The Military Emergency Tourniquet Program: Devices, Designs, and Data
Abstract
Background: Emergency first aid tourniquets are controversial and have changed recently with new research. We, the US military Emergency Tourniquet Program leaders, recovered devices discarded after use in war casualty care. We analyzed emergency tourniquet data from a prospective survey of casualties and their records at a combat support hospital in Baghdad who had tourniquets used at a hospital in Baghdad (NCT00517166 at ClinicalTrials.gov) in order to associate wear and tear patterns, effectiveness rates, and device designs.
Methods: Emergency tourniquets retrieved on the battlefield after clinical use (N=159 for 499 patients who had 862 tourniquets applied on 651 limbs) were evaluated for design traits, wear and tear, and clinical performance.
Results: Early use of emergency tourniquets after major limb trauma was associated with improved survival and only minor morbidity. We found morbidity was minor in light of major survival benefits. If one device did not stop the bleeding, then a wider device or two side-by-side increased effectiveness. Different devices had different components that wear or break depending on use or misuse. When user expectations mismatched device science, problems abounded. When user expectations matched the device science, optimal care was more easily attained.
Conclusions: Users often assumed that optimal use required more force, but optimal use was not synonymous with effective as optimal use required safety. Mechanical effectiveness was essential to optimal use; it was only one of multiple essentials. Users should understand how devices work best in order to attain optimal outcomes. Designs should meet user expectations if scientifically grounded.
