 2019;19(2):69–72
been lost between conflicts. Understanding the historical roots
of combat first responder care may enable us to better under- The Use of the Abdominal Aortic and Junctional Tourniquet
stand and overcome barriers to recognition and retention of Versus Combat Gauze in a Porcine Hemicorporectomy Model
essential knowledge. Schwartz RB, Shiver SA, Reynolds BZ, et al.
ABSTRACT Conclusion: AAJT is superior to CG in con-
2018;18(2):148 trolling hemorrhage in a junctional wound in a swine model.
Re: Tourniquet Effectiveness When Placed Over the Joint 2019;19(2):128–133
Service Lightweight Integrated Suit Technology Picard CT,
Douma MJ (Letter) Improvised Inguinal Junctional Tourniquets: Recommenda-
tions from the Special Operations Combat Medical Skills Sus-
2018;18(3):71–74 tainment Course Kerr W, Hubbard B, Anderson B, et al.
Does Pain Have a Role When It Comes to Tourniquet Train- ABSTRACT Effectively and rapidly controlling significant
ing? Alterie J, Dennis AJ, Baig A, et al. junctional hemorrhage is an important effort of Tactical Com-
bat Casualty Care (TCCC) and can potentially contribute to
ABSTRACT Conclusion: The unexpected low pain values re- greater survival on the battlefield. Although the US Food and
corded when loss of signal was reached make the use of pain Drug Administration (FDA) has approved labeling of four
too sensitive as an indicator to confirm adequate occlusion of devices for use as junctional tourniquets, many Special Op-
vasculature and, thus, successful TQ application.
erations Forces (SOF) medics do not carry commercially mar-
keted junctional tourniquets. As part of ongoing educational
2018;18(4):57–63
improvement during Special Operations Combat Medical
Use Your Noodle to Simulate Tourniquet Use on a Limb with Skills Sustainment Courses (SOCMSSC), the authors surveyed
and Without Bone Kragh JF Jr, Zhao NO, Aden JK 3rd, et al. medics to determine why they do not carry commercial tour-
niquets and present principles and methods of improvised
ABSTRACT Conclusion: In simulated first aid, mechanical junctional tourniquet (IJT) application. The authors describe
modeling demonstrated how tourniquet compression applied the construction and application of IJTs, including the use of
to a limb squeezed the soft tissues better when underlying bone available pressure delivery devices and emphasizing that suc-
was present. Bone loss altered the compression profile and may cessful application requires sufficient and repetitive training.
complicate control of bleeding in care. This knowledge, its de-
piction, and its demonstration may inform first-aid instructors.
2019;19(3):45–50
2019;19(1):35–43 Deliberate Practice in Combat Application Tourniquet Place-
ment by Loop Passage Kragh JF Jr, Aden JK 3rd, Dubick MA
Limb Tourniquet Configuration: Preliminary Investigation of
Problems and Principles Kragh JF Jr, Aden JK 3rd, Dubick MA ABSTRACT Conclusion: Each metric had value in assessing
first aid, but turning attention to gauging wound-tourniquet
ABSTRACT Conclusion: People are too often unreliable at gaps revealed placement errors. Analysis of such errors un-
putting C-A-Ts into the optimal configuration for use. That covered what 2–3 inches meant in operation. Spiral learning
ready-to-use configuration includes the tourniquet being at its may inform the development of best readiness practices such
full length, having the stabilization plate positioned correctly
as coaching deliberate-practice sessions.

18 | JSOM Volume 20, Edition 2 / Summer 2020