Page 18 - JSOM Fall 2025

TABLE 3 Tourniquet Need for Tightening-System Use
Arm, all applications of all tourniquets on all recipients
Group; no. of recipients
SICH DNIPRO PULS Y&B X8T χ p-value
2
1st occlusion occurred without tightening-system use 6 9 10 0 6 .009
1st occlusion required tightening-system use 24 21 20 30 34
1st occlusion occurred without tightening-system
use and no tightening-system use required beyond 1 5 2 NA 4
securing tightening system .159
1st occlusion occurred without tightening-system use
but required additional tightening-system use after 4 4 8 NA 2
1st completion
Additional tightening-system use after 1st completion 5 5 8 8 5
No additional tightening-system use after 1st 24 25 22 22 35 .484
completion
Arm, applications of tourniquets on 22 recipients who received each tourniquet
1st occlusion required tightening-system use 2 6 7 0 3
1st occlusion occurred without tightening-system .026 (.015)*
use and no tightening-system use required beyond 20 16 15 22 19
securing tightening system
1st occlusion occurred without tightening-system use
but required additional tightening-system use after 1 4 1 NA 1
1st completion NA
Additional tightening-system use after 1st completion 1 2 6 NA 2
No additional tightening-system use after 1st
completion 5 3 6 6 3 .632 (.671)*
1st occlusion required tightening-system use 16 19 16 16 19
Thigh, all applications of all tourniquets on all recipients
1st occlusion occurred without tightening-system use 0 0 0 0 0 NA
Additional tightening-system use after 1st completion 11 9 8 15 28
No additional tightening-system use after 1st 19 21 22 14 12 .001
completion
Thigh, applications of tourniquets on 22 recipients who received each tourniquet
Additional tightening-system use after 1st completion 8 7 7 11 17
No additional tightening-system use after 1st 14 15 15 10 5 .010 (.460)*
completion
*P values before the parentheses are for χ comparisons for all five tourniquets; p values in parentheses are for chi-square comparisons for only
2
the four Ukrainian-manufactured tourniquets.
SICH = Strengthened Individual Combat Hybrid Tourniquet; DNIPRO = TQ DNIPRO GEN 2; PULS = PULS Tourniquet; Y&B = Yellow & Blue
tourniquet; X8T = X8T-T2G tourniquet; NA = not applicable.

No X8T pressures were over 500mmHg. No arm occlusion pres- pressures (Figure 3A, 3B) were both associated with need-
sures were over 500mmHg (Figure 3A). Among the Ukrainian- ing more total turns of the tightening system (circumference
manufactured tourniquets, pressures over 500mmHg occurred p<.0001, pre-tightening system use p=.096 for Y&B and
in 39 arm first completions (9 SICH, 13 DNIPRO, 16 PULS, 1 p<.0002 for others, Figure 3C). Difficulty securing the Y&B
Y&B), 49 arm pre-releases (12 SICH, 11 DNIPRO, 24 PULS, rod in the triangle was caused by turn-related rod migration
2 Y&B), 10 thigh occlusions (3 SICH, 4 DNIPRO, 2 PULS, (Table 2).
1 Y&B), 67 thigh first completions (19 SICH, 19 DNIPRO,
18 PULS, 11 Y&B), and 83 thigh pre-releases (21 SICH, 22 The median (IQR) times from audible pulse detection to
DNIPRO, 23 PULS, 17 Y&B) (Figure 3A, 3B). hands-off after completion of an additional windlass-rod
turn were as follows: SICH 10 (9, 15) seconds (p=.028 versus
Within each application across all five designs, 99 of 101 per- DNIPRO, p=.005 versus PULS), DNIPRO 18 (13, 21) seconds,
turn, after-first-completion pressure increases were greater than PULS 17 (16, 20) seconds, Y&B 12 (11, 18) seconds (p=.058
per-turn, first-completion pressure increases (Figure 3D). Arm versus PULS, but does not include non-secured Y&Bs).
applications generally had higher per-turn, first- completion
pressure increases and higher per-turn, after-first- completion Tourniquet Signs of Wear
pressure increases than leg applications (Figure 3D). Compared With 30 arm and 30 thigh uses for each Ukrainian- manufactured
to the other tourniquets, Y&B per-turn pressure increases were tourniquet, none became unusable. Each required resetting be-
lower, and PULS per-turn pressure increases tended to be higher. tween uses, including thorough untwisting of the inner straps
of the SICH, DNIPRO, and PULS. Y&B resetting included flat-
As expected, 17–19 larger circumference limbs required higher tening of the fabric-enclosed, thin, small plate after most thigh
pressures for occlusion (p<.0001 each tourniquet). Larger cir- applications. The base plates of the DNIPRO and PULS did not
cumference limbs and lower achieved pre-tightening- system-use require any repositioning as part of tourniquet resetting.

16 | JSOM Volume 25, Edition 3 / Fall 2025