Pediatric Trauma Society

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Comparison of Commercial Tourniquets in a Pediatric Arm Manikin Model
James G. Vretis, DO, MSc
Center for Tactical Medicine, Carlsbad, TX

Background: Young children are frequently injured in peacetime and wartime. Trauma registries at US military medical facilities during the Iraq and Afghanistan conflicts show as the age of a child a child decreases the injury severity and mortality increases. Tourniquet use for control of extremity hemorrhage in adult trauma patients is associated with increased survival. Tourniquet use in pediatric patients treated at US military facilities shows similar survival benefits.

Methods: The study was a prospective and non-blinded test of nine commercial tourniquets on a pediatric arm hemorrhage test model using six sized manikins to simulate pediatric arms. The Stretch Wrap And Tuck (SWAT), TacMed K9 (TMK9) and Rapid Application Tourniquet System (RATS) tourniquets apply compressive forces by the elastic recoil. The Combat Application Tourniquet (CAT), Sam XT (SAMXT), Tactical Mechanical Tourniquet (TMT) and SOF Tactical Tourniquet Wide (SOFTTW) use a windlass to increase circumferential compression. The Child Ratcheting Medical Tourniquet (CRMT) uses a ratchet and ladder mechanism for circumferential compression. The Mechanical Advantage Tourniquet (MAT) has a turnkey apparatus mounted on a fixed length C-shaped housing that pulls a portion of the retaining strap into the housing to increase circumferential pressure.

Results: The SWAT, TMK9 and RATS were successful stopping the flow of water on all sized manikins. The CRMT was the only mechanical advantage tourniquet that was successful in stopping fluid flow on all manikin sizes.

Conclusions: We have shown that many commercially available tourniquets do not stop fluid flow in our pediatric arm hemorrhage test model.

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