Google Analytics Alternative

Ok

En poursuivant votre navigation sur ce site, vous acceptez l'utilisation de cookies. Ces derniers assurent le bon fonctionnement de nos services. En savoir plus.

08/10/2019

Formation au Tourniquet: Il faut mieux faire

High Tourniquet Failure Rates Among Non-Medical Personnel Do Not Improve with Tourniquet Training, Including Combat Stress Inoculation: A Randomized Controlled Trial.

 

BACKGROUND:

The rate of failing to apply a tourniquet remains high.

HYPOTHESIS:

The study objective was to examine whether early advanced training under conditions that approximate combat conditions and provide stress inoculation improve competency, compared to the current educational program of non-medical personnel.

METHODS:

This was a randomized controlled trial. Male recruits of the armored corps were included in the study. During Combat Lifesaver training, recruits apply The Tourniquet 12 times. This educational program was used as the control group. The combat stress inoculation (CSI) group also included 12 tourniquet applications, albeit some of them in combat conditions such as low light and physical exertion. Three parameters defined success, and these parameters were measured by The Simulator: (1) applied pressure ≥ 200mmHg; (2) time to stop bleeding ≤ 60 seconds; and (3) placement up to 7.5cm above the amputation.

RESULTS:

Out of the participants, 138 were assigned to the control group and 167 were assigned to the CSI group. The overall failure rate was 80.33% (81.90% in the control group versus 79.00% in the CSI group; P value = .565; 95% confidence interval, 0.677 to 2.122). Differences in pressure, time to stop bleeding, or placement were not significant (95% confidence intervals, -17.283 to 23.404, -1.792 to 6.105, and 0.932 to 2.387, respectively).

Tourniquet failure.jpeg

 

Tourniquet placement was incorrect in most of the applications (62.30%).

CONCLUSIONS:

This study found high rates of failure in tourniquet application immediately after successful completion of tourniquet training. These rates did not improve with tourniquet training, including CSI. The results may indicate that better tourniquet training methods should be pursued.

| Tags : tourniquet

06/08/2019

Garrot tactique: Oui, mais avec une réévaluation PRECOCE

Tactical tourniquet: Surgical management must be within 3 hours.

L'usage précoce et libéral des garrot a prouvé son bien fondé. Encore faut il que ce que l'on appelle le garrot tactique soit bien on, mis en oeuvre. En effet ce garrot sauve  la vie au prix de certaines complications dès lors que sa durée dépasse 02h00 (1). Cette stratégie libérale repose sur quelques éléments fondamentaux (une pose bien indiquée et réalisée interrompant le flux artériel ET une réévaluation précoce systématique visant à établir le besoin et la mise en oeuvre éventuelle d'alternatives. Ceci n'est pas toujours parfaitement fait. C'est ce que montre cette publication qui rappelle quelques fondamentaux. Curieusement certaines leçons du passé ont été oubliées notamment celles qui portent sur les alternatives au garrot quand les durées d'évacuations sont longues (2)

------------------------------------------

Despite longstanding controversy, tourniquets are widely used in tactical combat casualty care, with undisputed benefits for recent conflicts in Iraq and Afghanistan. Increased time delays are a particular issue in large areas, such as the Sahel-Saharan band. Complications associated with tourniquet use are predominantly related to acute ischemia with risk of amputation and ischaemia-reperfusion injury, as shown in the first clinical case. Often stated but poorly described, misuse of tourniquet and subsequent failure to interrupt arterial blood flow is also a clinical scenario that should be recognized. In the case of misuse of the tourniquet, more significant blood loss may be expected because of venous compression (« venous tourniquet », second clinical case). Early medical re-evaluation of the tourniquet is an essential component in prolonged field care. This includes reassessment of the tourniquet's ability to achieve hemostasis, abolish the downstream pulse and the relevance of the tourniquet altogether. This combat tool requires training to be successful and complications are time dependent. Tourniquet use requires appropriate application, re-evaluation and triage of wounded personnel within 3 h towards more structured surgical management.

| Tags : tourniquet

16/05/2019

Hémorragie: Garrot, mais aussi COMPRESSION

Bleeding control in combat fields with extreme transfer time

 
Cette lettre à l'éditeur émane d'une équipe srilankaise qui a l'expertise de prise en charge de plaies vasculaires avec des délais de prise en charge de près de 04heures (1)  Ceci se rapproche des conditions  dans lesquelles opèrent nos équipes. Les auteurs y rappellent tout l'intérêt lors de la révision du bien fondé de la pose d'un garrot du packing de plaies ET des compressions sélectives par des pansements adaptés dont un exemple est proposé ici.

