Occlusion Pressures of Tactical Pneumatic Tourniquet 2".

Background: The Tactical Pneumatic Tournqiuet 2" (TPT2, 5.1cm-wide deflated) allows total average applied pressure measurement, which should be useful toward development of emergency-use limb tourniquet certification devices.

Methods: The TPT2 hand bulb was replaced with stopcocks and syringes, allowing filling with continuous pressure measurement.

Effects of Tourniquet Features on Application Processes Times.

Background: We investigated emergency-use limb tourniquet design features effects on application processes (companion paper) and times to complete those processes (this paper).

Methods: Sixty-four appliers watched training videos then each applied all eight tourniquets: Combat Application Tour- niquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T-Tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop Tourniquet (RST). Application processes times were captured from videos.

Effects of Tourniquet Features on Application Processes.

Background: We investigated emergency-use limb tourniquet design features effects on application processes (this paper) and times to complete those processes (companion paper).

Methods: Sixty-four appliers watched training videos and then each applied all eight tourniquets: Combat Application Tourniquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop™ Tourniquet (RST). Application processes were scored from videos.

Limb Tourniquet Holding Location: Model Results Fail to Translate to Human Results.

Background: During strap pulling, how limb tourniquet sliding is prevented affects secured pressure achievement. Data from model setups indicated moving the Tactical Ratcheting Medical Tourniquet (Tac RMT; m2 inc.) holding loop location could be advantageous regarding strap-pulling pressure achievement.

Pressure Responses of Tourniquet Practice Models to Calibrated Force Applications.

Background: Tourniquet training sometimes involves models, and a certification process is expected to use something other than human limbs; therefore, investigating model- and limb-pressure responses to force application is important.

Methods: Pressure response to force was collected for a 3.8cm-wide nonelastic strap and a 10.

Limb Position Change Affects Tourniquet Pressure.

Background: Limb position changes are likely during transport from injury location to definitive care. This study investigated passive limb position change effects on tourniquet pressure and occlusion.

Methods: Triplicate buddy-applied OMNA® Marine Tourniquet applications to Doppler-based occlusion were done to sitting and laying supine mid-thigh (n=5) and sitting mid-arm (n=3).

OMNA Marine Tourniquet Self-Application.

Background: The OMNA Marine Tourniquet is a 5.1cm-wide, simple redirect buckle, hoop-and-loop secured, ratcheting tourniquet designed for storage and use in marine environments. This study evaluated self-application effectiveness and pressures.

Clothing Effects on Limb Tourniquet Application.

Background: Sometimes tourniquets are applied over clothing. This study explored clothing effects on pressures and application process.

Methods: Generation 7 Combat Application Tourniquets (C-A-T7), Generation 3 SOF® Tactical Tourniquets-Wide (SOFTTW), Tactical Ratcheting Medical Tourniquets (Tac RMT), and Stretch Wrap And Tuck Tourniquets (SWATT) were used with different clothing conditions (Bare, Scrubs, Uniform, Tights) mid-thigh and on models (ballistic gel and yoga mats).

Characterizing a System for Measuring Limb Tourniquet Pressures.

Background: Pressure is an important variable in emergency use limb tourniquet science. This study characterizes one system for measuring tourniquet-applied pressure.

Methods: A neonatal blood pressure cuff bladder was inflated to target pressures over atmospheric.

Review: Getting Tourniquets Right = Getting Tourniquets Tight.

Tourniquet application to stop limb bleeding is conceptually simple, but optimal application technique matters, generally requires training, and is more likely with objective measures of correct application technique. Evidence of problems with application techniques, knowledge, and training can be ascertained from January 2007 to August 2018 PubMed peer-reviewed papers and in Stop The Bleed-related videos. Available data indicates optimal technique when not under fire involves application directly on skin.

Best Tourniquet Holding and Strap Pulling Technique.

Background: Appropriate strap pressure before tightening-system use is an important aspect of nonelastic, limb tourniquet application.

Methods: Using different two-handed techniques, the strap of the Generation 7 Combat Application Tourniquet (C-A-T7), Tactical Ratcheting Medical Tourniquet (Tac RMT), Tactical Mechanical Tourniquet (TMT), Parabelt, and Generation 3 SOF® Tactical Tourniquet-Wide (SOFTTW) was secured mid-thigh by 20 appliers blinded to pressure data and around a thigh-sized ballistic gel cylinder by gravity and 23.06kg.

Masimo Perfusion Index Versus Doppler for Tourniquet Effectiveness Monitoring.

