Effects of Training and Simulated Combat Stress on Leg Tourniquet Application Accuracy, Time, and Effectiveness (original) (raw)
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The Military Emergency Tourniquet Program’s Lessons Learned With Devices and Designs
Military Medicine, 2011
Objective: The purpose of this study is to report the device lessons learned from an emergency tourniquet program and, in particular, to emphasize analysis of discarded devices recovered after clinical use. Methods: Discarded tourniquet devices were analyzed after use in emergency care of war casualties to determine wear and tear patterns, effectiveness rates, and associations among device designs. Results: The 159 devices recovered comprised seven designs. Emergency & Military Tourniquet (92%) and Combat Application Tourniquet (79%) effectiveness rates were significantly different from each other and better than other tourniquets (p < 0.002) as the most effective ambulance and fi eld tourniquets, respectively. Designs had specifi c pitfalls (e.g., sand-clogged ratchets) and strengths (the pneumatic design was least painful). Every device had wear, abrasions, or deformity about the band edges or bladder. User understanding of how devices work best helped attain better results. Some desirable traits (e.g., one-handed application, use for entrapped limbs) were rarely needed. Tourniquets fi t casualty limbs well. Conclusions: Correct user actions (e.g., following the instructions to remove slack before twisting) led to device effectiveness, but misuse did not. Users often assumed that optimal use required more force, but this was associated with misuse. Training should include tourniquet pearls and pitfalls.
Re-Evaluating the Field Tourniquet for the Canadian Forces
Military Medicine, 2013
Objective: To determine the best field tourniquet for Medical Technician (Med Tech) use in the Canadian Forces (CF). Methods: We conducted a prospective controlled trial, comparing the efficacy and ease of applicability of 3 types of commercially available windlass tourniquets in 4 tactical situations on simulated patients. The primary outcome was time to tourniquet application with secondary outcomes including effectiveness and Med Tech satisfaction. Results: The overall finding of this study indicates that the Combat Application Tourniquet (C-AT) was applied the fastest in each scenario and was also significantly the most effective in occluding distal blood flow. The survey results show that the 3 tourniquet types are similar in many of the measures of ease of learning and application, with the C-AT scoring highest in self-application and the Special Operations Forces Tactical Tourniquet Wide having the lowest scores for both durability and effectiveness. Conclusion: When tested on a group of CF Med Techs, the C-AT remained the CF field tourniquet of choice, based on the assessed criteria. Although there is inherent bias in the approach of this study, it reflects the process required to determine if a new piece of kit is superior to what is already considered the standard to a trained and equipped military.
Testing of junctional tourniquets by military medics to control simulated groin hemorrhage
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2014
Junctional hemorrhage is a common cause of death on the battlefield, but there is no documented direct comparison for the use of junctional tourniquet models by US medics. The purpose of this testing is to assess military medic experience with the use of junctional tourniquets in simulated out-of-hospital trauma care. Nine medics (seven men and two women) used four different junctional tourniquets: Combat Ready Clamp™ (CRoC™; http://www.combatmedicalsystems .com), Abdominal Aortic and Junctional Tourniquet™ (AAJT™; http://www.compressionworks.net), Junctional Emergency Treatment Tool (JETT™; http://www.narescue .com), and SAM Junctional Tourniquet® (SJT®; http:// www.sammedical.com/products). These medics also acted as simulated casualties. Effectiveness percentages, as measured by stopped distal pulse by Doppler auscultation, and time to effectiveness were recorded in two tests per tourniquet (72 total tests). Tourniquet users ranked their preference of model by answering the quest...
Evaluation of Possible Battlefield Tourniquet Systems for the Far-Forward Setting
Military Medicine, 2000
A significant number of casualties in previous conflicts died from peripheral vascular wounds. A well-designed tourniquet could possibly have prevented these deaths. The objective of this study was the identification of such a tourniquet. Asurvey of Special Operations corpsmen established important characteristics necessary in an ideal tourniquet. Because most available devices do not and patented ideas could not meet these criteria, a number of prototypes were developed. Seven potentially satisfactory tourniquets were evaluated by 15 Navy SEAL corpsmen. The success and timing of placement were recorded, and a follow-up questionnaire was completed. Ofthe several successful tourniquets, two were preferred. Tourniquets incorporating a windlass technique take longer to place and often fail when placed with only one hand. New, relatively simple tourniquet devices incorporating bladder and ratchet mechanisms can significantly improve tourniquet performance.
