Improvised Tourniquet Research Articles

Improvised tourniquets can cease blood flow in a crisis situation

Abstract: Introduction: In a crisis, such as an active shooter situation, the use of a tourniquet or tourniquets may be necessary for the preservation of life. Depending on the location of the incident and the body sizes of the victims, what materials are used for the band and windlass will ultimately vary. Methods: We used an ultrasound with one improvised tourniquet example of a phone receiver and necktie, which one could arguably find in places including but not limited to a school, healthcare facility, shopping mall, and sports arena; to prove the concept of blood flow cessation. This IRB-approved study used a gentleman with a height of six feet and a weight of 225 pounds. Results: When the necktie (the improvised band) and the phone receiver (the improvised windlass) were used together as a tourniquet on the forearm of the gentleman, his arterial blood flow stopped, as determined by visual inspection of the ultrasound screen. Conclusion: Though some research indicates improvised tourniquets will fail, this will not likely not stop people from administering bleeding control assistance during a crisis. We wanted to prove the concept that an improvised tourniquet can work at ceasing the flow of blood, thereby not fail. If the proper band and windlass are used, blood flow can be stopped and a life can be saved.

ПЕРВАЯ ПОМОЩЬ ПРИ ТЯЖЕЛОМ НАРУЖНОМ КРОВОТЕЧЕНИИ: АКТУАЛИЗАЦИЯ РЕКОМЕНДАЦИЙ И ПОДХОДОВ К ОБУЧЕНИЮ

The article presents a short literature review of on first aid for severe external bleeding, and analyzes possible approaches to training. The review takes into ac-count the recommendations of the European Resuscitation Council 2021 and the recommendations of the Red Cross and Red Crescent Society 2020 on first aid, resuscitation and education, American Heart Association and American Red Cross Focused Update for First Aid 2020, as well as other recent scientific pa-pers on this topic. New changes in international recommendations in comparison with the previous ones are highlighted, their assessment is given. Special atten-tion is given on the stages of training and the conditions required for it. International recommendations and own experience in external bleeding first aid teaching for non-healthcare professionals and healthcare professional are compared. The key components of the first aid algorithm have been identified. Practical recommendations for assessing the situation and completing the first-aid kit, for training in pressure on the wound, the use of a commercial or improvised tourniquet, pressure and hemostatic bandage are given.

A Comparison of Improvised and Commercially Available Point-of-Wounding Tourniquets in Simulated Traumatic Amputation with Catastrophic Hemorrhage.

Catastrophic hemorrhage is the leading cause of preventable trauma deaths in the military and civilian populations. The use of tourniquets by first responders (medical and nonmedically trained) is supported and has the potential to save lives if applied correctly. We sought to examine the use of 5 tourniquets: 1 improvised and 4 commercially available tourniquets to investigate the time taken to stop simulated bleeding and to secure the device; evidence of rebleeding when the "blood pressure" was restored and to gain qualitative feedback on their application. Four commercially available tourniquets (Combat Application Tourniquet [C-A-T], Special Operations Forces Tactical Tourniquet - Wide (SOFTT-W), stretch, wrap, and tuck tourniquet [SWAT-T], and the Tourni-key) and an improvised tourniquet (tie & wooden spoon) were tested on a complex silicone simulation model used to replicate catastrophic hemorrhage from a blast injury with above traumatic knee amputation (SAM 4.1 Trauma Simulation Ltd, UK). To limit the user variability, the same investigator applied each tourniquet and each was tested 3 times. No ethical approval was required to conduct this study. None of the devices took longer than 1minute to secure. The C-A-T and SOFTT-W were quickest to occlude and secure. Although the Tourni-key took longer statistically, this was unlikely to be a clinically important difference. Compared to the others, the SOFTT-W rebled on 2 out of 3 applications. The improvised tourniquet had an obvious ligature effect because of its narrowness, followed by the Tourni-key. This effect was least evident with the SWAT-T; however, particular care was needed to ensure it was safely secured as it was slippery when wet. All tourniquets tested were effective and swift to apply. The Tourni-key's antipinch card seems helpful in reducing local pain under the windlass. Reinspection for rebleeding is important and should be routinely performed irrespective of the device. The width of the SWAT-T may be beneficial, thereby, reducing the risk of crush injury.

The safety and efficacy of improvised tourniquets in life-threatening hemorrhage: a systematic review.

