Page 91 - JSOM Summer 2020

FIGURE 4 Phase 3: Flow charts.

(A) (B)

(C) (D)

Each panel starts with 225 applications and shows the number of applications at each point along the path through the end of the trial. Fewer
completions were achieved with the windlass tourniquets (p < .0001). The reasons for the windlass noncompletions were different; C-A-T-7 non-
completions were for recipient discomfort; SOFTTW noncompletions were split between recipient discomfort and applier inability (p < .0001).
(A) C-A-T7. The ‘applier error’ was a failure to secure adequate hook-and-loop length; so the hook-and-loop connection pulled apart during turn-
ing of the windlass rod. The ‘applier inability’ was that they could not turn the windlass rod to a securable position. (B) SOFTTW. The inability in
‘no occlusion’ and ‘applier inability & recipient discomfort’ was that appliers could not turn the windlass rod to a securable position. The ‘protocol
error’ was the directive to secure at the next location after occlusion and did not take into account the possibility of pulse return within 5 seconds
after occlusion before moving to completion. This occurred in five SOFTTW applications, failing the definition of completion. (C) Tac RMT. The
‘applier inability’ in ‘no occlusion’ and ‘noncompletion’ was inability to advance the ratcheting buckle. (D) SWATT. One application did not reach
occlusion for applier inability to maintain appropriate stretch during wraps. The same applier failed to reach completion in six additional appli-
cations, relating to inability to maintain appropriate stretch and problems with preplanning for the completing tuck (recipient thigh circumference
61cm). A different applier had two noncompletions: one involved problems with preplanning for the completing tuck and the other involved lost
grip on the SWATT (recipient thigh circumference 62cm). The third applier with a noncompletion involved problems with preplanning for the
competing tuck and resulting lost grip on the SWATT (recipient thigh circumference 61cm). The fourth applier with a noncompletion lost grip
on the SWATT during the tucking process, resulting in a loss of stretch and loss of occlusion. The eleventh noncompletion resulted from SWATT
breakage due to a sharp fingernail causing tearing while struggling for the completing tuck.

from poor technique). SWATT application videos showed ap- not secure (Figure 4B). With the Tac RMT, the three noncom-
pliers frequently not maintaining stretch going from occlusion pletions for applier inability (Figure 4C) involved 11, 12, and
to completion. 13 clicks. The 18 clicks for Tac RMT completion followed a se-
cured pressure of 51.7mmHg. Despite the SWATT instructional
Most C-A-T7 occlusions took < 1 turn resulting in completions video, most appliers did not do more than one wrap following
11
at 1 turn (Figure 5E–5F). SOFTTW required more windlass rod occlusion (Figure 5E to 5F, applier 14 versus other appliers).
turns. Only three of 36 SOFTTW recipient discomfort non-
completions involved ≥ 3 turns. All 36 applier inability to reach Three recipients had compression tights (two 2XU, one Adi-
completion would have had ≥ 3 turns (occlusions 2.75 turns das, adidas.com). Clothing versus Bare had a difference in
or greater): 23 appliers could not rotate the rod to a securable completion versus noncompletion for only the Tac RMT and
location while 13 reached the rod-securable location but could recipient discomfort (p < .0001).

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