The Certification Matters: A Comparative Performance Analysis of Combat Application Tourniquets versus Non-Certified CAT Look-Alike Tourniquets.

INTRODUCTION: The Stop the Bleed campaign provided civilians with tourniquet application training and increased the demand for tourniquets among the general population, which led to the development of new commercially available devices. However, most widely available tourniquets have not undergone testing by regulatory bodies and their efficacy remains unknown. STUDY OBJECTIVE: This study aimed to compare the efficacy and performance of Combat Application Tourniquets (CAT) versus uncertified tourniquets. METHODS: This study compared 25 CAT with 50 commercially available "look-alike" tourniquets (LA-TQ) resembling the CAT. The CAT and the LA-TQ were compared for cost, size, and tested during one-hour and six-hour applications on a manikin's leg. The outcomes were force applied, force variation during the application, and tourniquet rupture rate. RESULTS: The LA-TQ were cheaper (US$6.07 versus US$27.19), shorter, and had higher inter-device variability than the CAT (90.1 [SE = 0.5] cm versus 94.5 [SE = 0.1] cm; P <.001). The CAT applied a significantly greater force during the initial application when compared to the LA-TQ (65 [SE = 3] N versus 14 [SE = 1] N; P <.001). While the initial application force was maintained for up to six hours in both groups, the CAT group applied an increased force during one-hour applications (group effect: F [1,73] = 105.65; P <.001) and during six-hour applications (group effect: F [1,12] = 9.79; P = .009). The rupture rate differed between the CAT and the LA-TQ (0% versus 4%). CONCLUSION: The LA-TQ applied a significantly lower force and had a higher rupture rate compared to the CAT, potentially affecting tourniquet performance in the context of public bleeding control. These findings warrant increased layperson education within the framework of the Stop the Bleed campaign and further investigations on the effectiveness of uncertified devices in real-world applications.

Design of a system to detect the force applied by tourniquets in a manikin's limb.

Massive hemorrhage remains the number one cause of preventable death in trauma worldwide. However, immediate intervention by a bystander can significantly improve the survival of the injured person. In this context, the tourniquets represent the most quick and effective devices for stopping arterial and venous blood flow. The aim of this study was to implement a system to detect the force applied by a tourniquet on a simulated limb, without blood flow. The system we designed is characterized by four low-cost force sensing resistors placed on each lower limb of a manikin, below the groin. Tests on 21 tourniquets, revealed that our system is able to detect the force applied for 60 minutes, also discriminating between turns. Hence, this system can be used to compare the performance of different types of devices, but also to assess proper tourniquet placement in trainees and trauma care providers, thus making it a versatile low-cost device.