Balloon tamponnade.jpeg

| Tags : tourniquet

02/05/2019

Apprendre à poser un garrot: En fait, pas si simple

Can they stop the bleed? Evaluation of tourniquet application by individuals with varying levels of prior self-reported training.

McCarty  et Al.  Injury.  2019 Jan;50(1):10-15. doi: 10.1016/j.injury.2018.09.041.

--------------------------------------------------------

1 garrot sur 3 posé correctement malgré une formation ad-hoc.

--------------------------------------------------------

BACKGROUND:

Application of extremity tourniquets is a central tenet of multiple national initiatives to empower laypersons to provide hemorrhage control (HC). However, the efficacy of the general population who self-report prior first-aid (FA) or HC training on individual's ability to control bleeding with a tourniquet remains unknown. Therefore, the objective of this study was to assess the effectiveness of laypeople with self-reported prior FA or HC training to control bleeding with a tourniquet.

STUDY DESIGN:

Employees of a stadium were assessed via simulation in their ability to apply a Combat Application Tourniquet. As a subgroup analysis of a larger study, participants who self-reported: 1) No prior training, 2) FA training only or 2) FA + HC training were compared. Logistic regression adjusting for age, gender, education, willingness-to-assist, and comfort level in HC was performed.

RESULTS:

317 participants were included. Compared to participants with no prior training (14.4%,n = 16/111), those with FA training only (25.2%,n = 35/139) had a 2.12-higher odds (95%CI:1.07-4.18) of correct tourniquet application while those with FA + HC (35.8%,n = 24/67) had a 3.50-higher odds (95%CI:1.59-7.72) of correct application. Participants with prior FA + HC were more willing-to-assist and comfortable performing HC than those without prior training (p < 0.05).

Tourniquet.jpeg

 

However, reporting being very willing-to-assist [OR0.83,95%CI:0.43-1.60] or very comfortable [OR1.11,95%CI:0.55-2.25] was not associated with correct tourniquet application.

CONCLUSION:

Self-reported prior FA + HC training, while associated with increased likelihood to correctly apply a tourniquet, results in only 1/3 of individuals correctly performing the skill. As work continues in empowering and training laypeople to act as immediate responders, these findings highlight the importance of effective layperson education techniques.

| Tags : tourniquet

26/04/2019

Bande de compression: Ne pas les vouer aux gémonies

Comparison of Two Tourniquets on a Mid-Thigh Model: The Israeli Silicone Stretch and Wrap Tourniquet vs. The Combat Application Tourniquet.

Glick CPTY et Al. Mil Med. 2018 Mar 1;183(suppl_1):157-161. doi: 10.1093/milmed/usx169.
 
-----------------------------------

Le succès des garrots artériels tels que le SOFT-T et le CAT ne doit pas occulter l'intérêt des bandes de compression élastiques (Bande d'Esmach, SWAT-Tourniquet, IDF Silicone Tourniquet) préconisées en médecine rurale lors d'explosion de mines antipersonnelles (1). Ce travail met en avant leur efficacité.

-----------------------------------

Introduction:

Experience from recent conflicts underlines the dramatic impact of effective tourniquet use on combat casualty mortality. Although the Combat Application Tourniquet (CAT) is replacing the silicone band tourniquets (IST; "Israeli Silicone Tourniquet") in the Israeli Defense Forces, no direct comparison was made between them. The purpose of this study is to compare the performance of the two tourniquets on a mid-thigh model.

Methods:

Participants were Israeli military recruits who previously had the military first aid course. Each participant applied both the CAT and the IST. Applications were assessed by the HapMed Leg Tourniquet Trainer, which measured the applied pressure and the time required to reach it.

m_usx169f01.png?Expires=1556701552&Signature=lzP7pfinskI1xxxLKraxmnv7VZcWteaOTSk8qr3M79J03gRwnzUeRUmxk7UNP10loCsp9M9Ej1no6p~CLQFcDrI58gXvWm~9wzpJvbYhViY5Znhmz9MKgj5qkACLsoR33MUCuRiC0DLrmFcvQtaVDraKNrrCkpy8JsGh15foJ7-uNdsKg7kl~nQAwXSeuCOLxHYtNbyo4Bji0G8nRlYkl0L-Gvlz1IXaXESlpNWGUC8QiJhP5aR5gMxC9L59ev8k4Ct1rUVdBw8rNhV4LW5M9bjShhak2XQMsMGOrAk~F6db6mRTcdzIxEkTN9M~Ac45yUedOqtS1smhsZZatNJVXw__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA

Results:

IST application resulted in higher rates of effective occlusion pressure compared with the CAT (91% vs. 73.1%, p < 0.01), and a higher mean occlusion pressure (41 mmHg, p < 0.01) was recorded using the IST. Among effective attempts, application time did not differ significantly between the tourniquets.