Background: In addition to a plethysmograph, Masimo pulse oximeters display a Perfusion Index (PI) value. This study investigated the possible usefulness of PI for monitoring limb tourniquet arterial occlusion.

Methods: Tactical Ratcheting Medical Tourniquets were applied to the thighs of 15 subjects.

From Pull to Pressure: Effects of Tourniquet Buckles and Straps.

Background: Limb tourniquet pressures > 100 mmHg before tightening system use eases achieving arterial occlusion, minimizes tightening system problems, and probably minimizes discomfort. This study examined effects of buckle and strap features on converting pulling force to strap pressure.

Study Design: Twenty-two buckle and strap combinations were evaluated using a thigh-diameter, ballistic gel cylinder and 3 thighs.

Effects of Distance Between Paired Tourniquets.

Background: In practice, the distance between paired tourniquets varies with unknown effects.

Methods: Ratcheting Medical Tourniquets were applied to both thighs of 15 subjects distally (fixed location) and proximally (0, 2, 4, 8, 12cm gap widths, randomized block). Applications were pair, single distal, single appropriate proximal.

Effectiveness of Pulse Oximetry Versus Doppler for Tourniquet Monitoring.

Background: Pulse oximeters are common and include arterial pulse detection as part of their methodology. The authors investigated the possible usefulness of pulse oximeters for monitoring extremity tourniquet arterial occlusion.

Methods: Tactical Ratcheting Medical Tourniquets were tightened to the least Doppler-determined occluding pressure at mid-thigh or mid-arm locations on one limb at a time on all four limbs of 15 volunteers.

Significant Pressure Loss Occurs Under Tourniquets Within Minutes of Application.

Background: Pressure decreases occur after tourniquet application, risking arterial occlusion loss. Our hypothesis was that the decreases could be mathematically described, allowing creation of evidence-based, tourniquet-reassessment- time recommendations.

Methods: Four tourniquets with width (3.

Pressures Under 3.8cm, 5.1cm, and Side-by-Side 3.8cm-Wide Tourniquets.

Background: Applications of wider tourniquet are expected to occlude arterial flow at lower pressures. We examined pressures under 3.8cm-wide, 5.

Different Width and Tightening System: Emergency Tourniquets on Distal Limb Segments.

Background: Tourniquets are used on distal limb segments. We examined calf and forearm use of four thigh-effective, commercial tourniquets with different widths and tightening systems: 3.8 cm windlass Combat Application Tourniquet® (CAT, combattourrniquet.

Initial tourniquet pressure does not affect tourniquet arterial occlusion pressure.

Background: Effective nonelastic strap-based tourniquets are typically pulled tight and friction or hook-and-loop secured before engaging a mechanical advantage system to reach arterial occlusion pressure. This study examined the effects of skin surface initial secured pressure (Friction Pressure) on the skin surface pressure applied at arterial occlusion (Occlusion Pressure) and on the use of the mechanical advantage system.

Methods: Combat Application Tourniquets(®) (CATs; combattourniquet.

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

Background: The primary study objectives were to gather information concerning the tourniquet knowledge, experience, training, protocols, preferences, and equipment of civilian prehospital providers.

Methods: This is a survey of 151 prehospital care providers.

Results: Survey respondents included 27 basic, 1 intermediate, and 75 paramedic emergency medical technicians; 1 registered nurse; 4 firefighters without medical certifications; 2 respondents not yet certified; and 1 respondent not listing certifications.

Tourniquet pressures: strap width and tensioning system widths.

Background: Pressure distribution over tourniquet width is a determinant of pressure needed for arterial occlusion. Different width tensioning systems could result in arterial occlusion pressure differences among nonelastic strap designs of equal width.

Methods: Ratcheting Medical Tourniquets (RMTs; m2 inc.

Tourniquets and occlusion: the pressure of design.

Unlabelled: Nerve injuries result from tourniquet pressure. The objective was to determine arterial occlusion and completion pressures with the 3.8-cm-wide windlass Combat Application Tourniquet (CAT) and the 10.

Stretch and wrap style tourniquet effectiveness with minimal training.

Unlabelled: The objective was to determine if proper application of the Stretch, Wrap, and Tuck Tourniquet (SWAT-T) would stop arterial flow and would occur with minimal training.

Methods: Fifteen undergraduates watched a 19 second video three times, practiced twice, and applied the tourniquet to volunteers at 10 locations: 3 above the elbow or knee and 2 below.

Results: Successful occlusion (60 second Doppler signal elimination) was more frequent than proper stretch (96 versus 75), more frequent on arms than legs (59 versus 37), and achieved before completed application (16 +/- 8 versus 33 +/- 8 seconds; each p < 0.