Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare

Abstract

Cold weather warfare is of increasing importance. Haemorrhage is the most common preventable cause of death in military conflicts. We analysed the pressure of the Combat Application Tourniquet® Generation 7 (CAT), the SAM® Extremity Tourniquet (SAMXT) and the SOF® Tactical Tourniquet Wide Generation 4 (SOFTT) over different military cold weather clothing setups with a leg tourniquet trainer. We conducted a selective PubMed search and supplemented this with own experiences in cold weather medicine. The CAT and the SAMXT both reached the cut off value of 180mmHg in almost all applications. The SOFTT was unable to reach the 180mmHg limit in less than 50% of all applications in some clothing setups. We outline the influence of cold during military operations by presenting differences between military and civilian cold exposure. We propose a classification of winter warfare and identify caveats and alterations of Tactical Combat Casualty Care in cold weather warfare, with a special focus on control of bleeding. The application of tourniquets over military winter clothing is successful in principle, but effectiveness may vary for different tourniquet models. Soldiers are more affected and impaired by cold than civilians. Military commanders must be made aware of medical alterations in cold weather warfare.

Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members

“…Even though various scholars have executed ET application studies, most of these have been conducted in laboratory settings or at ambient temperatures. [24][25][26][27][28][29] The Antarctic field conditions of humidity levels, windchill impact, Zodiac movements, and cold weather conditions present a considerable obstacle when striving to replicate experimental outcomes. 22,23 Despite these challenges, the participants could SA most of the ET in the upper and lower extremities donned in the AES.…”

“…Their study demonstrated the achievable vascular occlusion pressure, proving the feasibility of this technique. 27 The authors acknowledge the difficulties in measuring the effectiveness of ETs for vascular occlusion pressure in the Antarctic field conditions of the study. Such challenges may include but are not limited to environmental variables, individual differences, and technical limitations.…”

Human performance and medical treatment during cold weather operations – synthesis of a symposium

“…Lechner et al [ 42 ] compared three candidate tourniquet systems for use over clothing in field conditions. The study suggested that maximum pressure is dependent on the clothing characteristics and emphasised the need to test such equipment under simulated Arctic conditions in the laboratory, as well as under field conditions as sub-zero temperatures could render components of such systems inoperable.…”