Research on Tourniquet Related Injury for Combat Casualty Care
2004
The tourniquet has been used for over 300 years for effective hemorrhage control during surgery and trauma. However, tourniquets are far from benign, causing a host of complications collectively known as tourniquet injury. A tremendous body of clinical experience and scientific research has resulted in principles of safe use and advances in tourniquet design, minimizing tourniquet injury under clinical conditions. Unfortunately, battlefield conditions preclude adherence to these safe principles and the use of surgical tourniquets. The United States Army Institute of Surgical Research (USAISR) has developed an integrated program designed to address the unique nature of tourniquet use under combat conditions with the goal of increasing the rate of limb salvage and saving lives.
Field tourniquets in an austere military environment: A prospective case series
Injury, 2022
Objective: Field tourniquets are often used for battlefield extremity injuries. Their effectiveness has been documented by a large combat theater trauma center. However, their use and effectiveness by an austere forward surgical team has not been reported. Aims of this study were to determine: Whether field tourniquets: (1) Were placed for appropriate indications; (2) significantly reduced hemorrhage as measured by transfusion requirements; (3) influenced vital signs and injury severity scores; and (4) did they cause limb amputation, changed amputation level, or other complications. Methods: Twenty-five patients with 30 involved extremities presenting to a forward surgical team in Iraq met the inclusion criteria. We prospectively collected data regarding the presence, indications for, and effectiveness of field tourniquets based on the need for blood transfusion. We recorded any complications associated with their use. Results: Tourniquets significantly reduced hemorrhage from penetrating injuries as measured by transfusion requirements. Those having major vascular injuries with effective tourniquets, a total of 12 units of blood were transfused (1.7 units/vascular injury; 2 units/patient). However, 19 units were transfused in patients (3.3 units/vascular injury; 3.8 units/patient) who had an ineffective or no tourniquet (p = 0.0 0 06). Transfusion requirements were related the presence of an effective tourniquet regardless of concomitant injuries. The group with effective tourniquets and compressed hemorrhage presented with higher mean systolic (p = 0.003) and diastolic (p = 0.023) blood pressures than the group with no tourniquets or ineffective ones. Complications included one peroneal nerve palsy and no amputations resulted from tourniquet application. Conclusion: Field tourniquets applied for penetrating injuries with severe bleeding can significantly reduce transfusion requirements and help maintain adequate blood pressure. Tourniquets were not the proximate cause of amputation and did not determine the choice of immediate amputation level.
U.S. Military Use of Tourniquets from 2001 to 2010
Prehospital Emergency Care, 2014
Objective. This study was conducted to associate tourniquet use and survival in casualty care over a decade of war in order to provide evidence to emergency medical personnel for the implementation and efficacy of tourniquet use in a large trauma system. Methods. This survey is a retrospective review of data extracted from a trauma registry. The decade (2001-2010) outcome trend analysis of tourniquet use in the current wars was made in order to associate tourniquet use and survival in an observational cohort design. Results. Of 4,297 casualties with extremity trauma in the total study, 30% (1,272/4,297) had tourniquet use and 70% (3,025/4,297) did not. For all 4,297 casualties, the proportion of casualties with severe or critical extremity Abbreviated Injury Scales (AIS) increased during the years surveyed (p < 0.0001); the mean annual Injury Severity Score (ISS) rose from 13 to 21. Tourniquet use increased during the decade by almost tenfold from 4 to nearly 40% (p < 0.0001). Survival for casualties with
Military medicine, 2018
Experience from recent conflicts underlines the dramatic impact of effective tourniquet use on combat casualty mortality. Although the Combat Application Tourniquet (CAT) is replacing the silicone band tourniquets (IST; "Israeli Silicone Tourniquet") in the Israeli Defense Forces, no direct comparison was made between them. The purpose of this study is to compare the performance of the two tourniquets on a mid-thigh model. Participants were Israeli military recruits who previously had the military first aid course. Each participant applied both the CAT and the IST. Applications were assessed by the HapMed Leg Tourniquet Trainer, which measured the applied pressure and the time required to reach it. IST application resulted in higher rates of effective occlusion pressure compared with the CAT (91% vs. 73.1%, p < 0.01), and a higher mean occlusion pressure (41 mmHg, p < 0.01) was recorded using the IST. Among effective attempts, application time did not differ signific...
