Optimizing the Use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02

Shackelford, Stacy; Butler, Frank K.; Kragh, John F; Stevens, Rom A.; Seery, Jason M.; Parsons, Donald L; Montgomery, Harold R; Kotwal, Russ S; Mabry, Robert; Bailey, Jeffrey A.

doi:10.55460/tdtk-rin8

Cited by 44 publications

(47 citation statements)

References 54 publications

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“…The CoTCCC process to evaluate commercial tourniquets is based on a multi-parameter scoring that includes the effectiveness of arterial occlusion; speed and easiness of application; optimal occlusion pressure; size and weight; occurrence of published complications, failures, or safety issues of devices; and combat usage reports, civilian usage reports, and user preferences in literature. 8 In the present study, the straps of the LA-TQ were significantly shorter compared to the CAT. While there is a paucity of data in the literature regarding the impact of strap length on tourniquet efficacy, it can be presumed that for the tourniquet to be secured through the buckle, the strap length should be superior to the circumference of the limb.…”

Section: Discussionmentioning

confidence: 38%

“…5,6 Traditionally, tourniquets have been used in military settings and by Emergency Medical Services; however, there is strong evidence in the literature supporting their use by non-medical personnel. [7][8][9][10][11][12][13] To spread awareness about the importance of using antihemorrhagic devices, in 2015, the American College of Surgeons (ACS; Chicago, Illinois USA) launched the Stop the Bleed campaign. 14,15 Its main aim is to train bystanders to act as immediate responders and treat massive external bleeding in emergency settings.…”

Section: Introductionmentioning

confidence: 99%

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The Certification Matters: A Comparative Performance Analysis of Combat Application Tourniquets versus Non-Certified CAT Look-Alike Tourniquets

Lagazzi,

Ballardini,

Drogo

et al. 2023

Prehosp. Disaster med.

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Introduction:The Stop the Bleed campaign provided civilians with tourniquet application training and increased the demand for tourniquets among the general population, which led to the development of new commercially available devices. However, most widely available tourniquets have not undergone testing by regulatory bodies and their efficacy remains unknown.Study Objective:This study aimed to compare the efficacy and performance of Combat Application Tourniquets (CAT) versus uncertified tourniquets.Methods:This study compared 25 CAT with 50 commercially available “look-alike” tourniquets (LA-TQ) resembling the CAT. The CAT and the LA-TQ were compared for cost, size, and tested during one-hour and six-hour applications on a manikin’s leg. The outcomes were force applied, force variation during the application, and tourniquet rupture rate.Results:The LA-TQ were cheaper (US$6.07 versus US$27.19), shorter, and had higher inter-device variability than the CAT (90.1 [SE = 0.5] cm versus 94.5 [SE = 0.1] cm; P <.001). The CAT applied a significantly greater force during the initial application when compared to the LA-TQ (65 [SE = 3] N versus 14 [SE = 1] N; P <.001). While the initial application force was maintained for up to six hours in both groups, the CAT group applied an increased force during one-hour applications (group effect: F [1,73] = 105.65; P <.001) and during six-hour applications (group effect: F [1,12] = 9.79; P = .009). The rupture rate differed between the CAT and the LA-TQ (0% versus 4%).Conclusion:The LA-TQ applied a significantly lower force and had a higher rupture rate compared to the CAT, potentially affecting tourniquet performance in the context of public bleeding control. These findings warrant increased layperson education within the framework of the Stop the Bleed campaign and further investigations on the effectiveness of uncertified devices in real-world applications.

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Section: Discussionmentioning

confidence: 38%

Section: Introductionmentioning

confidence: 99%

The Certification Matters: A Comparative Performance Analysis of Combat Application Tourniquets versus Non-Certified CAT Look-Alike Tourniquets

Lagazzi,

Ballardini,

Drogo

et al. 2023

Prehosp. Disaster med.

