Page 20 - JSOM Fall 2025

FIGURE 3 Cont.
(C) Occlusion, 1st Completion, and Total Tightening-System 180° Turns. P values ≤.2 for turns comparisons between tourniquets are as
follows:
• Arm Occlusion Tightening-System Turns (to the closest 0.5 turn): medians SICH 0.5, DNIPRO 0.5, PULS 0.5, Y&B 1.5, X8T 0.5; one-way
ANOVA: p<.0001 Y&B>SICH, DNIPRO, PULS, and X8T. Repeated measures one-way ANOVA: p<.0001 Y&B>SICH, DNIPRO, PULS, and
X8T. Repeated measures one-way ANOVA only Ukrainian-manufactured tourniquets: p<.0001 Y&B>SICH, DNIPRO, and PULS.
• Arm 1st Completion Tightening-System Turns: medians SICH 1.5, DNIPRO 1.5, PULS 1.5, Y&B 1.5, X8T 0.6; one-way ANOVA: p<.0001
X8T<SICH, DNIPRO, PULS, and Y&B; p<.0001 Y&B>SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA: p<.003 X8T<SICH,
DNIPRO, PULS, and Y&B; p<.004 Y&B>SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA only Ukrainian-manufactured
tourniquets: p<.002 Y&B>SICH, DNIPRO, and PULS.
• Arm Total Tightening-System Turns: medians SICH 1.5, DNIPRO 1.5, PULS 1.5, Y&B 2.5, X8T 0.7; one-way ANOVA: p<.0001 X8T<SICH,
DNIPRO, PULS, and Y&B; p<.0001 Y&B>SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA: p<.0001 X8T<SICH, DNIPRO,
PULS, and Y&B; p<.003 Y&B>SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA only Ukrainian-manufactured tourniquets:
p<.002 Y&B>SICH, DNIPRO, and PULS.
• Thigh Occlusion Tightening-System Turns: medians SICH 1.5, DNIPRO 1.5, PULS 1.0, Y&B 2.8, X8T 1.3; one-way ANOVA: p<.0001
Y&B>SICH, DNIPRO, PULS, and X8T. Repeated measures one-way ANOVA: p<.0001 Y&B>SICH, DNIPRO, PULS, and X8T. Repeated
measures one-way ANOVA only Ukrainian-manufactured tourniquets: p<.0001 Y&B>SICH, DNIPRO, and PULS.
• Thigh 1st Completion Tightening-System Turns: medians SICH 2.5, DNIPRO 2.0, PULS 1.5, Y&B 3.5, X8T 1.4; one-way ANOVA: p<.005
X8T<SICH, DNIPRO, and Y&B; p<.0001 Y&B>SICH, DNIPRO, and PULS; p=.188 SICH>PULS. Repeated measures one-way ANOVA:
p<.02 X8T<SICH, DNIPRO, and Y&B; p<.0006 Y&B>SICH, DNIPRO, PULS, and X8T. Repeated measures one-way ANOVA only Ukrainian-
manufactured tourniquets: p≤.0003 Y&B>SICH, DNIPRO, and PULS; p=.152 SICH>PULS; p=.069 DNIPRO>PULS.
• Thigh Total Tightening-System Turns: medians SICH 2.5, DNIPRO 2.5, PULS 2.0, Y&B 3.5, X8T 1.5; one-way ANOVA: p≤.0004 X8T<SICH,
DNIPRO, and Y&B; p=.072 X8T<PULS; p<.0001 Y&B>SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA: p≤.0003
X8T<SICH, DNIPRO, and Y&B; p=.102 X8T<PULS; p<.0001 Y&B>SICH, DNIPRO, and PULS. Repeated measures one-way ANOVA only
Ukrainian-manufactured tourniquets: p<.0001 Y&B>SICH, DNIPRO, and PULS; p=.069 DNIPRO>PULS.
(D) Per-180°-Turn Pressure Increases. First completion pressure changes were excluded for the nine DNIPRO and 10 PULS applications with
occlusion before tightening-system use because these tourniquets do not begin tightening in response to windlass-rod turning until approximately
90° of rod rotation has occurred. Arm per-turn pressure increases were higher than thigh (all five tourniquets combined paired t-test p<.0001). In
99 of 101 applications with tightening after first completion, additional per-turn pressure increases were greater than per-turn, first-completion
pressure increases. P values ≤.2 for per-turn pressure increase comparisons between the tourniquets are as follows:
• Arm 1st Completion: mmHg medians SICH 211, DNIPRO 221, PULS 309, Y&B 127, X8T 192; one-way ANOVA: p<.0004 Y&B<SICH,
DNIPRO, PULS, and X8T; p<.002 PULS>SICH, DNIPRO, and X8T.
• Arm Additional: mmHg medians SICH 469, DNIPRO 376, PULS 681, Y&B 210, X8T 454; one-way ANOVA: p=.077 Y&B<SICH, p=.0001
Y&B<PULS, p=.138 Y&B<X8T; p=.109 PULS>DNIPRO.
• Thigh 1st Completion: mmHg medians SICH 172, DNIPRO 185, PULS 201, Y&B 109, X8T 196; one-way ANOVA: p<.0001 Y&B<SICH,
DNIPRO, PULS, and X8T; p=.195 PULS>SICH.
• Thigh Additional: mmHg medians SICH 226, DNIPRO 300, PULS 334, Y&B 163, X8T 367; one-way ANOVA: p<.007 Y&B<DNIPRO, PULS,
and X8T; p=.103 SICH<DNIPRO; p=.104 SICH<PULS; p<.0001 SICH<X8T.

(C) 7 6 Occlusion Arm Applications Total Turns 1 add. turn Thigh Applications (D) 900
850
1st Completion
never secured rod
(not completed)
Tightening-System 180° Turns ° 5 4 3 2 unsecureable 700
1 add. turn
800
not secured
750
2 add. turns
not secured
650
600
550
500
400
350
0 1 Occlusion 1st Completion Total Turns Per-180°-Turn Pressure Increases (mmHg) 450
SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B ° 300
250
200
150
100
50
Arm 1st Completion Arm Additional Thigh 1st Completion Thigh Additional
0
SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B SICH DNIPRO PULS Y&B
SICHs developed a small amount of fraying of the sides of the The Y&B applied to left arms and thighs developed stitching
sewn-on area on which to write application time. SICHs devel- failures with increasing separation of the plate-adjacent lay-
oped fraying of the base area strap under the opening through ers of strap fabric held together by the broken and pulling
which the inner strap passed upward and through the slot in apart threads (Figure 4B) and separation of the loop of strap
the windlass rod (Figure 4A). sewn around the windlass rod (only on the side away from the
plate-adjacent stitching failure, Figure 4B). Y&B plate bending
DNIPROs and PULSs did not develop any visible evidence of in left thigh applications was always downward in the middle
wear. of the plate (Figure 4C) and, for each of the three left thigh

18 | JSOM Volume 25, Edition 3 / Fall 2025