The increased incidence of mass casualty incident (MCI) with penetrating injuries in the civilian setting creates a call for implementing devices, such as a tourniquet (TQ), in civilian first aid. Bystanders could act as immediate responders after an MCI in order to prevent a victim from exsanguination using direct pressure or commercial tourniquets (C-TQ). Reports have shown that immediate access to C-TQs was not available and bystanders used objects available at the trauma scene to make an improvised tourniquet (I-TQ). The aim of this systematic review of literature was to summarize the existing literature on designs, efficacy and safety of I-TQs. A systematic review of the literature was performed. Bibliographic databases PubMed, EMBASE.com and Cochrane Library were searched. All types of original studies about I-TQ's were included. Review studies, exempts from textbooks or studies with TQs applied during elective surgeries were excluded. Twenty studies were included. In both simulated experiments and real-life situations, I-TQs outperformed commercial TQs (C-TQ) regarding success rate. Of the I-TQs, the band and windlass design performed most consistently. Although lacking any statistical analysis, there was no reported difference in adverse events between I-TQs and C-TQs. The use of- and training in I-TQ by civilian immediate responders is not recommended because of limited efficacy and safety concerns; direct pressure is a viable alternative. However, I-TQs may save lives when applied correctly with proper objects; therefore, future studies regarding the best design and training in application of effective and safe I-TQs should be encouraged.

The management of acute peripheral arterial bleeding in emergencies: a plastic surgeon’s perspective

Sir, Peripheral arterial bleeding following trauma commonly presents to the emergency department. There is currently no national guideline for achieving haemostasis in the acute setting prior to definitive management. As plastic surgeons, we are often referred patients with uncontrolled bleeding in the accident and emergency (AE the other two said they would apply manual pressure without attempting to dress the wound. Twenty-two described a compression bandage comprising multiple layers of tight bandage around the wrist. The remaining nine described a point pressure dressing, using a solid object to focus the pressure of the bandage over the wound, such as a specimen lid or folded gauze placed over a non-adherent dressing over the wound. Twenty-one clinicians would apply manual pressure directly over the wound with or without a dressing. Surprisingly, only 14 mentioned elevation of the limb and 7 mentioned application of a tourniquet. Several other suggestions were made, such as underrunning the vessel with a suture, applying a surgical clip to the vessel or administering a local anaesthetic containing epinephrine. Although these suggestions can obtain haemostasis, it is preferable to stop bleeding without invasive measures that will potentially traumatise the vessel further endangering viable tissue for repair later, and this is only recommended as a last resort in order to preserve life. Often when faced with an acute traumatic arterial bleed, manual digital pressure is appropriate initially; however, this is impractical over prolonged periods and an appropriate dressing to control the bleeding is required until definitive surgical management is achieved. Rudge [1] et al. described using a specimen pot lid filled with cotton wool, placed over a non-adherent dressing over the wound and bandaged into position, with the bandage twisted over the lid to increase compression. We have also found this technique to be effective. Our management differed as we placed the lid flat side down and bandaged over the lid without twisting the bandage or filling the lid with cotton wool and still found this to be effective. In practice, the specimen lid can be interposed with anything that is relatively firm and can focus the compressive force over the desired point. This allows pressure to be localised to the desired point without compromising distal blood flowwhich commonly occurs with traditional tight bandaging. Our questionnaire identified elevation is not commonly implemented by over half of our cohort. This is easily rectifiable by educating and training staff. Furthermore, a tourniquet can be applied proximally to the wound to prevent blood loss if other methods fail. If provision allows, an improvised tourniquet can be made using a normal blood pressure cuff. This allows an easily applicable and controllable method of * Metin Nizamoglu mnizam@doctors.org.uk

Tourniquet use at the Boston Marathon bombing: Lost in translation.

The Boston Marathon bombing was the first major, modern US terrorist event with multiple, severe lower extremity injuries. First responders, including trained professionals and civilian bystanders, rushed to aid the injured. The purpose of this review was to determine how severely bleeding extremity injuries were treated in the prehospital setting in the aftermath of the Boston Marathon bombing. A database was created and populated by all the Boston Level I trauma centers following the Boston Marathon bombing. Data regarding specific injuries, extremities affected, demographics, prehospital interventions (including tourniquet types), and outcomes were extracted. Of 243 injured, 152 patients presented to the emergency department within 24 hours. Of these 152 patients, there were 66 (63.6% female) experiencing at least one extremity injury, with age ranging from younger than 15 years to 71 years, and with a median Injury Severity Score (ISS) of 10 (range, 1-38). Of the 66 injured patients, 4 had upper limbs affected, 56 had injuries on the lower limbs only, and 6 had combined upper and lower limbs affected. The extremity Abbreviated Injury Scale (AIS) scores had a median of 3 (range, 1-4). There were 17 lower extremity traumatic amputations in 15 patients. In addition, there were 10 patients with 12 lower extremities experiencing major vascular injuries. Of 66 injured patients, 29 patients had recognized extremity exsanguination at the scene. In total, 27 tourniquets were applied: 16 of 17 traumatic amputations, 5 of 12 lower extremities with major vascular injuries, and 6 additional limbs with major soft tissue injury. All tourniquets were improvised, and no commercial, purpose-designed tourniquets were identified. Among all 243 patients, mortality was 0%. After the Boston Marathon bombings, extremity exsanguination at the point of injury was either left untreated or treated with an improvised tourniquet in the prehospital environment. An effective, prehospital extremity hemorrhage control posture should be translated to all civilian first responders in the United States and should mirror the military's posture toward extremity bleeding control. The prehospital response to extremity exsanguination after the Boston Marathon bombing demonstrates that our current practice is an approach, lost in translation, from the battlefield to the homeland. Epidemiologic study, level V.

