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The Efficacy of Novel Commercial Tourniquet Designs for Extremity Hemorrhage Control: Implications for Spontaneous Responder Every Day Carry

Published online by Cambridge University Press:  13 April 2020

Joshua Ellis ,
Melissa M. Morrow ,
Alec Belau ,
Luke S. Sztajnkrycer ,
Jeffrey N. Wood ,
Tobias Kummer  and
Matthew D. Sztajnkrycer Open the ORCID record for Matthew D. Sztajnkrycer [Opens in a new window]
Joshua Ellis
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
Melissa M. Morrow
Affiliation:
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MinnesotaUSA
Alec Belau
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
Luke S. Sztajnkrycer
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
Jeffrey N. Wood
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
Tobias Kummer
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
Matthew D. Sztajnkrycer*
Affiliation:
Department of Emergency Medicine, Mayo Clinic, Rochester, MinnesotaUSA
*
Correspondence: Matthew D. Sztajnkrycer, MD, PhD, Professor of Emergency Medicine, Mayo Clinic GE-GR-G410, 200 1st Street SW, Rochester, Minnesota55905USA, E-mail: [email protected]
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Abstract

Introduction:

Tourniquets (TQs) save lives. Although military-approved TQs appear more effective than improvised TQs in controlling exsanguinating extremity hemorrhage, their bulk may preclude every day carry (EDC) by civilian lay-providers, limiting availability during emergencies.

Study Objective:

The purpose of the current study was to compare the efficacy of three novel commercial TQ designs to a military-approved TQ.

Methods:

Nine Emergency Medicine residents evaluated four different TQ designs: Gen 7 Combat Application Tourniquet (CAT7; control), Stretch Wrap and Tuck Tourniquet (SWAT-T), Gen 2 Rapid Application Tourniquet System (RATS), and Tourni-Key (TK). Popliteal artery flow cessation was determined using a ZONARE ZS3 ultrasound. Steady state maximal generated force was measured for 30 seconds with a thin-film force sensor.

Results:

Success rates for distal arterial flow cessation were 89% CAT7; 67% SWAT-T; 89% RATS; and 78% TK (H 0.89; P = .83). Mean (SD) application times were 10.4 (SD = 1.7) seconds CAT7; 23.1 (SD = 9.0) seconds SWAT-T; 11.1 (SD = 3.8) seconds RATS; and 20.0 (SD = 7.1) seconds TK (F 9.71; P <.001). Steady state maximal forces were 29.9 (SD = 1.2) N CAT7; 23.4 (SD = 0.8) N SWAT-T; 33.0 (SD = 1.3) N RATS; and 41.9 (SD = 1.3) N TK.

Conclusion:

All novel TQ systems were non-inferior to the military-approved CAT7. Mean application times were less than 30 seconds for all four designs. The size of these novel TQs may make them more conducive to lay-provider EDC, thereby increasing community resiliency and improving the response to high-threat events.

Keywords

every day carryhemorrhage controlmass-casualty incidentspontaneous respondertourniquet
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 3 , June 2020 , pp. 276 - 280
Copyright
© World Association for Disaster and Emergency Medicine 2020

