Page 89 - JSOM Winter 2023

3D-Printed Tourniquets Used at the Battlefront in Ukraine

A Pilot Study

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Jørgen Melau, PhD *; Pål Bergan-Skar, MSc ; Nigel Callender, MBBS ;
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Martin Rognhaug, BSc ; Erling Bekkestad Rein, MD, PhD 5

ABSTRACT
Background: The war in Ukraine urged a need for prompt deliv- exsanguinating hemorrhage of an extremity and have been de-
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erance and resupply of tourniquets to the front. Producing tour- scribed since ancient Roman times. These devices can be used
niquets near the battlefront was a feasible option with respect at a point proximal to an injury, as a temporary hemorrhage
to resupply and cost. Methods: A locally produced 3D-printed control awaiting definitive treatment.
tourniquet (Ukrainian model) from the “Tech Against Tanks”
charity was tested against commercially available and The literature describes different types of tourniquets with dif-
Committee of Tactical Combat Casualty Care (CoTCCC)- ferent mechanisms and are made for use mainly in a prehos-
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recommended tourniquets (C-A-T and SOF TT-W). We tested pital environment. Prefabricated tourniquets generally have a
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how well the tourniquets could hold pressure for up to 2 hours. windlass mechanism and strap that allow the tourniquet to be
Results: A Kruskal-Wallis test revealed significant differences tightened and locked in place around an extremity. In the war
between the groups (p<.05). Post-hoc testing revealed a signif- in Ukraine, tourniquets are widely used and there is an urgent
icant difference between the C-A-T and the Ukrainian tourni- need to resupply the Ukrainian soldiers and civilian commu-
quet (p=.004). A similar significance was not found between nity with a readily available method of hemorrhage control.
the SOF TT-W Wide and the Ukrainian model (p=.08). Dis-
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cussion: The Ukrainian model can hold pressure as well as the To control exsanguinating extremity bleeding, the tourniquet
commercially available tourniquets. There is much value if this must be able to compress the arterial flow proximal to the
can be produced close to the battlefield. Factors including lo- bleeding wound, amputation, or crush injury. In addition, the
gistics, cost, and self-sufficiency are important during wartime. windlass mechanism and strap need to be rugged, and wide
Conclusion: We found that our sample of 3D-printed tourni- enough to provide sufficient pressure to avoid additional tis-
quets, currently used in the war in Ukraine, could maintain sue injury and pain, since this method is particularly painful in
pressure as well as the commercially available tourniquets. In- the conscious patient. Several organizations give recommen-
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deed, our tests demonstrated that it could maintain a signifi- dations for the use of tourniquets. In the Western military sys-
cantly higher pressure. tem, the Committee of TCCC (CoTCCC) recommendations
are the most widely used. 7
Keywords: tourniquet; hemorrhage; armed conflicts; 3D print-
ing; battlefront resupply Similar to a commercial prefabricated tourniquet, 3D-printed
tourniquets are becoming more accessible in the modern era.
Tourniquets can be produced via 3D printing to increase
their accessibility and availability, especially in remote or re-
Introduction
source-constrained places where regular tourniquets might
Military forces have used tourniquets in tactical combat casu- not be easily accessible. However, like commercially available
alty care (TCCC) for decades, with undisputed benefits from tourniquets, 3D-printed tourniquets need to be manufactured
recent conflicts in Iraq and Afghanistan, in which modern in- and tested if they are to meet adequate standards for safety
dustry-designed tourniquets were used. Some civilian agencies and effectiveness. In an emergency, misusing a tourniquet—or
have implemented them based on military forces experience. using a noneffective tourniquet—can do more harm than good
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Nevertheless, hemorrhage remains the leading cause of death and potentially increase the risk for the casualty.
among casualties with potentially survivable injuries. 3
Just after the Russian invasion of Ukraine in February
Modern combat casualty care focuses on hemorrhage control, 2022, Sygnis SA, a Polish deep tech company, along with
airway control, and hypothermia prevention. There are several 3 YOURMIND, an on-demand manufacturing software com-
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methods to control life-threatening hemorrhage from the ex- pany, created a joint venture entitled “Tech Against Tanks.”
tremities; one option is the use of tourniquets. Tourniquets are This venture sought to collect and design solutions that use 3D
simple, portable, and inexpensive instruments for controlling printing as the fastest way to obtain protective gear, equipment,
*Correspondence to jmelau@protonmail.com
1 Dr Jorgen Melau is a scientist affiliated with the Norwegian Armed Forces, Joint Medical Services, Sessvollmoen, Norway and the Department of
Vascular Surgery, Oslo University Hospital, Oslo, Norway. Capt Pål Bergan-Skar is affiliated with the Norwegian Armed Forces, Joint Medical
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Services, Sessvollmoen, Norway. Nigel Callender is a physician affiliated with the Department of Vascular Surgery, Oslo University Hospital,
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Oslo, Norway. Martin Rognhaug is affiliated with the Norwegian Special Operations Command, Norway. LtCol Erling Bekkestad Rein is a
physician-scientist affiliated with the Norwegian Armed Forces Joint Medical Services, Department of Vascular Surgery, Oslo University Hospital,
Oslo, Norway, and the Norwegian Special Operations Command, Norway.
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