Evaluation of emergency tourniquets for prehospital use in China

Objective Massive hemorrhage is life-threatening during armed conflicts. Tourniquets are important medical devices used to reduce severe bleeding in trauma. The aim of this study was to empirically evaluate the current tourniquets used in China and provide information to emergency nurses in selecting the appropriate tourniquet. Methods Five tourniquets were self-applied by 20 healthy participants. The blood flow distal to the tourniquet site was assessed using vascular Doppler ultrasound. Application time, pain, numbness, and other parameters were evaluated. Results The bladder tourniquet and windlass tourniquet effectively occluded arterial blood flow with success rates higher than 75% in both the upper and lower extremities. The Cargo-strap was the fastest to apply, taking (7.22±2.30) s for the upper extremity and (6.48±2.40) s for the lower extremity. The rubber tube was the most painful, and the improvised tourniquet was the least efficient. The success rates were higher in the lower extremity than in the upper extremity ( P<0.05, X 2=5.714). Conclusions The bladder tourniquet and the windlass tourniquet are efficient tourniquets, although the windlass is superior with respect to portability and pain. The Cargo-strap and rubber tourniquets have several disadvantages that reduce their suitability for field use. The improvised tourniquet is not recommended because of low efficiency and severe pain during implementation.

Use of a Tourniquet After a Gunshot Wound to the Thigh

A 46-year-old man was shot in his right thigh during an altercation outside a bar. He sustained significant tissue damage and was actively bleeding from the wound. A bystander used a leather belt as an improvised tourniquet. The paramedics noted significant blood loss at the scene. The patient’s systolic blood pressure was 70 mm Hg but improved with crystalloid infusion. The paramedics kept the tourniquet in place and brought the patient by medical helicopter to the trauma center. On arrival, his blood pressure was 127/70 mm Hg and his hematocrit level was 27.6%.

Evaluation of Possible Tourniquet Systems for Use in the Canadian Forces

Hemorrhage from extremity wounds is the leading cause of preventable death on the battlefield. Tourniquets have been identified as the most reasonable option for controlling life threatening extremity hemorrhage in the tactical phase of an operation. The purpose of this trial was to determine which tourniquet systems are effective under simulated combat conditions and make recommendations to the Canadian Forces (CF) on an approach to tourniquet use. 5 tourniquet systems were tested: Self Applied Tourniquet System (SATS); One-Handed Tourniquet (OHT); tie & cravat Improvised Tourniquet (IT); pneumatic Emergency Medical Tourniquet (EMT); and latex surgical tubing (ST). On June 25, 2004, ten junior medics from 1 Field Ambulance volunteered for the study. They were divided into five groups of two and rotated through all tourniquets. Each group was timed on the speed of application, and effectiveness of the tourniquets on the lower limbs was determined by a Doppler probe and loss of palpable pulses. Subjective analysis by questionnaire was used to determine ease of use, durability, portability, patient comfort, and preference. Occlusion of the posterior tibial pulse, as measured by Doppler flow, occurred 0-10% of the time with the OHT, 40-50% with the SATS and IT, 70-80% with the EMT, and 90% with the ST. The presence of winter clothing did not change the effectiveness of the tourniquets. The OHT, SATS, IT, and EMT took an average of 30-40 seconds to apply while the ST took only 24 seconds. From most painful to least were: the IT (severe pain-could not tolerate); ST and SATS (moderate-severe pain); OHT (minor-moderate pain); and EMT (no pain-minor discomfort). The most effective tourniquets were the EMT and ST. The ST is also the lightest, fastest, easiest to learn, and the cheapest but it causes a lot of pain and presumably, local tissue damage. ST can be issued to every soldier with a minimum of training and used effectively in the "Care Under Fire" phase. The EMT, which causes the least pain and is equally effective, can be applied during the "Tactical Field Care" phase by the medic to replace the surgical tubing. Fine adjustments can be made to the EMT, which allows the medic to safely deflate the device, assess the wound, determine if a tourniquet is required, and re-inflate quickly if necessary.