Effect of Elapsed Time Since First Aid Course on Success Rate

  Experience More Than 1 mo (n = 15)  Experience Equal to or Less Than 1 mo (n = 63)  p-Value 
Succeeded with CAT, n (%)  7 (46.7)  50 (79.4)  0.01 
Succeeded with IST, n (%)  14 (93.3)  57 (90.5)  0.5

Conclusion:

The IST was superior to the CAT in producing effective occlusion pressure while not prolonging application time. These results may indicate that the IST remains a valid option for controlling mid-thigh bleeding.

| Tags : tourniquet

21/07/2018

+ d'1 Tourniquet et 1/4 converti

Point of injury tourniquet application during Operation Protective Edge-What do we learn?


BACKGROUND:

Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate- and short-term outcomes of point of injury (POI) tourniquet applications during "Operation Protective Edge" (OPE).

METHODS:

A case series study regarding tourniquet application at the POI during OPE was collected. The data gathered included reports by medical providers at the POI, aerial and land evacuation vehicles, and receiving hospitals. Variables collected included, the number of tourniquet applications, caregiver level, tourniquet type, limb characters, tourniquet effectiveness, in-hospital procedures, complications, and short-term limb outcome.

RESULTS:

During OPE, the Israeli Defense Forces Medical Corps treated 704 casualties. Of these, 90 casualties were treated with 119 tourniquets of which 79 survived. Penetrating trauma was the mechanism of injury in 97.8% (88 of 90) of the casualties. Injuries sustained from improvised explosive devices and shrapnel were related to the use of more than one tourniquet per casualty and per limb (p = 0.034). The success rate of the first tourniquet was reported to be 70% (84 of 119), regardless of caregiver level (p = 0.56), tourniquet type (p = 0.16), or limb characters (p = 0.48). Twenty-seven (25.7%) of 105 of the tourniquets were converted to direct pressure dressings enroute to receiving hospitals two of the conversions failed and thus a new tourniquet was applied. Fasciotomy was performed on eight casualties (a single limb in each). Vascular injury was presumed to be the indication for fasciotomy in three of these cases, in the other five limbs (6%, 5 of 85), no vascular involvement was discovered during surgery, and the fasciotomy is suspected as tourniquet related. 7%) 6 of 85) suffered from neurological sequela that could not be explained by their primary injury. Total complication rate was 11.7% (10 of 85) (one patient had both fasciotomy and neural complication without vascular injury).

CONCLUSION:

Tourniquet use on the battlefield is a simple method of eliminating preventable death, we believe that clinical practice guidelines should promote liberal use of tourniquets by trained combatants and medical personnel with abilities to convert to direct pressure hemorrhage control when possible since an unjustified tourniquet application risks low rates minor morbidity, whereas a justifiable tourniquet not applied may be lethal.

| Tags : tourniquet

01/05/2018

Tourniquet: Une vieille histoire

A brief history of the tourniquet

Welling DR et Al. Vasc Surg 2012;55:286-90

 

Matas Cmpressor.jpg

Le compresseur de Matas

Clic ici pour accéder à l'article

| Tags : tourniquet

03/12/2017

Garrot: Pas si simple sans formation

The Tourniquet Gap: A Pilot Study of the Intuitive Placement of Three Tourniquet Types by Laypersons

Ross EM et Al. http://dx.doi.org/10.1016/j.jemermed.2017.09.011

--------------------------

La pose de garrot par l'intervenant le plus proche d'une victime blessé semble être une évidence. Pourtant ce travail met en évidence un taux relativement important d'échec. Ceci milite pour la conduite de campagne de formation avant toute mise à disposition de garrot industriel

--------------------------

Background
The “Stop the Bleed” campaign in the United States advocates for nonmedical personnel to be trained in basic hemorrhage control and that “bleeding control kits” be available in high-risk areas. However, it is not clear which tourniquets are most effective in the hands of laypersons.

