Page 44 - JSOM Winter 2023

APPENDIX A.
APPLICATION-STEP-RELATED TIMES FROM DISPLAYED TIMER

Times Points with additional attempts to pull the strap tighter mixed
1. “Go” in with use of the tightening system, “touch tightening
2. Strap/redirect secured system” is the first time at which applier touches tight-
3. Touch tightening system ening system as part of starting to use tightening system.
4. First Doppler signal loss If the holding location includes part of the tightening
5. Last Doppler signal loss before hands off system, then the time to touch tightening system is to
6. Hands off for Done when applier starts to use the tightening system.
c. If applier puts the tourniquet on the limb and works on
Instructions Regarding Time Points securing and on tightening but then undoes the tour-
1. Start of “Go” niquet and restarts the securing process, then “touch
2. Strap/redirect secured tightening system” is not the very first time at which
a. If applier only puts the tourniquet on the limb once and applier touches tightening system as part of starting to
goes from placing the tourniquet around the limb to use tightening system. Instead, “touch tightening sys-
securing the tourniquet to using the tightening system tem” is the “touch tightening system” time within the
with additional attempts to pull the strap tighter mixed last set of secured to tightening system use. “List other”
in with use of the tightening system, “strap/redirect se- in the “Problems with or without failure” receives the
cured” is first time at which applier stops securing strap explanation.
to go to tightening system. If applier continues to pull 4. First Doppler signal loss
on the strap while using the tightening system, time of a. With ratcheting buckle tourniquets, this is the time with
“strap/redirect secured” will match time of “touch tight- no pulse with the buckle in its flat resting position. With
ening system.” tightening systems that rotate in a plane parallel to the
b. If applier never secures strap/redirect system, no other limb (windlass and X8T), this is the time of the missing
times recorded. beat that is the first of the missing beats of occlusion. If
c. If applier puts the tourniquet on the limb and works on the applier fails to achieve a Doppler signal loss, there
securing or even on tightening but then undoes the tour- will not be a time.
niquet and restarts the securing process, then “strap/ 5. Last Doppler signal loss before hands off
redirect secured” is not the very first time at which ap- a. For applications with only one Doppler signal loss, this
plier stops securing the strap. Instead, “strap/redirect is the same time as first Doppler signal loss.
secured” is the “strap/redirect secured” time within the b. For applications with more than one Doppler signal
last set of secured to tightening system use. “List other” loss, this is the time of the last Doppler signal loss prior
in the “Problems with or without arterial occlusion at to hands off and “Done.”
Done” receives the explanation. 6. Hands off
3. Touch tightening system a. Applier is done touching the tourniquet.
a. “Touch tightening system” time is when applier touches b. If the applier takes hands off but then realizes the Dop-
tightening system with purpose to use the tightening sys- pler signal isn’t gone and does additional tightening be-
tem, for example not hand resting on tightening system fore saying “Done,” then “hands off” is not the first time
while still wondering what to do with rest of strap. but the last time with hands off the tourniquet.
b. If applier only puts the tourniquet on the limb once and
goes from placing the tourniquet around the limb to PMID: 38112184; DOI: 10.55460/RPO1-CB79
securing the tourniquet to using the tightening system

42 | JSOM Volume 23, Edition 4 / Winter 2023