Page 58 - JSOM Fall 2025

advances in tightening. We believe these windlass-rod versus to affect occlusion results: a desire to be fast promotes not
ratcheting-buckle tightening-system differences are the reasons using a “listening pause” to be sure of occlusion before saying
for evidence of beneficial first-use learning regarding occlusion “Done,” and making “Done” a non-reversible endpoint pre-
at “Done” occurring only with the ratcheting-buckle systems. cludes fixing a hasty utterance.

Regarding applier experience and occlusion at “Done,” many Conclusion
experienced appliers used a brief “listening pause” with their
hands off the tourniquet before saying “Done.” Because remov- Knowledge-of-results is critical for, but does not guarantee,
ing any hand pressure from the tourniquet can easily result in tourniquet-application-useful first-use learning. The existence
a pulse return if one is near the occlusion-pressure threshold, of first-use learning can allow limited experience with one
this is quite helpful to having Doppler-audible occlusion still tourniquet to improve performance with a different tourniquet
present when saying “Done.” Also, experienced appliers in this with shared-design features. Therefore, exposure to different
study had all been well-indoctrinated with the importance of designs may have value, and providing tourniquet-training
having arterial occlusion with emergency-use tourniquets, and knowledge-of-results, whether intrinsically or via instructor
all had prior research or teaching applications of tourniquets feedback, is important.
on their own limbs.
Acknowledgments
Regarding applier experience and training scars, use of a We thank the following Drake University undergraduates of the
“listening pause” was part of all prior tourniquet research Trauma Research Team for their help carrying out the exper-
studies in which any of the experienced appliers participated. iments: JaNiese Jensen, Alex White, Jared Defriend, Mikayla
This means use of a “listening pause” may not have been a Soelter, Amanda Gregory, Bryan Williams, Mia Fidanze, Erin
conscious decision in this study. A definite training scar was O’Keefe, Quynh Pham, Lindsey Skerrett, Kristen Skriver, Erin
noted in the securing process of a CAT7 application: one ex- Steffenson, Dani Eernisse, Jack Libbesmeier, Kayla Markuson,
perienced applier did not place the limb-encircling strap in the Taylor Rentschler, and Stephanie Richardson.
bracket before placing the time strap across the bracket. The
applier knew the correct strap-securing processes, but all prior Author Contributions
research in which the applier had participated that involved PW and CB contributed to concept development and project
CATs did not include complete, double strap securing of the design. All authors contributed to the acquisition, analysis,
rod in the bracket (different study objectives). and interpretation of data and the drafting and revising of the
article. All authors had final approval of the manuscript.
Data from others regarding the speed of tourniquet learning
in appliers with some level of tourniquet experience support Disclosures
rapid learning regarding some tourniquet processes. 20–23 Our None of the authors have any financial relationships relevant
data indicates beneficial first-use learning can occur regard- to this article to disclose, and there was no outside funding. As
ing tourniquet applications. We believe this makes it highly stated in reference 1, tourniquets were requested from manu-
desirable to teach possible tourniquet users general applica- facturers or distributors, and seven of the eight models of tour-
tion principles and, ideally, provide possible tourniquet users niquets were donated. PW and CB are paid by their respective
hands-on experience with more than one general strap/redirect institutions, and CHR was a volunteer researcher. None of the
system and more than one general tightening system. Training authors has stock in any tourniquet companies, and none do
with each design should include intrinsic and instructor- origin any paid consulting with any tourniquet companies. The au-
knowledge-of-results feedback with fully- secured, arterially- thors communicate and share data with any and all interested
occlusive, correct applications. To maximize training benefit, companies and individuals, and do not keep any tourniquet-
major design aspects and critical endpoints should be specifi- related secrets. The lab equipment belongs to Drake University
cally noted (major design aspects: clip/no clip, hook-and-loop and UnityPoint Health Iowa Methodist Medical Center.
strap/self-securing redirect, windlass-rod tightening system,
ratcheting-dial tightening system, ratcheting-buckle tighten- Funding
ing system; endpoints: strap security, tightening-system secu- No funding was received for this work. Please see the Disclo-
rity, arterial occlusion with hands off the tourniquet). sures section for information regarding equipment and mate-
rial support.
Our data suggest that, with inclusion of knowledge-of- results,
even limited training with tourniquets with different strap/ References
redirect systems and different tightening systems would in- 1. Wall P, Buising C, Jensen J, White A, Davis J, Renner CH. Effects
crease the potential for application success if faced with a new of tourniquet features on application processes. J Spec Oper Med.
tourniquet (such as might be the case with public access bleed- 2023;23(4):11–30. doi:10.55460/8FFG-1Q48
ing control kits or with someone else’s first aid kit). 2. Wall P, Buising C, White A, Jensen J, Davis J, Renner CH. Effects
of tourniquet features on application processes times. J Spec Oper
Med. 2023;23(4):31–42. doi:10.55460/RPO1-CB79
Study Limitations 3. Wall P. Brief, General Tourniquet Training Video. Vimeo. 2020.
The data came from a preplanned subset from a larger study. Accessed January 24, 2022. https://vimeo.com/447166122/aefd
The study had the laboratory-associated limitations of no 4b257a
actual injuries, no bleeding, low stress as compared to clini- 4. Wall P. Combat Application Tourniquet Gen 7 application.
cal-use environments, and all tourniquet applications occur- Vimeo. 2020. Accessed January 21, 2022. https://vimeo.com/
447166808/df55fa1603
ring in quick succession, immediately after watching training 5. Wall P. Special Operations Forces Tactical Tourniquet-W Gen 3
videos. Additionally, being timed and being prevented from application. Vimeo. 2020. Accessed January 21, 2022. https://
doing any more tightening after saying “Done” are both likely vimeo.com/447167377/1d70b203bb

56 | JSOM Volume 25, Edition 3 / Fall 2025