Objectives

The objective of this pilot study was to determine which tourniquet type was the most intuitive for a layperson to apply correctly.

Methods

This project is a randomized study derived from a “Stop the Bleed” education initiative conducted between September 2016 and March 2017. Novice tourniquet users were randomized to apply one of three commercially available tourniquets (Combat Action Tourniquet [CAT; North American Rescue, LLC, Greer, SC], Ratcheting Medical Tourniquet [RMT; m2 Inc., Winooski, VT], or Stretch Wrap and Tuck Tourniquet [SWAT-T; TEMS Solutions, LLC, Salida, CO]) in a controlled setting. Individuals with formal medical certification, prior military service, or prior training with tourniquets were excluded. The primary outcome of this study was successful tourniquet placement.

Results

Of 236 possible participants, 198 met the eligibility criteria. Demographics were similar across groups. The rates of successful tourniquet application for the CAT, RMT, and SWAT-T were 16.9%, 23.4%, and 10.6%, respectively= 0.149). The most common causes of application failure were: inadequate tightness (74.1%), improper placement technique (44.4%), and incorrect positioning (16.7%).

Conclusion

Our pilot study on the intuitive nature of applying commercially available tourniquets found unacceptably high rates of failure. Large-scale community education efforts and manufacturer improvements of tourniquet usability by the lay public must be made before the widespread dissemination of tourniquets will have a significant public health effect.

| Tags : tourniquet

31/08/2017

Tourniquet: Bien en contexte civil AUSSI

The trauma center is too late: Major limb trauma without a pre-hospital tourniquet has increased death from hemorrhagic shock

Scerbo MH et Al. Journal of Trauma and Acute Care Surgery,10.1097/TA.0000000000001666

 

Background: To date, no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement.

Methods: All patients arriving to a Level-1, urban TC between 10/2008 and 01/2016 with a tourniquet placed prior to (T-PH) or after arrival to the TC (T-TC) were evaluated. Cases were assigned the following designations: indicated [absolute indication (vascular injury requiring repair/ligation, operation within 2 hours for extremity injury, or traumatic amputation), or relative indication (major musculoskeletal/soft-tissue injury requiring operation 2-8 hours after arrival, documented large blood loss)], or non-indicated. Outcomes were death from hemorrhagic shock, physiology upon arrival to the TC and massive transfusion requirements. Following univariate analysis, logistic regression was carried out to assess independent predictors of death from hemorrhagic shock.

Results: 306 patients received 326 tourniquets for injuries to 157 upper and 147 lower extremities. 281 (92%) had an indication for placement. 70% of patients had a blunt mechanism of injury. T-TC patients arrived with a lower systolic blood pressure [101 (86, 123) versus 125 (100, 145)mmHg, p<0.001], received more transfusions in the first hour of arrival (55% versus 34%, p=0.02) and had a greater mortality from hemorrhagic shock (14% vs. 3.0%, p=0.01). When controlling for year of admission, mechanism of injury and shock upon arrival (SBP  ≤90mmHg or HR ≥120 bpm or base deficit ≤ 4), indicated T-TC had a 4.5-fold increased odds of death compared to T-PH [OR 4.5, 95% CI 1.23-16.4, p=0.02)].

Conclusions: Waiting until TC arrival to control hemorrhage with a tourniquet was associated with worsened blood pressure and increased transfusion within the first hour of arrival. In routine civilian trauma patients, delaying to T-TC was associated with 4.5-fold increased odds of mortality from hemorrhagic shock

| Tags : tourniquet

21/07/2017

SOFT-Tourniquet: Du nouveau

Tactical Médical Solutions qui est le fabricant du SOFT-Tourniquet, garrot en dotation dans l'armée française, propose une nouvelle version de son garrot Wide. Sa nouvelle boucle est d'emploi bien plus aisé que la précédente et positionne ce garrot parmi les tous meilleurs(CAT, SOFT-T, TK4,...)

 

productimage-picture-sof-tactical-tourniquet-wide-new-buckle-1502.png

Clic sur l'image pour accéder au site. Le distributeur en France.

| Tags : tourniquet

29/04/2017

Une ceinture pour tourniquet ? Plutôt l'inverse.

Belts Evaluated as Limb Tourniquets: BELT Study Comparing Trouser Supporters Used as Medical Devices in a Manikin Model of Wound Bleeding.

