Page 21 - JSOM Summer 2020

2019;19(3):52–63 2019;19(4):51–57
Review: Getting Tourniquets Right = Getting Tourniquets Interoperable Readiness to Use Tourniquets by One’s Famil-
Tight Wall PL, Buising CM, Sahr SM iarity with Different Models Kragh JF Jr, Aden JK 3rd, Du-
bick MA
ABSTRACT Tourniquet application to stop limb bleeding is
conceptually simple, but optimal application technique mat- ABSTRACT Conclusions: Timesaving strongly favored the
ters, generally requires training, and is more likely with ob- model with which the user had maximal familiarity. In theory
jective measures of correct application technique. Evidence of and simulation, interoperability bears costs in successfully at-
problems with application techniques, knowledge, and train- taining it, in maintaining it, and in failing either. The user›s fa-
ing can be ascertained from January 2007 to August 2018 miliarity with tourniquet model was associated with improved
PubMed peer-reviewed papers and in Stop the Bleed-related interoperability as seen by improved performances. If multi-
videos. Available data indicates optimal technique when not ple models are fielded, then organizations may plan on extra
under fire involves application directly on skin. For nonelas- spending, supplying, training, and managing.
tic tourniquets, optimal application technique includes pulling
the strap tangential to the limb at the redirect buckle (paral- 2019;19(4):74–79
lel to the limb-encircling strap entering the redirect buckle).
Before engaging the mechanical advantage tightening system, The Potential Use of the Abdominal Aortic Junctional Tour-
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the secured strap should exert at least 150mmHg inward, and niquet in a Military Population: A Review of Requirement,
skin indentation should be visible. For Combat Application Effectiveness, and Usability Handford C, Parker PJ
Tourniquets, optimal technique includes the slot in the wind- ABSTRACT Uncontrolled hemorrhage is the leading cause
lass rod parallel to the stabilization plate during the single of preventable prehospital death on the battlefield; 20% is
180° turn that should be sufficient for achieving arterial oc- junctional. This is a challenge to manage in the forward and
clusion, which involves visible skin indentation and pressures prehospital military environment. With the widespread use of
of 250mmHg to 428mmHg on normotensive adult thighs. body armor, peripheral tourniquets and continued asymmetric
Appropriate pressures on manikins and isolated-limb simula- warfare this consistent figure is unlikely to reduce. Resusci-
tions depend on how the under-tourniquet pressure response tative endovascular balloon occlusion of the aorta (REBOA)
of each compares to the under-tourniquet pressure response is an often-quoted potential solution; however, this invasive
of human limbs for matching tourniquet-force applications. strategy requires a high skill level alongside a significant fail-
Lack of such data is one of several concerns with manikin and ure and complication rate. The Abdominal Aortic Junctional
isolated-limb simulation use. Regardless of model or human Tourniquet (AAJT) is a noninvasive potential adjunct for the
®
limb use, pictures and videos purporting to show proper tour- management of hemorrhage below the level of the aortic bi-
niquet application techniques should show optimal tourniquet furcation with published case reports of successful use in pre-
application techniques and properly applied, arterially occlu- hospital blast and gunshot wounds. When placed at the level
sive limb tourniquets. Ideally, objective measures of correct of the aortic bifurcation, alongside a pelvic binder, it can be
tourniquet application technique would be included. used to control pelvic hemorrhage, buying time until definitive
management. Importantly it has a low training burden and is
2019;19(3):123–127 easy to use. The AAJT has potential use as a prehospital de-
vice in the exsanguinating patient, those in traumatic cardiac
Proficiency in Improvised Tourniquets for Extremities: A Re- arrest, as a bridging device, and as fluid conserving device in
view Rohrich C, Plackett TP, Scholz BM, et al.
resource-limited environments. The evidence surrounding the
ABSTRACT Tourniquets have become ubiquitous tools for AAJT is reviewed, and potential uses in the military setting are
controlling hemorrhage in the modern prehospital environ- suggested.
ment, and while commercial products are preferable, impro-
vised tourniquets play an important role when commercial 2019;19(4):120–122
options are not available. A properly constructed improvised
tourniquet can be highly effective provided the user adheres “There I Was”: A Cup of Improvisation Hubbard B, Freeman
to certain principles. This review article identifies key skills C, McKay K
in the construction and application of improvised tourniquets EXCERPT: Clearance Team 1 was well into their day, con-
on an extremity. An improvised tourniquet design for an ex- ducting building clearance operations in order to exploit ma-
tremity should include three components: a strap, a rod, and a terial left behind by key enemy personnel. While another team
securing mechanism. The strap can be made from a variety of was assessing the next target, the three-man clearance team
materials, but cravat-like fabric has been shown to work well. was inside a masonry, one-story residence. While clearing the
Optimal strap dimensions should be at least 2cm in width and structure, an improvised explosive device (IED) was triggered
a continuous segment long enough to extend around the ex- three rooms deep into the building. The blast caused a massive
tremity while still offering ends to accommodate and secure fire in the room with a trapped individual, fallen debris was
the rod. The rod should be constructed from a material that everywhere, smoke filled much of the space.
is hard, strong, and capable of withstanding the torque placed
on it without bending or breaking. After torque is applied, the 2020;20(1):47–54
rod must be secured into position to maintain the constricting
force and survive patient transport. Finally, the need for an Characterizing a System for Measuring Limb Tourniquet Pres-
improvised tourniquet is a contingency that all first respond- sures Hingtgen E, Wall P, Buising C
ers should anticipate. Hands-on training should be conducted ABSTRACT Conclusions: Within the linear response range, the
routinely in conjunction with other first responder tasks. bladder pressure accurately indicates surface-applied pressure.

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