Page 31 - JSOM Winter 2023

APPENDIX B.
APPLICATION SCORING CRITERIA TO USE WITH VIDEOS

1. Strap pull mechanics h. Applier physically unable to secure windlass rod
a. Angle of strap pulls at redirect i. Tourniquet broke
b. Applier pulling effort: strong/weak j. Hook-and-loop failure during tightening system use
c. Pull force capture with hook-and-loop systems: good/ k. Strap backsliding during tightening system use
poor l. List other
d. Number of effortful pulls 8. Application problems with or without arterial occlusion at
e. Body weight engagement versus just arms use Done
f. Strap visual tightness: tight/not very tight a. Redirect problems
2. Redirect buckle location at start and finish of strap pull i. Problem finding/recognizing clip
(lateral, medial, anterior, posterior) and accompanying pull ii. Problem using clip
direction iii. Tried to unthread clip
3. Tourniquet location relative to injury iv. Unthreaded clip
a. Proximal/distal v. Problem rethreading clip
b. Estimated distance proximal (<1 inch, 2–3 inches, >5 vi. Problem rethreading non-clip redirect
inches) vii. Problem figuring out where to pull
4. Holding location used to prevent slippage during strap b. Redid pull or did more pulling after using tightening
pulling system
a. None c. Tourniquet slipping around limb during strap pulling
b. Rod-securing bracket or triangle d. Spent time trying to decide what to do with what many
c. Rod appliers seemed to view as “excess” strap at the end of
d. Holding loop (Tac RMT) strap pulling
e. Ratcheting buckle e. Held strap while using the tightening system
f. Hand pressing on tourniquet “above” redirect f. Significant hook-and-loop interaction during strap pulling
g. Base of X8T dial g. Hook-and-loop difficulty other than interference with
h. Redirect buckle strap pulling
5. Tightening system use to Doppler signal loss and at hands off h. Incorrect securing of limb encircling hook-and-loop
a. Rod turns/ratchet clicks (0 rod turns defined as first strap:
time rod parallel to strap and each 180° rotation there- i. Did not secure all available hook-and-loop
after defined as one rod turn) circumferentially
b. Direction of rotation (rod or dial clockwise/counter- ii. Had <2/3 side-to-side overlap of engaged hook-
clockwise or ratcheting buckle away from/toward and-loop
applier) i. Hook-and-loop failure during tightening system use
6. How the rod of the SOFTTW5 was secured: bracket only, j. Strap backsliding during tightening system use
triangle only, both bracket and triangle (For this study, the k. Clip problem during tightening system use
instructional video for the SOFTTW5 allowed appliers to l. Lost hold of windlass rod
finish the application with the windlass rod only in the m. Chose to redo windlass rod twisting
bracket, only in the triangle, or in both the bracket and the n. Ratchet tooth skips
triangle. This was done specifically for examining the influ- o. Difficulty achieving locking pawl advancement
ence of securing the rod in the triangle versus in an open p. Struggled with securing windlass rod
bracket between the two generations of SOFTTW. Correct q. Incorrect securing of windlass rod
medical use requires rod securing in the triangle.) i. CAT7: incorrect or lack of bracket use, neither
7. Why an application did not achieve arterial occlusion (elim- hook-and-loop strap used, only limb encircling strap
ination of audible Doppler signal) or did not have arterial placed over rod, only time strap placed over rod,
occlusion when completed time strap placed over rod followed with an attempt
a. Understanding problems with the strap/redirect system: to place limb encircling strap over time strap, limb
threading, clip, correct strap pull location encircling strap placed in bracket before rod
b. Understanding problems with the tightening system ii. SOFTTW3: rod not in triangle
c. Stopped advancing the tightening system prematurely iii. TMT: rod balancing on open side of securing
when could have continued bracket, rod just under first part of securing bracket
d. Applier too weak to advance tightening system sufficiently but not clipped in, rod balancing on wrong side of
e. Ran out of tightening system (ladder teeth) securing bracket
f. Didn’t secure windlass rod r. List other
g. Didn’t try to secure windlass rod

Tourniquet Processes | 29