Bequette BW et Al Wilderness Environ Med. 2017 Apr 19. pii: S1080-6032(17)30060-1. 

 

--------------------------------

Une idée, qui n'est pas nouvelle de même que celui de pantalon intégrant un garrot (1),  mais on devrait plutôt dire un tourniquet pour ceinture. Ce travail est par ailleurs intéressant car il aborde la problématique des garrots insuffisamment serrés.

--------------------------------

OBJECTIVE:

The purpose of the present study is to compare several models of commercially designed belts as used as a tourniquet.

METHODS:

In the Belts Evaluated as Limb Tourniquets (BELT) study, an experiment was designed to test the effectiveness of pants belts as non improvised medical devices to control hemorrhage in a manikin. Models of belts included Tourni-belt, Tourniquet Belt, ParaBelt, and Battle Buddy. Data collected included effectiveness, time to stop bleeding, total time of application, pressure, blood loss, and composite results (score count of good results; composite outcome good if every component was good).

RESULTS:

Differences in effectiveness percentages among models were not statistically significant. The difference in mean between users was statistically significant for stop time, total time, pressure, blood loss, composite score, and composite outcome. Mean time to stop bleeding differed for only 1 pair of models after the Tukey-Kramer adjustment; ParaBelt was faster than Tourniquet Belt. Mean total time of application differed between ParaBelt-Tourniquet Belt and Tourni-belt-Tourniquet Belt; the former model in both pairs was faster. No significant difference in mean blood loss measured by model was found. For composite outcome score, no pairwise difference between models was significant. For composite outcome (good-bad), ParaBelt had good results in 75% of tests; the other 3 models had significantly worse results.

CONCLUSIONS:

In a preliminary laboratory analysis of belt tourniquet models using a manikin, performance differed by model. ParaBelt performed better than other models for the composite outcome.our tourniquet ?

| Tags : tourniquet

11/04/2017

Tourniquet: Les israéliens, pour +++

Point of injury tourniquet application during Operation Protective Edge - what do we learn?

 
------------------------------------
Un point récent sur l'emploi du garrot dans un contexte de combat mixte zone urbaine mais aussi hors de la ville. Disons immédiatement que ce travaille CONFIRME l'intérêt du garrot, qui doit pouvoir être rapidement converti. Le contexte de pose du garrot est  avant tout tactique (exposition au feu, plusieurs blessés, nuit complète). L' efficacité du premier garrot est de 70%. Près d'1/4 nécessitent au moins 2 garrots et encore 1/4 sont convertis pendant la medevac. Sur 13% des blessés sont réalisés des gestes de sauvetage: décompression thoracique /Intubation ou Cricothyrotomie. Ce document exprime parfaitement l'importance de la maîtrise et partant de l'entraînement à la réalisation des gestes de la procédure du sauvetage au combat.
------------------------------------

BACKGROUND:

Hemorrhage is a leading cause of preventable death on the battlefield. Timely tourniquet application to massively bleeding extremity wounds is critical for casualty survival albeit with reported adverse effects to extremity integrity. The aim of this study was to describe the immediate and short term outcomes of point of injury (POI) tourniquet applications during 'Operation Protective Edge' (OPE).

METHODS:

A case series study regarding tourniquet application at the POI during OPE was collected. The data gathered included reports by medical providers at the POI, aerial and land evacuation vehicles, and receiving hospitals. Variables collected included, the number of tourniquet applications, caregiver level, tourniquet type, limb characters, tourniquet effectiveness, in-hospital procedures, complications and short term limb outcome.

RESULTS:

During OPE, the Israeli Defense Forces Medical Corps (IDF-MC) treated 704 casualties. Out of these, 90 casualties were treated with 119 tourniquets out of which 79 survived. Penetrating trauma was the mechanism of injury in 97.8% (88/90) of the casualties. Injuries sustained from Improvised explosive devices (IED) and shrapnel were related to the use of more than one tourniquet per casualty and per limb (p=0.034). The success rate of the first tourniquet was reported to be 70% (84/119), regardless of caregiver level (P=0.56), tourniquet type (P=0.16) or limb characters (p=0.48).  two of the conversions failed and thus a new tourniquet was applied. Fasciotomy was performed on 8 casualties (a single limb in each). Vascular injury was presumed to be the indication for fasciotomy in three of these cases, in the other five limbs (6%, 5/85) no vascular involvement was discovered during surgery and the fasciotomy is suspected as tourniquet related. 7%) 6/85) suffered from neurological sequela that could not be explained by their primary injury. Total complication rate was 11.7% (10/85) (one patient had both fasciotomy and neural complication without vascular injury)

