The Military Emergency Tourniquet Program’s Lessons Learned With Devices and Designs

Abstract

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.

What do the people who transport trauma patients know about tourniquets?

“…3,30 Lack of knowledge is an important barrier to EMS incorporating appropriate tourniquets into their trauma patient care tools 29 and is also a barrier to best tourniquet use.…”

An evaluation of combat application tourniquets on training military personnel: changes in application times and success rates in three successive phases

“…They showed that self-applied CAT, researcher-applied CAT and EMT occluded popliteal flow in 16.6%, 8.3% and 75% of subjects, respectively. In 2011, Kragh et al 6 compared seven different tourniquet designs and emphasised the vital role of training, which should include pitfalls and pearls.…”

“…Concerns centre on the ability of the CAT to control haemorrhage when applied at mid-thigh level and its effectiveness rate has been reported to range between 8.3% and 100% 2–5. The variation may be attributed to different tourniquet education and training levels of researchers, participants, combat medics, wounded soldiers and also the combat environment 2 5 6. Despite the practicality of the device, this huge variation remains largely unexplained.…”

Use of Advanced Bleeding Control Mechanisms in Athletic Training: A Shift in the Thought Process of Prehospital Care—Part 1: Tourniquets

“…Tourniquets using a wider straps or cuffs help to distribute pressure more evenly and produce lower pressure gradients, 31 are more likely to control hemorrhaging and less likely to cause damage to underlying tissue, and reduce pain compared with narrower straps and bands. 28 Practicing tourniquet application in the prehospital or educational setting requires very little equipment-normally just a device and possibly an educational model. Devices range in price from $2.75 to $45.00 and are obviously contingent on the features attached to the unit as well as the quality of the device (Table 6).…”

“…simple, lightweight, compact, and of a rugged design to withstand a multitude of environments 27,28 and should be applied before the signs of shock are evident. 14,16 In terms of device effectiveness with placement, an awareness of application to the lower extremity may present anatomical challenges due to the presence of two bones.…”