The effects of military-wide introduction of advanced tourniquets in the Israel Defense Forces
Injury-international Journal of The Care of The Injured, 2020
Background: Early application of tourniquets has reduced injury death rates. At the end of 2013, the Israel Defense Forces Medical Corps completed a military-wide introduction of the Combat Application Tourniquet as the standard-issued tourniquet. The accompanying clinical practice guideline encouraged combat soldiers and medical teams towards a liberal use of tourniquets for extremity injuries, even when in doubt. Objectives: This study aimed to assess the effects of the wide introduction of advanced tourniquets on the rate of tourniquet applications, the type of tourniquet applied, and the differences in hospitalisation outcomes following the introduction. Methods: The study population was composed of hospitalised military casualties with an extremity injury treated by military medical teams between 2006 and 2015. Prehospital data were extracted from the Israel Defense Forces Trauma Registry and matched to corresponding hospital data from the Israeli National Trauma Registry. Two periods were compared: 2006-2013 "pre-intervention period" and 2014-2015 "post-intervention period". Results: A total of 1,578 casualties were recorded during the study period. Of these, 320 (20.3%) occurred between 2014-2015. Characteristics of casualties in the post-intervention period were similar to those in the pre-intervention period including the rate of traumatic amputations (2.5% vs 2.2%, p = 0.93) and Injury Severity Score of 16 or above (12.8% vs 14.9%, p = 0.40). The rate of tourniquet application was more than four-fold in the post-intervention period compared to the pre-intervention period (22.8% vs 5.5%, p < 0.001). Nevertheless, rates of in-hospital amputations (1.6% vs 1.6%, p = 1.00) and death (0.9% vs 1.3%, p = 0.53) were similar in the two periods. Conclusion: Following the IDF military-wide introduction of advanced tourniquets, the tourniquet application rate rose sharply, the use of old tourniquets ceased over time, and in-hospital amputation rate did not increase. These findings suggest that the awareness for haemorrhage control using advanced tourniquets rose.
Military Medicine
Background: The Combat Application Tourniquet (CAT) is the tourniquet of choice in the Israeli defense forces. Applying the device loosely before windlass twisting is a main pitfall in CAT application. This study objective is to assess the effectiveness of a novel design modification of the CAT, aiming to prevent loose applications, by minimizing the slack. Methods: Using the HapMed leg tourniquet trainer, an above the knee traumatic amputation was simulated. Active duty combatants and Special Forces basic medics were randomly assigned to apply the modified (n = 67) or conventional CAT (n = 65) once. Applied pressure, hemorrhage control status, time to stop the bleeding, and estimated blood volume loss were measured. Results: Using the modified CAT, the mean (±SD) pressure applied was significantly higher compared to the conventional one (231.49 ± 37.84 mm Hg vs. 213.31 ± 45.51 mm Hg, p < 0.05). Hemorrhage control rate was 86.6% in the modified CAT group versus 67.7% in the conventional CAT group (p < 0.05). Analyzing only the applications that succeeded in hemorrhage control, blood loss (171.12 ± 72.43 mL vs.187.75 ± 91.72 mL, p > 0.05) and time to stop bleeding (27.27 ± 13.15 seconds vs. 27.5 ± 11.25 seconds, p > 0.05) were similar. Conclusions: The modified CAT demonstrated an upgraded pressure profile and hemorrhage control rate, potentially indicating its improved efficacy.