CONCLUSION:

Tourniquet use on the battlefield is a simple method of eliminating preventable death, we believe that clinical practice guidelines should promote liberal use of tourniquets by trained combatants and medical personnel with abilities to convert to direct pressure hemorrhage control when possible since an unjustified tourniquet application risks low rates minor morbidity whereas a justifiable tourniquet not applied may be lethal.

| Tags : tourniquet

17/03/2017

Tourniquet: La nouveauté de SamMedical

SAM Tourniquet XT

Un garrot, dont l'intérêt apparaît être d'une part sur sa largeur et d'autre part sur sa boucle de serrage innovante. 

lookbook-1.jpg

 Clic sur l'image pour accéder à une vidéo

| Tags : tourniquet

14/03/2017

Tourniquet: Attention

Cat on a Hot Tin Roof: Mechanical Testing of Models of Tourniquets After Environmental Exposure.
O'Conor DK et Al.  J Spec Oper Med. 2017 Spring;17(1):27-35.

------------------- 

La pose d'un garrot est essentiel à la survie d'un blessé présentant une hémorragie sévère des membres. Encore faut-il qu'il soit de bonne qualité. Les autorités sanitaires américaines insistent sur l'importance de ne se fournir qu'auprès de distributeurs connues distribuant des garrots éprouvés plutôt que de céder aux sirènes de la copie chinoise de basse qualité. En effet même ces garrots  voient leur efficacité réduite après exposition aux conditions de combat. C'est ce que met une fois de plus en évidence ce travail.

------------------- 

BACKGROUND:

The purpose of the present study was to mechanically assess models of emergency tourniquet after 18 months of environmental exposure to weather to better understand risk of component damage.

MATERIALS AND METHODS:

An experiment was designed to test tourniquet performance on a manikin thigh. Three tourniquet models were assessed: Special Operations Forces Tactical Tourniquet Wide, Ratcheting Medical Tourniquet, and Combat Application Tourniquet. Unexposed tourniquets formed a control group stored in a laboratory; exposed tourniquets were placed outdoors on a metal roof for 18 months in San Antonio, Texas. Two users, a military cadet and a scientist, made 300 assessments in total. Assessment included major damage (yes-no), effectiveness (hemorrhage control, yes-no), casualty survival (alive-dead), time to stop bleeding, pressure, and blood loss. Time, pressure, and blood loss were reported in tests with effectiveness.

RESULTS:

Exposed devices had worse results than unexposed devices for major damage (3% [4/150] versus 0% [0/150]; &rho; = .018), effectiveness (89% versus 99%; &rho; = .002), and survival of casualties (89% versus 100%; &rho; &lt; .001). In tests for effectiveness, exposed devices had worse results than unexposed devices for time to stop bleeding (29 seconds versus 26 seconds; &rho; = .01) and pressure (200mmHg versus 204mmHg; &rho; = .03, respectively), but blood loss volume did not differ significantly.

CONCLUSION:

Compared with unexposed control devices, environmentally exposed tourniquets had worse results in tests of component damage, effectiveness, and casualty survival.

| Tags : tourniquet

16/02/2017

TMT tourniquet: Un nouveau venu

Un nouveau venu qui fait aussi bien que la référence US, à savoir le CAT, sans apporter plus (1). Ne pas confondre ce garrot dont le distributeur est connu et dont la fabrication parfaitement tracée. Sans aucune comparaison avec nombre de copies qui ne bénéficient pas des mêmes contrôle de qualité distribués à moins de 10 Euros et qui peuvent faire illusion.