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References

Kauvar, DS, Leferin, R, Wade, CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma. 2006;60(6 Suppl):S3–11.CrossRefGoogle ScholarPubMed
Eastridge, BJ, Mabry, RL, Seguin, P, et al.Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–S437.CrossRefGoogle ScholarPubMed
Kragh, JF Jr, Littrel, ML, Jones, JA, et al.Battle casualty survival with emergency tourniquet use to stop limb bleeding. J Emerg Med. 2011;41(6):590–597.CrossRefGoogle ScholarPubMed
Beekley, AC, Sebesta, JA, Blackbourne, LH, et al.Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma. 2008;64(2 Suppl):S28–S37.CrossRefGoogle ScholarPubMed
Callaway, DW, Robertson, J, Sztajnkrycer, MD. Law enforcement applied tourniquets: a case series of life-saving interventions. Prehosp Emerg Care. 2015;19(2):320–327.CrossRefGoogle ScholarPubMed
King, DR. Initial care of the severely injured patient. N Engl J Med. 2019;380(8):763–770.10.1056/NEJMra1609326CrossRefGoogle ScholarPubMed
Elkbuli, A, Dowd, B, Casin, A, et al.Stop the bleed training outreach initiatives targeting high school students: it takes a community to save a life. Am J Emerg Med. 2019;37(10):1985–1987.CrossRefGoogle Scholar
Lei, R, Swartz, MD, Harvin, JA, et al.Stop the bleed training empowers learners to act to prevent unnecessary hemorrhagic death. Am J Surg. 2019;217(2):368–372.CrossRefGoogle ScholarPubMed
Loftus, A, Pynn, H, Parker, P. Improvised first aid techniques for terrorist attacks. Emerg Med J. 2018;35(8):516–521.CrossRefGoogle ScholarPubMed
Kragh, JF Jr, Walters, TJ, Baer, DG, et al.Practical use of emergency tourniquets to stop bleeding in major limb trauma. Trauma. 2008;64(2 Suppl):S38–S50.Google ScholarPubMed
Stiles, CM, Cook, C, Sztajnkrycer, MD. A descriptive analysis of tactical casualty care interventions performed by law enforcement personnel in the State of Wisconsin, 2010-2015. Prehosp Disaster Med. 2017;32(3):284–288.CrossRefGoogle Scholar
Goodwin, T, Moore, KN, Pasley, JD, Tronsco, R Jr, Levy, MJ, Coolsby, C. From the battlefield to main street: tourniquet acceptance, use, and translation from the military to civilian settings. Trauma Acute Care Surg. 2019;87(1S Suppl 1):S35–S39.CrossRefGoogle ScholarPubMed
Holcomb, JB, McMullin, NR, Pearse, L, et al.Causes of death in US special operations forces in the global war on terrorism. Ann Surg. 2007;245:986–991.CrossRefGoogle Scholar
King, DR, Larenrzakis, A, Ramly, EP; Boston Trauma Collaborative. Tourniquet use at the Boston Marathon bombing: lost in translation. J Trauma Acute Care Surg. 2015;78(3):594–599.CrossRefGoogle ScholarPubMed
Ramly, EP, Runyan, G, King, DR. The state of the union: nationwide absence of uniform guidelines for the prehospital use of tourniquets to control extremity exsanguination. J Trauma Acute Care Surg. 2016;80(5):787–791.CrossRefGoogle ScholarPubMed
Ross, EM, Redman, TT, Mapp, JG, et al.Stop the bleed: the effect of hemorrhage control education on laypersons’ willingness to respond during a traumatic medical emergency. Prehosp Disaster Med. 2018;33(2):127–132.CrossRefGoogle ScholarPubMed
Drury, J, Carter, H, Cocking, C, Ntontis, E, Tekin Guven, S, Amlot, R. Facilitating collective psychosocial resilience in the public in emergencies: twelve recommendations based on the Social Identity Approach. Front Public Health. 2019;7:141.CrossRefGoogle ScholarPubMed
Drury, J, Cocking, C, Reicher, S. Everyone for themselves? A comparative study of crowd solidarity among emergency survivors. Br J Soc Psychol. 2009;48(pt3):487–506.CrossRefGoogle ScholarPubMed
Cocking, C. The role of “zero responders” during 7/7: implications for the emergency services. Int J Emerg Services. 2013;2:79–93.CrossRefGoogle Scholar
Kellermann, AL, Peleg, K. Lessons from Boston. N Engl J Med. 2013;368(21):1956–1957.CrossRefGoogle ScholarPubMed
Dhillon, NK, Dodd, BA, Hotz, H, et al.What happens after a Stop the Bleed class? The contrast between theory and practice. J Surg Ed. 2018;76(2):446–452.CrossRefGoogle ScholarPubMed
Zwislewski, A, Nanassy, AD, Meyer, LK, et al.Practice makes perfect: the impact of Stop the Bleed training on hemorrhage control knowledge, wound packing, and tourniquet application in the workplace. Injury. 2019;50(4):864–868.CrossRefGoogle ScholarPubMed
Ross, EM, Mapp, JG, Redman, TT, Brown, DJ, Kharod, CU, Wampler, DA. The tourniquet gap: a pilot study of the intuitive placement of three tourniquet types by laypersons. J Emerg Med. 2018;54(3):307–314.CrossRefGoogle ScholarPubMed
Goolsby, C, Chen, E, Branting, A, et al.Analysis of layperson tourniquet application using a novel color-coded device. Disaster Med Public Health Prep. 2016;10(2):274–280.CrossRefGoogle ScholarPubMed
Dennis, A, Bajani, F, Schlanser, V, et al.Missing expectations: windlass tourniquet use without formal training yields poor results. J Trauma Acute Care Surg. 2019;87(5):1096–1103.CrossRefGoogle ScholarPubMed
Tsur, AM, Binyamin, Y, Koren, L, Ohayon, S, Thompson, P, Glassberg, E. High tourniquet failure rates among non-medical personnel do not improve with tourniquet training, including combat stress inoculation: a randomized controlled trial. Prehosp Disaster Med. 2019;34(2):282–287.CrossRefGoogle Scholar