Page 62 - JSOM Fall 2020

the pressure increase per click, and how well the researchers Author Contributions
detected the pulsatile Doppler signal and its cessation. Unlike All authors contributed to all aspects of the project: concept
the variation observed regarding within subject secured pres- development; project design; the acquisition, analysis, and in-
sures, this variation would be expected to be independent of terpretation of data; and the drafting and revising of the arti-
most subject training variables. cle. All authors had final approval of the manuscript.
Although limb circumference and the ratio of limb circumfer- References
ence to pneumatic tourniquet width have been shown to have 1. Ballas R, Saetta G, Peuchot C, et al. Clinical features of 27 shark
an effect on occlusion pressure, 25-28 this study shows once again attack cases on La Réunion Island. J Trauma Acute Care Surg.
that the relationship does not involve a strong correlation when 2017;82(5):952–955.
using nonpneumatic, emergency-use limb tourniquets. 29-33 Not 2. Lentz AK, Burgess GH, Perrin K, et al. Mortality and manage-
ment of 96 shark attacks and development of a shark bite severity
only did limb circumference fail to give a strong relationship scoring system. Am Surg. 2010;76(1):101–106.
with occlusion pressures, but as previously seen with the 5.1cm 3. Colier R. Recurring attacks by white sharks on divers at two Pa-
Wide Ratcheting Medical Tourniquet, occlusion pressures were cific sites Mexico and California. Environ Biology Fishes. 1992;
not higher than with the 3.8cm-wide Tactical Ratcheting Med- 33:319–326.
ical Tourniquet. This means that using the equation derived 34 4. Nathanson N, Hayes P, Galanis D. Surfing Injuries. Am J Emerg
33
Med. 2002;20(3):155–160.
from Graham’s work with pneumatic tourniquets to indicate 5. Klick C, Jones CM, Adler D. Surfing USA: an epidemiological
25
pressures likely to be needed for occlusion with nonpneumatic, study of surfing injuries presenting to US EDs 2002 to 2013. Am
emergency-use limb tourniquets is flawed. J Emerg Med. 2016;34(8):1491–1496.
6. Valenti´c D, Stojanovi´c D, Mi´covi´c V, et al. Work-related diseases
This study had obvious laboratory setting limitations: clean, and injuries on an oil rig. Int Marit Health. 2005;56(1-4):56–66.
dry skin; clean, dry tourniquets; low stress; fresh training; 7. Boyle TA, Rao KA, Horkan DB, et al. Analysis of water sports in-
tourniquet pre-placed around the limb because of pressure juries admitted to a pediatric trauma center: a 13year experience.
Pediatr Surg Int. 2018;34(11):1189–1193.
measurement system; and limb position and movement con- 8. Centers for Disease Control and Prevention (CDC). Boat-
straints related to distal pulse Doppler monitoring. Obvious propeller-related injuries—Texas, 1997. MMWR Morb Mortal
laboratory setting strengths were controlled, consistent setting; Wkly Rep. 1998;47(17):354–356.
applications on human limbs; and many appliers. It would be 9. Frasqueri-Quintana VM, Oliveras García CA, Adams LE, et al.
interesting to know if the tacky section design feature of this Injury-related emergency department visits after Hurricane Maria
tourniquet is helpful to applications in other settings and if it in a southern Puerto Rico hospital. Disaster Med Public Health
Prep. 2020;14(1):63–70. Doi:10.1017/dmp.2019.75
creates any resistance to tourniquet displacement during casu- 10. Wall P. OMNA Marine Tourniquet description [video]. https://
alty transportation. vimeo.com/434732616. Accessed 2 July 2020.
11. Wall P. 00130 [video]. https://vimeo.com/372430402/cde56b3f9e.
Accessed 11 November 2019.
Conclusions 12. Wall P. 00127 [video]. https://vimeo.com/372429725/bb3ed46022.
