Clothing Effects on Limb Tourniquet Application

Wall, Piper; Buising, Charisse; Hingtgen, Emma; Smith, Hailey; Renner, Catherine Hackett

doi:10.55460/2cxr-1uvj

Cited by 5 publications

(8 citation statements)

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“…An interaction of the tourniquet surface texture with these layers seems plausible but cannot be quantified. Low friction surfaces have the potential risk of tourniquet dislocation distally towards the slimmer portion of the limb due to strap sliding [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is little data on the placement of tourniquets over winter clothing. Several studies evaluated the application of tourniquets over clothing, mainly over combat trousers and CBRN trousers, but only one study analysed a winter warfare configuration [ 7 , 11–13 ]. There was no significantly increased failure rate in the winter warfare configuration compared to the control group [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…There was no significantly increased failure rate in the winter warfare configuration compared to the control group [ 13 ]. Two studies recorded recipient discomfort and pain and found that application over clothing was less painful, presumably due to less skin pinching [ 7 , 12 ]. This can be viewed as an advantage since pain can be an indirect indication of pressure damage.…”

Section: Discussionmentioning

confidence: 99%

“…In general, the application of the tourniquet appears to be more tolerable in the injured patient with the clothing layers providing some form of padding [ 12 ]. Two of those studies compared the CAT with the SOFTT [ 7 , 13 ]. They found that the CAT was significantly more effective, generated more pressure and had less applier inability with closing the tourniquet over various clothing setups.…”

Section: Discussionmentioning

confidence: 99%

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

Lechner

Beres

Oberst

et al. 2023

International Journal of Circumpolar Health

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Lechner

Beres

Oberst

et al. 2023

International Journal of Circumpolar Health

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“…Some studies reported that devices had never been used (Childers et al, 2011)a previously exposed tourniquet was tested on one thigh of each subject, while an unexposed tourniquet was tested on the opposite thigh. We recorded tourniquet efficacy (absence of distal pedal pulse for at least 30 seconds, other studies used devices that had been used extensively (over one hundred previous applications) (Wall et al, 2020) or times prior to the study and these device experience? differences may have affected performance.…”

Section: Participant Datamentioning

confidence: 99%

Comparison Of Non-clinical Tourniquet Research for Appliance Superiority & Tolerance (CONTRAST)

Picard

O'Dochartaigh²,

Bakal³

et al. 2022

CJEN

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BACKGROUND: Tourniquets are effective tools to manage life-threatening extremity hemorrhage. Commercial devices are recommended over improvised ones; however, mass casualty incidents and austere environments may prevent access to commercial devices. The aim of this review is to systematically search and meta-analyze commercial and improvised tourniquets: arterial occlusion, application speed, and patient tolerance. METHODS: We searched MEDLINE, Embase, CINAHL, Cochrane Library, SPORTDiscus, and ProQuest Dissertations & Theses Global using controlled terms; without date limits. Manikin, animal, and operative studies were excluded. Tourniquet devices were pooled by design and compared. Data regarding provider training and experience, recipient anthropometrics, application site, ease of application, speed, tolerance, and device efficacy were examined. RESULTS: 5169 studies were screened. The 36 included studies were prospective trials on healthy volunteers and published between 2000 and 2021. There were 8205 unique tourniquet applications to 1921 subjects using 23 unique commercial and improvised devices. Median sample size of included studies was 20 (IQR 26) participants, ranging from 1 to 773 participants; and 102 (IQR=152) applications ranging from 20 individual applications to 1546 unique applications. The most commonly assessed outcomes were: effectiveness (n=30), pain (n=18), speed of application (n=13), and amount of mechanical advantage (ex. Windlass turns) required (n=13). Male participants outnumbered females 1,414 to 169, mean age ranged from 21 to 45 years of age. Devices were pooled into 5 categories according to mechanical advantage mechanism: elastic, friction, mechanical, pneumatic, and windlass. Initial hemostasis was achieved in 95% of upper extremity placements (CI=0.89-0.98, p= 0.02), and 88% of mid-thigh applications (CI=0.78-0.94, p>0.01), in both groups pneumatic and mechanical tourniquet devices had the highest rates of success, with friction and elastic devices having the lowest rates of success. Meta-analysis showed that mechanical and pneumatic advantage systems had superior rates of hemostasis, ease of use, and pain tolerance scores. Due to study heterogeneity, we could not determine which devices were the fastest to apply. The overall risk of bias assessment for included studies found the certainty of studies ranged from moderate to critical. CONCLUSION: In pre-clinical studies mechanical and pneumatic advantage systems appear to be the superior tourniquet design. Due to the low certainty of evidence and non-randomizable nature of traumatic injury, pre-clinical tourniquet devices will likely continue to be tested on well volunteers. Adoption of a minimum data set, agreed upon definitions for testable metrics, and a standardized experimental design could improve the comparability and quality of future tourniquet device studies.

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Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members

Yánez Benñitez,

Lorente-Aznar,

Labaka

et al. 2023

Disaster med. public health prep.

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Search and rescue teams and Antarctic research groups use protective cold-water anti-exposure suits (AES) when cruising on Zodiacs. Extremity tourniquet (ET) self-application (SA) donned with AESs has not been previously studied. Our study therefore assessed the SA of 5 commercial ETs (CAT, OMNA, RATS, RMT, and SWAT-T) among 15 volunteers who donned these suits. Tourniquet‘s SA ability, ease of SA, tolerance, and tourniquet preference were measured. All ETs tested were self-applied to the upper extremity except for the SWAT, which was self-applied with the rest to the lower extremity. Ease- of- SA mean values were compared using the Friedman and Durbin-Conover post hoc tests (P < 0.001). Regarding the upper extremity, OMNA achieved the highest score of 8.5 out of 10, while RMT, and SWAT received lower scores than other options (P < 0.001). For lower extremities, SWAT was found to be inferior to other options (P < 0.01). Overall, OMNA was the best performer. The RATS showed significantly lower tolerance than the other groups in repeated- measures ANOVA with a Tukey post hoc test (P < 0.01). Additionally, out of the 5 ETs tested, 60% of subjects preferred OMNA. The study concluded that SA commercial ETs are feasible over cold-water anti-exposure suits in the Antarctic climate.

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Clothing Effects on Limb Tourniquet Application

Cited by 5 publications

References 0 publications

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

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

Comparison Of Non-clinical Tourniquet Research for Appliance Superiority & Tolerance (CONTRAST)

Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members

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