Page 15 - JSOM Fall 2025

FIGURE 1 Tourniquets.
Each tourniquet has a 3.8cm-wide, nonelastic strap that encircles the limb and a base area containing a tightening system and a redirect buckle.
Redirect buckles are contained within white outlined rectangles and have a short text description. The securing mechanisms for the windlass rods
of the four Ukrainian-manufactured tourniquets are indicated by a white arrow. Left to right: SICH, DNIPRO, PULS, Y&B, X8T.
The SICH, DNIPRO, and PULS use hook-and-loop for strap/redirect system security. The Y&B uses a self-securing slider redirect buckle for strap/
redirect security. The metal SICH redirect buckle can be threaded as a simple redirect buckle, which we did using the outer slot, or as a triglide
redirect buckle. The DNIPRO and PULS have simple redirect buckles. Only the Y&B has a clip portion of the redirect buckle; the straps of the
others must be unthreaded and rethreaded if placing around a trapped limb.
All four have non-self-securing, windlass-rod tightening systems with the SICH, DNIPRO, and Y&B having metal windlass rods. The wind-
lass-rod securing brackets are a modified triangle for the SICH, an open-top bracket for the DNIPRO and PULS, and a triangle for the Y&B.
In response to windlass-rod rotations, the SICH, DNIPRO, and PULS have internal-width circumferential strap shortening dependent on direct
movement of only the separate, internal strap that passes through a slot in the windlass rod and is contained within and anchored to the wider
strap that encircles the limb. Y&B windlass-rod rotations cause full-width circumferential strap shortening via a loop of strap sewn around the
windlass rod and attached to the limb-encircling strap via rivets and sewing through a fabric-enclosed, thin, small plate and the clip via sewing.
Windlass-rod rotations immediately affect strap pressure with the SICH and Y&B. Slack in the internal strap of the DNIPRO and PULS results
in a lack of pressure increase during the first 90° of rod rotation.
The X8T has a self-securing double redirect strap/redirect system that cannot be unthreaded and has a clip for securing around a trapped limb
and a self-securing tightening system with unidirectional dial rotation parallel to the limb surface. Dial rotation results in immediate, full-width
circumferential strap shortening via shortening of a strap that is sewn around the secondary strap redirect and the clip of the primary strap redi-
rect. Ten teeth advances (10 clicks) create 180° of dial rotation (equivalent to one 180° windlass-rod turn).

Starting with 0° as the beginning position of the windlass rod Resetting and Cleaning
(perpendicular to the limb-encircling strap), every 180° of Between arm and thigh applications and after pictures, each
tightening-system rotation was considered one turn (10 clicks tourniquet was reset with untwisting of all strap parts, flatten-
of the X8T/turn). This differs from counting choices consid- ing of Y&B riveted plate piece, and full-length stretching. Each
ering 0 turns as the first rod position parallel to the limb- tourniquet was sprayed with 70% denatured ethyl alcohol and
encircling strap (90° rod rotation). 13–15 allowed to dry between recipients.

PW supervised applications and called Doppler signal loss Statistical Analysis
and return. A separate person collected pressure data and Data were organized in Excel for Microsoft 365 MSO (Version
also listened for Doppler signal loss and return. Ukrainian- 2508 Build 16.0.19127.20082 64-bit; Microsoft Corp., Red-
manufactured tourniquet applications were videoed, and video mond, WA). Graphing and statistical analyses were performed
review was used to help confirm times, pressures, and rod rota- with GraphPad Prism, version 7.04 for Windows (GraphPad
tions. Recipients could stop applications at any time. Software Inc., Boston, MA). One-way analysis of variance
(ANOVA) and repeated measures one-way ANOVA, both with
Visual Assessments Tukey’s multiple comparisons, were used to compare pressure,
Tourniquets were inspected and photographed after each pair tightening-system use, pressure/turn, and speed of additional
of arm and thigh applications. Because of the bending of the tightenings between tourniquets. T-tests or paired t-tests were
thin, small plate involved in the Y&B strap connection, video used for pressure, tightening- system use, pressure/turn compar-
was shot of Y&Bs after thigh applications. isons between limbs with a tourniquet, and for first-completion

Four Ukrainian-Manufactured Tourniquets | 13