Page 15 - JSOM Winter 2023

TABLE 1 Tourniquets
Tourniquet Strap/Redirect System Tightening System
Combat Application Tourniquet Generation 7 No clip Non-self-securing rough, Non-self-securing windlass, Rod rotation
(CAT7, Lot 101K179; C-A-T Resources, LLC, simple redirect buckle with top open bracket for securing parallel to limb
http://combattourniquet.com/) hook-and-loop strap windlass rod, two hook-and- surface
loop straps to place over
secured rod (limb strap then
time strap)
SOF Tactical Tourniquet–Wide Generation Clip Self-securing slider redirect Non-self-securing windlass, Rod rotation
®
3 (SOFTTW3, MFG Date 010819; Tactical buckle with smooth strap limited mobility vertical parallel to limb
Medical Solutions, www.tacmedsolutions.com) triangle for securing windlass surface
®
rod
SOF Tactical Tourniquet–Wide Generation Clip Self-securing slider redirect Non-self-securing windlass, Rod rotation
®
5 prototype (SOFTTW5, MFG Date buckle* with smooth strap limited mobility top open parallel to limb
®
CS1A; Tactical Medical Solutions, bracket for holding and surface
www.tacmedsolutions.com) *† limited mobility vertical
triangle for securing
windlass rod †
Tactical Mechanical Tourniquet (TMT, Lot Clip Non-self-securing triglide Non-self-securing windlass, Rod rotation
040517 for appliers 1-12; MFG April 2019, redirect buckle with hook- unidirectional side entrance parallel to limb
Lot 45097 for appliers 13-64; Combat Medical, and-loop strap bracket with click-in for surface
https://combatmedicalsystems.com) ‡ securing windlass rod ‡
OMNA Marine Tourniquet Gen 2 (OMT, No clip Non-self-securing smooth, Self-securing ratcheting Ratcheting
Manufacture Nov 12, 2019, Lot 0I0015; simple redirect buckle with buckle on a toothed ladder buckle rotation
OMNA, www.omnainc.com) hook-and-loop strap perpendicular to
limb surface
X8T-Tourniquet (X8T, 2020-05-20; RCR Clip Self-securing double redirect Self-securing ratcheting dial Unidirectional dial
Medical Products, LLC, www.rcrmedic.com) system (2 smooth simple rotation parallel
redirect buckles with smooth to limb surface
strap trapped against limb)
Tactical Ratcheting Medical Tourniquet No clip Self-securing overlapping Self-securing ratcheting Ratcheting
(Tac RMT, Jan 15 2020; m2 inc., rings redirect buckle with buckle on a toothed ladder buckle rotation
®
www.m2inc.biz) smooth strap perpendicular to
limb surface
RapidStop Tourniquet (RST, Lot 032620; Clip Self-securing double redirect Self-securing ratcheting Ratcheting
Aero Healthcare, www.rapid-stop.com) system (2 smooth simple buckle on a toothed ladder buckle rotation
redirect buckles with smooth perpendicular to
strap trapped against limb) limb surface
*The redirect buckle of the commercially available SOFTTW5 is slightly changed from the prototype such that the sliding piece of the redirect
cannot be dislodged from the buckle.
† For this study, appliers were allowed to finish the SOFTTW5 application with the windlass rod only in the bracket, only in the triangle, or in
both the bracket and the triangle. This was done specifically to examine the influence of securing the rod in the triangle versus in an open bracket
between the two generations of SOFTTW. Correct medical use requires rod securing in the triangle.
‡ Two TMT design changes were present: 1) The size of strap end increased. The size on the older version allowed strap unthreading and reth-
reading through the triglide buckle with sufficient applier effort. The increased size of the strap end on the newer version made unthreading
impossible. 2) The bracket for securing the windlass rod had some shape change to the non-click-in side. The non-click-in side of the older version
was continuous with the top of the bracket and had a rounded corner that was the back side against which the rod would be in contact when
fully clicked into the securing bracket (version shown in reference videos 17,26,34 ). The non-click-in side of the newer version has an extension of
the top of the bracket as a separate wing past the vertical aspect of the bracket against which the rod would be in contact when fully clicked into
the securing bracket (version shown in Figure 1).

pulled tighter with additional pulls, whereas this was possible and relaxed as possible. Each application was videoed from
for self-securing strap/redirect systems. two angles at 90 frames per second with GoPro Hero 5 Ses-
sions (GoPro Inc., www.gopro.com).
Appliers
Appliers were a convenience sample of adults. Appliers were Appliers knelt beside the recipient’s leg and waited for the
given printed instructions (Appendix A). Each watched a 6 director to say “Go” before picking up the tourniquet. Each
22
minute, 13 second training video with opportunity to take tourniquet was presented threaded or clipped in a closed loop
notes and replay. Appliers wrote answers to seven questions and folded in approximate quarters, with the (primary) redi-
(Table 2) presented at the video start, answered during the rect buckle as the location of the center fold. 23–30 Each tourni-
video, and re-answered in summary form at the video end, quet was on the same side of the applier as the recipient’s feet
22
then watched 35 to 56 second training videos 14–21 for each and oriented with the (primary) redirect buckle away from the
tourniquet in assigned order with opportunity to take notes recipient’s leg. 13–20 Appliers had to unthread or unclip the tour-
and replay before moving to the next video. Then the applier niquet to place it around the limb; lifting the recipient’s foot to
went to the tourniquet application room. slide an intact tourniquet loop up the leg was not allowed (con-
sidered a trapped limb). Applications were considered com-
Tourniquet Applications plete when the applier was hands off and had stated “Done,”
The dorsal pedal artery Doppler signal was audible before or the director stopped the application 5 minutes from saying
starting applications. Recipients remained as non-responsive “Go,” or the recipient called for a halt. A researcher released

Tourniquet Processes | 13