Tourniquet Device Reviews #1

As part of an ongoing project I've been looking back over the primary literature that supports the use of tourniquets for hemorrhage control. The earliest study I could find to compare various devices was a 2000 article by Calkins et al. This is a worthwhile starting point in what will become a series of posts because this was the first academically published study to directly compare devices. 






This study took 15 Navy SEAL corpsmen and had them apply, compare and evaluate 7 different commercial and improvised tourniquet devices on the upper and lower extremities of volunteers. Each application was assessed for speed of application, and successful occlusion rates. Successful application was determined by obliteration of palpable/doppler radial and dorsal pedal pulses. The corpsmen than ranked each device according to 15 different criteria.   

The study found that that bladder design tourniquets had the best occlusion rates; and more importantly that the military issued tourniquets at the time were so ineffective that they weren't even included in statistical analysis. 

This study has some definite weaknesses: it failed to describe the level of skill or training received by each operator, where the tourniquets were applied (upper versus lower leg/arm), or when doppler versus palpation was used. It didn't include volunteer perceptions of pain, or anthropometric data of participants (size, age, gender, vitals, etc.). There is risk for bias given that the authors were assessing tourniquets of their own design, that some tourniquet designs weren't tested without a rational to why, and that there was no discussion as to why each item that was on the needs assessment list was included.  

Regardless of these weaknesses this study is a seminal piece in the body of knowledge to support tourniquet use. It was the launch point for a series of similarly designed studies and provided a foundation approach to assessing tourniquets. It was the first, and one of only a few to assess commercial as well as improvised tourniquets.  

This is a seminal piece of literature in the field Calkins, Snow, Costello and Bentley's work laid the foundation for improvements in hemorrhage control that have thousands of lives. Any provider interested in the genesis of current tourniquet designs, hemorrhage control, or tactical medicine should consider reading this. 

Calkins, M. D., Snow, C., Costello, M., & Bentley, T. B. (2000). Evaluation of possible battlefield tourniquet systems for the far-forward setting. Military medicine, 165(5), 379-384.