The OMNA Marine Tourniquet is an effective design that can Accessed 11 November 2019.
be successfully self-applied one-handed to the dominant arm 13. Wall P. 00135 [video]. https://vimeo.com/372430832/abdc-
dac0e5. Accessed 11 November 2019.
as well as two-handed to the thigh. Adult appliers should reg- 14. Wall P, Buising C, Donovan S. Best tourniquet holding and strap
ularly achieve secured pressures >150mmHg with good tech- pulling technique. J Spec Oper Med. 2019;19(2):48–56.
nique. Despite the 5.1cm width, occlusion pressures with the 15. Hingtgen E, Wall P, Buising C. Characterizing a system for mea-
OMNA Marine Tourniquet may not be substantially lower suring limb tourniquet pressures. J Spec Oper Med. 2020;20(1):
than with 3.8cm-wide nonpneumatic, nonelastic emergen- 47–54.
cy-use limb tourniquets. The incorporation of limb-contact 16. Wall P, Buising C, Hingtgen E, et al. Clothing effects on limb
tourniquet application. J Spec Oper Med. 2020;20(2):83–94.
tackiness in a short section of tourniquet holding the redirect 17. Kragh JF Jr. Burrows S, Wasner C, et al. Analysis of recovered
buckle may be an advantageous design feature in nonelastic tourniquets from casualties of Operation Enduring Freedom and
emergency-use limb tourniquets. Operation New Dawn. Mil Med. 2013;178:806–810.
18. Polston RW, Clumpner BR, Kragh JF Jr, et al. No slackers in tour-
Acknowledgments niquet use to stop bleeding. J Spec Oper Med. 2013;13(2):12–19.
We thank the undergraduates of the Drake University Trauma 19. Slaven SE, Wall PL, Rinker JH, et al. Initial tourniquet pressure
Research Team for all their help carrying out the experiments, does not affect tourniquet arterial occlusion pressure. J Spec Oper
Med. 2015;15(1):39–49.
especially team mentors Cidney Lokemoen, Cara McCarthy, 20. Wall P, Buising C, Sahr S. Review: Getting tourniquets right =
Rachel Elliott, and Taylor Baine. getting tourniquets tight. J Spec Oper Med. 2019;19(3):52–63.
21. Valliere MJ, Wall PL, Buising CM. From pull to pressure: effects of
Disclosures tourniquet buckles and straps. J Am Coll Surg. 2018;227:332–345.
None of the authors have any financial relationships relevant 22. Wall P. OMNA Marine Tourniquet thigh self-application pulling
to this article to disclose, and there was no outside funding. down [video]. https://vimeo.com/434743937. Accessed 2 July
2020.
P.W. and C.B. are paid by their respective institutions, and 23. Wall P. OMNA Marine Tourniquet thigh self-application pulling
E.H. volunteered her research time. None of the authors have up [video]. https://vimeo.com/434767987. Accessed 2 July 2020.
any stock in any tourniquet companies, and none do any paid 24. Wall P. OMNA Marine Tourniquet arm self-application [video].
consulting with any tourniquet companies. The authors talk https://vimeo.com/434772121. Accessed 2 July 2020.
to and share data with any and all companies and individu- 25. Graham B, Breault MJ, McEwen JA, et al. Occlusion of arterial
als who are interested and will not keep any secrets. The lab flow in the extremities at subsystolic pressures through the use of
wide tourniquet cuffs. Clin Orthop. 1993;286:257–261.
equipment belongs to Drake University and UnityPoint Health 26. Tuncali B, Karci A, Erdalkiran B, et al. A new method for esti-
Iowa Methodist Medical Center. The tourniquets were re- mating arterial occlusion pressure in optimizing pneumatic tour-
quested from and donated by OMNA, Inc. niquet inflation pressure. Anesth Analg. 2006;102:1752–1757.

60 | JSOM Volume 20, Edition 3 / Fall 2020