Dory R, Bequette J, Cox D
Naval Medical Research Unit San Antonio;NAMRU-SA Report #2017-54
EXECUTIVE SUMMARY
BACKGROUND: Since doctrinal changes made in 2005, tourniquets have become standard issue equipment for the US warfighter operating in the tactical environment. Previous Joint Operational Evaluation of Field Tourniquets (JOEFT) studies have gathered performance data to compare commercially available tourniquet designs utilizing instrumented mannequin systems, as well as synthetic cadaver models of severe hemorrhage; however, human end-user testing remains critical for identifying those tourniquet designs best suited for use by our military service members.
OBJECTIVE: To compare the performance of three candidate tourniquets, theCombat Application Tourniquet® (CAT), Ratcheting Medical Tourniquet™ (RMT), and Tactical Mechanical Tourniquet (TMT), in the hands of military end-users during selfapplications.
METHODS: Fifty five volunteer participants (n=55) were first trained to correctly position and apply each tourniquet design, according to the manufacturers’ instructions for use, on instrumented mannequins designed for tourniquet training. Participants then self-applied each tourniquet once to their arm and once to their leg, halting at cessation of the distal pulse.Occlusion was maintained for one minute. Measurements included success/failure rate, applications time, discomfort, and participant preference and feedback. Results: Of the three tourniquet designs, the CAT achieved the highest combined success rate across arm and leg applications (97.27%), followed by the RMT (94.55%) and the TMT (90.91%). The CAT hadthe shortest arm application time (43.6 ± 18.2 sec) and was significantly faster (p < 0.05) than the TMT (67.6 ± 30.5 sec) but not the RMT (44.2 ± 22.3 sec). The CAT also had the shortest leg application time (40.4 ± 13.0) and was significantly faster (p < 0.05) than the RMT and TMT (47.4 ± 17.9 sec and 48.0 ± 13.2 sec, respectively). The three tourniquets did not differ inreported discomfort levels. The CAT was most often ranked the preferred tourniquet design for arm (51.9%) followed by the RMT (38.9%) and TMT (9.3%). The CAT also ranked most preferred for the leg (41.5%) followed by the RMT (30.2%) and TMT (28.3%).
CONCLUSIONS: Because buddy aid or aid from a medic or corpsman is never guaranteed, it is imperative that tourniquets can be quickly applied by those who must administer self-aid. The results of the present study provide data that differentiate the three tourniquet designs through measures of tourniquet success, application times, and user feedback. These data can be used to identify which current design(s) are best suited for use by our warfighter, and to identify opportunities to improve existing tourniquet features in subsequent generations of tourniquet designs.