No Slackers in Tourniquet Use to Stop Bleeding
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Background Tourniquets on casualties in war have been loose in 4 9 of uses, and such slack risks death from uncontrolled bleeding. A tourniquet evidence gap persists if there is a mechanical slack performance association. Objective The purpose of the present study was to determine the results of tourniquet use with slack in the strap versus no slack before windlass turning, in order to develop best practices. Methods The authors used a tourniquet manikin 254 times to measure tourniquet effectiveness, windlass turns, time to stop bleeding, and blood volume lost at 5 degrees of strap slack 0mm, 25mm, 50mm, 100mm, and 200mm maximum. Results When comparing no slack 0mm to slack any positive amount, there were increases with slack in windlass turns p .0001, 3-fold, time to stop bleeding p .0001, 2-fold, and blood volume lost p .0001, 2-fold. When comparing no slack to 200mm slack, the median results showed an increase in slack for windlass turns p .0001, time to stop bleeding p .0001, and blood volume lost p .0001. Conclusions Any slack presence in the strap impaired tourniquet performance. More slack had worse results. Trainers can now instruct tourniquet users with concrete guidance.
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