Page 48 - JSOM Fall 2020

TABLE 2 Test Procedures TABLE 2 Cont.
1 Begin test timing by starting a stopwatch. 36 Wrap tightly and spirally the elastic bandage to cover the roll
2 Step up to a manikin. gauze and some exposed skin.
3 Begin tourniquet trial timing by starting the manikin: bleeding 37 Finish wrapping elastic bandage by securing clip at end to a
is to be controlled. prior spiral wrap layer.
4 Apply hasty tourniquet (high and tight): grasp and unwrap 38 Grasp pump (hand bulb), firmly press its tip into the blue
tourniquet. Put wrapper aside. inflation port.
5 Open the folded loop of self-adhering band by pulling its 39 Squeeze pump by hand to force air from bulb into bladder.
Velcro surfaces apart. 40 Repeat if air flows visibly or audibly to complete inflation.
6 Pass the opened loop around end of thigh to place tourniquet 41 Troubleshoot no inflow: may push pump tip deeper into port
high on limb at groin. to open its blue valve.
7 Pull red tip of self-adhering band to peel its top layer from its 42 Inflate bladder of AirWrap. A pressure indicator pops up
bottom layer. when complete.
8 Pull running end of band tight to pull slack out of the band 43 Detach pump from port. Adjust AirWrap as needed. Monitor
portion still looped around limb. wound for bleeding.
9 Secure the running end of the self-adhering band to its portion 44 Release and remove tourniquet.
still looped around limb. 45 Assess bleeding.
10 Turn rod to make the tourniquet squeeze the limb and stop 46 Stop manikin to end timing of conversion trial.
the external bleeding.
11 Finish the final turn and secure the rod in a clip. 47 Stop stopwatch to end test timing.
12 Attach the time strap over the rod to the opposite clip.
13 Pickup manikin and move to cover at a nearby spot in TABLE 3 Results of Tests
laboratory. Gunfire stops. Wrap Test Blood
14 Look for wound bleeding while feeling for an artery pulse Inflation Model Duration Loss
behind the distal thigh. Test Date and Time Status (in.) (min) (mL)
15 Troubleshoot if bleeding is seen or pulse is felt. Troubleshoot 1 5/5/16 15:21 Uninflated 6 17 1,139
until both are stopped. 2 5/6/16 12:18 Uninflated 4 16 976
16 Put any excess of the running end of the band between the 3 5/11/16 14:02 Inflated 4 13 931
clips. Adjust strap if needed.
4 5/12/16 09:10 Inflated 6 7 122
17 Tape over the strap. Write with a marker the time of day onto
the tape. 5 5/13/16 10:39 Uninflated 4 8 151
18 Stop manikin to end timing of tourniquet trial. 6 6/3/16 09:45 Uninflated 6 9 155
19 Record data of tourniquet trial. 7 6/7/16 14:10 Inflated 6 7 114
20 Enter manikin scenario for emergency care, and start manikin 8 6/13/16 14:10 Inflated 4 12 473
for a conversion trial. 9 6/29/16 14:35 Uninflated 4 8 136
21 Grasp a packaged hemostatic gauze, tear package, remove 10 6/30/16 13:35 Inflated 4 7 98
gauze, and set package aside. 11 7/1/16 09:00 Uninflated 6 7 78
22 Apply a hemostatic gauze to dress wound. Pack the gauze into 12 7/1/16 11:07 Inflated 6 6 147
the wound surface.
23 Hold gauze to wound with one hand as other dresses to cover 13 7/6/16 09:01 Uninflated 4 6 134
wound entirely with gauze. 14 7/6/16 12:00 Inflated 6 6 190
24 Hold bimanual compression on gauze for 3 minutes to 15 7/13/16 10:56 Uninflated 6 7 166
compress wound and stop bleeding.
25 Wrap the roll gauze over the dressing to secure the hemostatic
gauze in place. (75%) occurred in the first three tests. Plainly, troubleshooting
26 Cover all of the hemostatic gauze with spiral wrapping of the controlled bleeding but at costs of time and blood loss. Of four
roll gauze. rewrap occurrences, two were with inflation and two were
27 Tuck the end of the roll gauze to secure end under an edge of without. Most rewraps (75%) were with 4-in.-wide AirWrap.
a prior revolution of gauze. Four of five unsatisfactory (“no go”) trial statuses were caused
28 Grasp an AirWrap, tear open package, remove wrap and by low pressure; pressures ≥137mmHg were satisfactory. Test
pump, and set package down. 14 had unsatisfactory trial status with brief bleeding at the
29 Put pump (hand bulb) down. end of the conversion trial. In every test, visual assessment of
30 Unwrap the plastic wrapper covering the rolled AirWrap. Put bleeding status was eventually blocked by applied dressings
wrapper aside. and wraps, which hid the wound. Worsening the impairment
31 Grasp with one hand the roll and with the other pinch the end of assessment was that the roll gauzes and wraps covered and
edge of the wrap to unroll it. padded the site where the pulse is to be detected by palpation.
32 Pull edge of wrap to peel back its underlying hook surface Inflation of the bladder added to padding, which compounded
from next wrap layer underneath. the impairment further. The conversion trial time was not flat
33 Unroll enough of the wrap to see the bladder, which has a by test number and accounted for the magnitude of improve-
sticker stating “This side up.” ment in test time.
34 Place the wrap with the other side down so the bladder side is
up (face up).
35 Center the bladder on skin overlying pressure transducers of Discussion
the manikin. The main finding of this simulation study was that a proce-
(continues) dural method of converting a use of a limb tourniquet for a use

46 | JSOM Volume 20, Edition 3 / Fall 2020