Page 18 - JSOM Winter 2023

FIGURE 2 Cont.
(E) 10 (F) 2
2
1
17
61
Good Good
7
1
3
1

Bad Bad

8 1 1 0 0 38 6 14 22 2 3 1 2 0 0 22 2 0 0 0
7
of
of
of
OMT X8T 3 35 3 36 49 1 63 63 10 13 of 63 1
63
orientation threading/clip understanding understanding opened hook-&-loop pull technique pull hook-&-loop strap tightness security understanding mechanical never occluded done at securing struggle security security orientation threading/clip understanding understanding pull technique strap tightness security understanding mechanical never occluded done at securing struggle security security
minor major strap occluded tightening tourniquet minor major strap occluded tightening tourniquet

strap/redirect tightening tightening strap/redirect tightening tightening
system system system system system system

(continues)
security, occlusion, and tourniquet security. Between the study Application Process Scoring: Orientation
prototype and the commercially available SOFTTW5, a small Fifty-one applications (10.0%) started with strap/redirect ori-
slider buckle change now prevents the possibility of this prob- entations other than shown. 14–22 In seven, appliers changed to
lem. The TMT problem related to poor strap pulling, result- the video-shown orientation. The other 44 are indicated as bad
ing in four rod turns creating a rod angle that precluded full orientation in Figure 2. Forty-two had strap/redirect-system
rod securing (Figure 2 open red circles). Considering the fre- problems (95.5% versus 80.6% for video shown, good orien-
quency of poor strap tightness, this is a rod-security problem tation; p=.013); 15 had tightening-system problems (34.9%
that could easily reoccur. The OMT problem was an instance versus 31.3% for good orientation; p=.61); 5 were never oc-
of tooth skipping, which can be disconcerting but does not cluded (11.4% versus 7.5% for good orientation; p=.37) and
39
preclude tightening and is avoidable with appropriate pressure 10 were not occluded at “Done” (22.7% versus 14.5% for
on the advancing part of the ratcheting buckle toward the lad- good orientation; p=.18). Bad orientation did not have a sig-
der. The RST problem that occurred 16 times was failure of nificantly greater incidence of less-than-optimal strap tight-
the locking pawl to advance a full tooth despite correct, full ness (59.1% versus 49.8% for shown orientation; p=.27) and
rotation of the lever arm of the ratcheting buckle. The problem did not appear to cause other problems so much as to be one
did not involve tooth skipping. In each instance, the applier of several problems in those 44 applications.
reset and re-rotated the RST ratcheting buckle lever arm with
successful advances of the locking pawl over the ladder teeth. Application Process Scoring:
We don’t know what caused this problem. The second RST Strap/Redirect System
problem occurred during two applications and was inadver- Problems with threading/clipping aspects of redirects were
tent activation of the releasing mechanism during ratcheting uncommon with the simple redirects and the side-release
buckle advancement (Figure 2 red circles). The problem oc- buckle (Figure 2 threading/clip). Threading/clip problems
curred because the releasing mechanism is located under the were most prevalent with the clip of the TMT (51.6% of
buckle lever arm and is activated by lifting. applications; p<.0001), but only acted as the cause of failure
to achieve occlusion with one SOFTTW5 application (mis-
Application Process Scoring threading, Figure 2, major understanding problem, filled red
Training videos 14–22 showed applications 2–3 inches (3–4 fin- circles, never occluded) and four Tac RMT applications (mis-
ger widths) proximal to the simulated injury and strap/ redirect threadings, Figure 2, major understanding problem, red cir-
orientations with redirect buckles lateral with downward, cles, not occluded at “Done”). Despite a non-secured strap,
optimal strap pulling. All 512 tourniquet applications were one Tac RMT applier still managed to achieve sufficient pres-
placed proximal to the simulated injury: 6 applications <1 sure with continuous strap holding to achieve occlusion, but
inch proximal, 490 applications 2–3inches proximal, 16 appli- none of the incorrectly threaded applications were occluded
cations >3 inches proximal. at “Done.”

16 | JSOM Volume 23, Edition 4 / Winter 2023