Efficacy of Tourniquets Exposed to the Afghanistan Combat Environment Stored in Individual First Aid Kits Versus on the Exterior of Plate Carriers

Abstract

Between February and May 2010, 1st Battalion, 6th Marines reported a 10% (10/92) breakage rate for tourniquets. One theory suggested was that tourniquets were weakened by exposure to the Afghan environment. Our study was designed to compare three groups of Afghanistan-exposed tourniquets to unexposed tourniquets. The three experimental arms were: (1) Afghan-exposed tourniquets worn on the plate carrier, (2) Afghan-exposed tourniquets carried in the Individual First Aid Kit (IFAK) and wrapped in manufacturer plastic wrapping, and (3) Afghan-exposed tourniquets carried in the IFAK with the manufacturer plastic wrapping removed. The outcome measures of this study were efficacy, breakage, and number of turns required to successfully stop the distal pulse. Tourniquets worn on the plate carrier had an efficacy of 57%, which was significantly lower than the control efficacy rate of 95.2%. When compared to the control arm, there were no significant differences in efficacy between the tourniquets stored in the IFAK with or without manufacturing packaging. No control tourniquets or tourniquets stored in IFAKs broke; however, 46 (12%) of the plate carrier-exposed tourniquets did break. No statistically significant differences were found between the four groups with regard to the median number of turns required to stop the distal pulse.

An Evaluation Concerning Tourniquets Application in a Simulated Tactical Environment

“…[11,13] The use of a personal first aid kit also increases the effectiveness of established tourniquets. [18] There is no doubt that despite disadvantages of tourniquet use, tourniquets greatly increase the chances of survival of victims. [10,17,18,19] The use of tourniquets is not exclusively reserved for military institutions.…”

“…[18] There is no doubt that despite disadvantages of tourniquet use, tourniquets greatly increase the chances of survival of victims. [10,17,18,19] The use of tourniquets is not exclusively reserved for military institutions. Because of the easy and quick access to specialist care, in case of massive hemorrhage in case of civil casualties, assistance is provided in stages, the last of which is the tourniquet application.…”

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

“…The mean sample size of included studies was 55.60 (SD = 130.39, Mdn = 20, IQR = 26) participants; with a mean of 210.91 applications (SD = 304.03, Mdn = 102, IQR = 152). Study sample sizes ranged from 1 participant (Kragh et al, 2019) to 773 participants (Weppner et al, 2013), and total tourniquet applications ranging from 20 individual applications (Peponis et al, 2016) to 1,546 individual applications (Weppner et al, 2013) (Table 1).…”

“…Device failures included mechanical teeth skipping ; windlass, strap or baseplate failure (Beaven et al, 2021) biological, radiological or nuclear (CBRN, or extensive device deformation (Slaven et al, 2015)50, 75, 100, 125, 150, 175 (CAT only. Failure rates were not compared because some devices were used extensively (Slaven et al, 2015) 50, 75, 100, 125, 150, 175 (CAT only, exposed to environmental degradation (Childers et al, 2011;Weppner et al, 2013)1st Battalion, 6th Marines reported a 10% (10/92, and while both of these conditions significantly increased the likelihood of failure, they were not consistently reported in the literature.…”

Should Civilian Pre-Hospital Emergency Care Provision Include Tourniquets for the Management of Uncontrolled Traumatic Haemorrhage?

“…Historically, haemorrhage from extremity injuries account for a significant percentage of preventable trauma deaths (1). The primary function of a tourniquet is to stop life-threatening and uncontrolled external haemorrhage.…”