Page 13 - JSOM Winter 2023

Effects of Tourniquet Features

on Application Processes

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1*
Piper Wall, DVM, PhD ; Charisse Buising, PhD ; JaNiese Jensen ;
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Alex White ; Justin Davis, MD ; Catherine Hackett Renner, PhD 6
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ABSTRACT
Background: We investigated emergency-use limb tourniquet Keywords: tourniquet; hemorrhage; first aid; emergency
design features effects on application processes (this paper) treatment
and times to complete those processes (companion paper).
Methods: Sixty-four appliers watched training videos and then
each applied all eight tourniquets: Combat Application Tour- Introduction
niquet Generation 7 (CAT7), SOF Tactical Tourniquet-Wide
®
Generation 3 (SOFTTW3), SOF Tactical Tourniquet-Wide Well-designed emergency-use limb tourniquets are lifesaving
®
Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet when correctly used to stop severe bleeding before shock or
(TMT), OMNA Marine Tourniquet (OMT), X8T tourniquet death. The national Stop the Bleed campaign and training
1–5
(X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), emphasize teaching everyone to provide first aid for bleeding
and RapidStop Tourniquet (RST). Application processes injuries, including tourniquet use for severe limb bleeding. 6
®
were scored from videos. Results: Thirty-three appliers had
no prior tourniquet experience. All 512 applications were The American College of Surgeons Committee on Trauma and
placed proximal to the recipient’s simulated distal thigh in- the Committee on Tactical Combat Casualty Care have a track
jury. Thirty-one appliers (13 with no experience) had 66 record of preference toward windlass designs, but published
7–9
problem-free applications (18 by no experience appliers). data shows untrained individuals are not necessarily more
Tightening- system mechanical problems were more frequent successful with a windlass tourniquet than with a ratcheting
with windlass rod systems (26 losing hold of the rod, 27 tourniquet or an elastic tourniquet (195 appliers; all applica-
redoing rod turns, and 58 struggling to secure the rod) ver- tions on a mannequin; Combat Application Tourniquet, 11
sus ratchet systems (3 tooth skips and 16 advance failures). successful of 65 applications; Ratcheting Medical Tourniquet,
Thirty-five appliers (21 with no experience) had 68 applica- 15 successful of 64 applications; Stretch Wrap And Tuck Tour-
tions (45 by no experience appliers) with an audible Dop- niquet, 7 successful of 66 applications; p=.149). Additionally,
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pler pulse when stating “Done”; causes involved premature rapid application with one windlass tourniquet design does
stopping (53), inadequate strap pull (1 SOFTTW3, 1 RST), not necessarily translate to equally rapid application with an
strap/redirect understanding problem (1 SOFTTW5, 1 X8T, alternate windlass design. 11
4 Tac RMT, 1 RST), tightening-system understanding problem
(2 CAT7, 1 SOFTTW3, 1 TMT, 1 RST), and physical inability Using scoring and time, we investigated the effects of different
to secure (1 SOFTTW3). Fifty-three appliers (32 no experi- tourniquet design features on appliers’ ability to correctly and
ence) had 109 applications (64 by no experience appliers) not quickly apply emergency-use limb tourniquets. The hypothe-
correctly secured. Six involved strap/redirect understanding sis was that different features would have different effects on
problems: 4 Tac RMT, 1 X8T, 1 SOFTTW5; 103 involved im- the successes and times of application processes. This paper
proper securing of non-self- securing design features: 47 CAT7 discusses the successfulness of application processes. The com-
(8 strap, 45 rod), 31 TMT (17 strap, 19 rod), 22 OMT (strap), panion paper discusses the effects of tourniquet features on
and 3 SOFTTW3 (rod). Conclusion: Self-securing systems process times. 12
have process advantages. Because most emergent tourniquet
recipients require transport, we believe tourniquet security is a Methods
critical design aspect. Decisions regarding tourniquet choices
may become very different when both occlusion and tourni- The Drake University Institutional Review Board approved
quet security are considered. this study. Tourniquets were requested (Figure 1, Table 1);
*Correspondence to piperwall@q.com
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1 Dr Piper Wall is a researcher in the Department of Research, UnityPoint Health Iowa Methodist Medical Center, Des Moines, IA. Dr Charisse
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Buising is a professor of biology at Drake University, Des Moines, IA. JaNiese Jensen was an undergraduate researcher at Drake University and
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is now a medical student at the Carver College of Medicine, University of Iowa, Iowa City, IA. Alex White was an undergraduate researcher
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at Drake University and is now a medical student at Des Moines University, Des Moines, IA. Dr Justin Davis is a surgery resident physician at
UnityPoint Health Iowa Methodist Medical Center, Des Moines, IA. Dr Catherine Hackett Renner is a volunteer researcher, UnityPoint Health
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Iowa Methodist Medical Center, Des Moines, IA.
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