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“…Early tourniquet application to achieve hemorrhage control is well supported in the military literature with multiple studies demonstrating the prevention of shock and improvement in survival without increasing limb complication rates. [3][4][5][6]18,19 Tourniquet use for MET in the civilian population has seen a concomitant renewed interest. [20][21][22][23][24] Several early studies focused on the safety of civilian tourniquet use, finding that PH tourniquets used for civilian extremity trauma had a low complication rate and high potential for benefit.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

Schroll

Smith

Alabaster

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been conducted to date. The objective of this study was to evaluate outcomes in MET patients with prehospital tourniquet use. We hypothesized that prehospital tourniquet use in MET decreases the incidence of patients arriving to the trauma center in shock. METHODS:Data were collected prospectively for adult patients with MET at 26 Level I and 3 Level II trauma centers from 2015 to 2020. Limbs with tourniquets applied in the prehospital setting were included in the tourniquet group and limbs without prehospital tourniquets were enrolled in the control group. RESULTS:A total of 1,392 injured limbs were enrolled with 1,130 tourniquets, including 962 prehospital tourniquets. The control group consisted of 262 limbs without prehospital tourniquets and 88 with tourniquets placed upon hospital arrival. Prehospital improvised tourniquets were placed in 42 patients. Tourniquets effectively controlled bleeding in 87.7% of limbs. Tourniquet and control groups were similarly matched for demographics, Injury Severity Score, and prehospital vital signs ( p > 0.05). Despite higher limb injury severity, patients in the tourniquet group were less likely to arrive in shock compared with the control group (13.0% vs. 17.4%, p = 0.04). The incidence of limb complications was not significantly higher in the tourniquet group ( p > 0.05). CONCLUSION:This study is the first prospective analysis of prehospital tourniquet use for civilian extremity trauma. Prehospital tourniquet application was associated with decreased incidence of arrival in shock without increasing limb complications. We found widespread tourniquet use, high effectiveness, and a low number of improvised tourniquets. This study provides further evidence that tourniquets are being widely and safely adopted to improve outcomes in civilians with MET.

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“…4,29 The US military took a different approach by training all servicepersons in tourniquet use and supplying tourniquets to them. [30][31][32][33] Limb ischemia from tourniquet use is important because skeletal muscle, the main tissue of the limbs, is the tissue type most sensitive to ischemic duration. Muscle ischemia can cause muscle cell damage, myonecrosis, myoglobinemia, kidney failure, limb loss by surgical amputation, and death.…”

Section: Safety Of Tourniquet Usementioning

confidence: 99%

Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

Kragh

Dubick

2017

Wilderness & Environmental Medicine

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The purpose of this review is to summarize tourniquet science for possible translation to wilderness settings. Much combat casualty data has been studied since 2005, and use of tourniquets in the military has changed from a last resort to first aid. The US Government has made use of tourniquets a health policy aimed to improve public access to bleeding control items. International authorities believe that education in first aid should be universal, as all can and should learn first aid. The safety record of tourniquet use is mixed, but users are reliably safe if trained well. Well-designed tourniquets can reliably attain bleeding control, may mitigate risk of shock progression, and may improve survival rates, but conclusive proof of a survival benefit remains unclear in civilian settings. Even a war setting has a bias toward survivorship by sampling mostly survivors in hospitals. Improvised tourniquets are less reliable than well-designed tourniquets but may be better than none. The tourniquet model used most often in 2016 by the US military is the Combat Application Tourniquet (C-A-T), and civilians use an array of various models, including C-A-T. Evidence on tourniquet use to date indicates that most uses are safe and effective in civilian settings. Future directions for study relevant to the wilderness setting include consideration of research priorities, study of the burdens of injury or capability gaps in caregiving for various wilderness settings, determination of the skill needs of outdoor enthusiasts and wilderness caregivers, and survey of wilderness medicine stewards regarding bleeding control.

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Optimizing the Use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02

Cited by 44 publications

References 54 publications

The Certification Matters: A Comparative Performance Analysis of Combat Application Tourniquets versus Non-Certified CAT Look-Alike Tourniquets

The Certification Matters: A Comparative Performance Analysis of Combat Application Tourniquets versus Non-Certified CAT Look-Alike Tourniquets

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma

Bleeding Control With Limb Tourniquet Use in the Wilderness Setting: Review of Science

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