Page 93 - JSOM Summer 2020

FIGURE 5 Cont.

(E) (F)

On each panel, the x-axis is organized by applier. Panels A–F show individual triplicate values with lines indicating 95% confidence intervals.
In A and B, recipient thigh circumference is shown above the x-axis. (A) Occlusion pressures are shown on the y-axis. Occlusion pressures were
higher with the C-A-T7 than with the other two 3.8cm-wide nonelastic tourniquets (p < .0001). The number of pressure measurements shown
are 224 C-A-T7 (1 data set removed for bladder location problems), 221 SOFTTW (2 data sets removed for bladder location problems and 2
applications did not reach occlusion), and 220 Tac RMT (3 data sets removed for bladder location problems, 1 of which did not reach occlusion,
and 2 other applications did not reach occlusion). Occlusion pressures were lowest with the 10.4cm-wide SWATT (p < .0001). There are 215
SWATT pressure measurements shown (10 data sets removed for bladder location problems, 1 of which did not reach occlusion). (B) Completion
pressures are shown on the y-axis. Completion pressures were highest with the C-A-T7 (p < .0001) and lowest with the SWATT (p < .0001). The
number of completion pressures shown are 141 C-A-T7 (1 data set removed for bladder location problems), 129 SOFTTW (1 data set removed
for bladder location problems), 212 Tac RMT (2 data sets removed for bladder location problems), and 204 SWATT (9 data sets removed for
bladder location problems). (C) Completion minus occlusion pressures are shown on the y-axis. The pressure differences for applications that
maintained occlusion for 5 seconds after completion are shown. (D) Completion minus occlusion pressures are shown on the y-axis. The pres-
sure differences for applications that did not maintain occlusion for 5 seconds after completion are shown. In panels C and D, 26 SOFTTW
applications had pressure decreases from occlusion to completion, and SOFTTW applications had the most occlusion losses within 5 seconds
of completion, (24 SOFTTW occlusion losses, p < .0001). (E) Turns, clicks, or wraps to reach occlusion are shown on the y-axis. The C-A-T7
required fewer turns than the SOFTTW (p < .0001). There are 225 C-A-T7 turn measurements shown, 223 SOFTTW turn measurements shown
(2 applications did not reach occlusion), 222 Tac RMT click measurements shown (3 applications did not reach occlusion), and 224 SWATT
wrap measurements shown (1 application did not reach occlusion). (F) Turns, clicks, or wraps to reach completion are shown on the y-axis.
The C-A-T7 required fewer turns than the SOFTTW (p < .0001). There are 142 C-A-T7 turn, 130 SOFTTW turn, 214 Tac RMT click, and 213
SWATT wrap measurements shown.

the clothing) did not result in clinically interesting pressure real-time pressure data. (2) Sliding items under tourniquets is
measurement differences. (3) Tights data with hanging weights not reliable for indicating adequate secured pressure. (3) The
show alteration of underlying compressibility changes pressure Generation 3 SOFTTW redirect buckle prevents a secured
response to applied force. (4) Phase 2 thigh model data show pressure improvement from body weight engagement. In con-
surface interactions between tourniquets and what is beneath trast, standing can help appliers reach higher secured pressures
them affect secured pressures. Namely, interactions inhibiting with the C-A-T7 and Tac RMT. (4) The mechanical advantage
strap movement to enter the redirect buckle interfere with se- of a moving redirect impacts secured pressure. (5) Occlusion
cured pressure achievement. With the C-A-T7, SOFTTW, and pressures differ for tourniquets of the same width. (6) Com-
Tac RMT, clean, dry scrubs and United States Military Army pletion difficulties can be caused by design-related problems
Combat Uniform pants appear to be as permissive to strap or applier technique.
movement as clean, dry skin.
Regarding redirect movement, allowing the redirect to act as a
This study provides coefficient of variation and standard devi- moving pulley system with movement inward and downward
ation information regarding audible Doppler detectable thigh during tissue compression results in higher secured pressures.
5
occlusion pressure in individual adult tourniquet recipients. This may explain the contrast between appliers generally
This study also provides coefficient of variation and standard achieving higher secured pressures with the Tac RMT than
deviation information regarding secured pressures achieved SOFTTW (Figure 3A) despite thigh models generally having
during applications without pressure data access by appliers higher secured pressures with the SOFTTW than Tac RMT
who trained with real-time pressure data access and a strong (Figure 2D). In the models’ system, attaching the Tac RMT
emphasis on the importance of maximizing secured pressures. holding loop to a vertically fixed location prevented redirect
movement. With appliers using the holding loop, at least some
Findings not related to clothing condition: (1) To consistently inward redirect movement visually occurs as tissue compresses
achieve desirable secured pressures, even trained appliers need during strap pulling; some mechanical advantage from a

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