1489769572INTMT2.jpg

| Tags : tourniquet

08/02/2017

Tourniquets contrefaits = DANGER

DANGER

 

Les événements récents ont mis en avant l'importance de l'application précoce de garrot. L'approvisionnement en garrot est un véritable challenge et un marché où la guerre commerciale fait maintenant rage. Si le nombre de fabricants historiques de garrot était relativement restreint  (CAT, SOFT-T, TK4, RATS, MAT, SWAT), on voit fleurir nombre de copies essentiellement chinoises dont il est relativement aisé de se procurer des exemplaires, notamment sur le marché de l'AIRSOFT. Deux fabricants sont particulièrement la cible de ces contrefacteurs CAT ressources et TACMED solutions, car ce sont les deux garrots validés par les US dans le cadre du TCCC. Ces deux fabricants diffusent leurs produits pour une 20aines d'euros. Le garrot en service dans l'armée française depuis une dizaine d'année est le SOFT-T de la société TACMED, garrot dont il existe une version adaptée pour l'enfant. Les contrefacteurs chinois affichent des tarifs parfois 10 fois moindres. Les produits proposés par ces sociétés ne peuvent pas disposer des qualités techniques de même niveau que ceux détenus par les originaux. Un aspect important des garrots est leur résistance au vieillissement, aux intempéries, au froid, aux UV. Il a été démontré que ces caractéristiques sont très importantes en terme d'efficacité après quelques mois de port du garrot en ambiance opérationnelle vraie. Il serait étonnant que ces copies de garrot, dont les matières premières et les circuits de fabrication sont pour le moins opaques offrent les mêmes garanties de sécurité que ceux de fabricants historiques maîtrisant tous les process de fabrication de leur production.

Par ailleurs il semblerait que les conditions des certifications CE et ISO 134 (1,2,3)85 soit sujettes à caution car en partie relevant d'une autocertification.

Les autorités américaines ne sont saisies de ce problème et rappellent l'importance de ne s'approvisionner que chez les forunisseurs des garrots validés dans le T3C, à savoir les garrots produits apr CAT ressources et TacMed Solutions en excluant toute autre production au prétexte de tarifs à première vue (tro) alléchants. Lire le rapport de la FDA

Je vous propose dans le lien suivant quelques exemples concernant le garrot SOFT-T

Matériel Tourniquet Contrefaçons.pdf

Certains modèles de tourniquet s'inspirent très fortement de ces produits et en particulier du SOF-T (notamment le wide) mais avec une démarche d' innovation réelle. Aussi ces tourniquets sont ils différents de simples copies et très probablement de bonne qualité. Ils ne sont pas produits en chine mais dans des pays de l'Est européen, voire en Russie (a,b). On manque néanmoins de recul d'expertise technique de ces derniers. 

Dans l'état actuel des choses, à moins de s'équiper pour de l'airsoft, la prudence est de rester à l'écart des ces garrots et de continuer à utiliser les produits distribués par les fournisseurs reconnus des fabricants historiques (4, 5,6)

| Tags : tourniquet

11/11/2016

15 ans d'emploi du tourniquet: Que dire ?

Battlefield Tourniquets: Lessons Learned in Moving Current Care Toward Best Care in an Army Medical Department at War

Kragh JF Jr et Al. US Army Med Dep J. 2016 Apr-Sep;(2-16):29-36.

------------------------------

Un point d'étape qui insiste sans surprise sur l'apport d'une pose précoce d'un garrot. Précoce mais aussi rapide:  25 secondes sont nécessaires aux plus entraînés mais c'est 20 secondes de trop. Plus on s'entraîne et plus vite ET mieux on pose ce garrot.  

------------------------------

Bleeding prevention and control by tourniquet use by out-of-hospital caregivers is a major breakthrough in military medicine of current wars. The present review documents developments in tourniquet practices since 2001 among the US military services for aid in improving doctrine, policy, and especially care in wars to come. Tourniquets are an adjunct for resuscitation in self-care and buddy aid and today are issued to all military service persons who deploy into a combat zone. In the US Army, virtually every Soldier is trained in first aid tourniquet use; since 2009 they are instructed early and often to use them early and often. Despite substantial knowledge gains among the services in tourniquet use and resulting improvements in casualty survival, current evidence shows persistent diffi culties in achieving best care with tourniquet use for individual trauma patients. Nevertheless, contemporary tourniquet use incorporates key lessons learned over the last 14 years of war that include: (1) tourniquet use reliably stops bleeding from limb wounds and prevents mortality in prehospital settings; and (2) brief tourniquet use appears to be safe. These 2 lessons have become so evident that civilian emergency medical systems have begun using them, albeit unevenly. Collection and interpretation of data of casualties with tourniquet use have showed that such intervention has lifesaving benefit through 2 mechanisms: control of both ongoing hemorrhage and shock severity. The next generation of interventions in bleeding control involves developing the skill sets, education, and standards of tourniquet users which may improve hemorrhage control in wars to come

 

tourniquet

 

 

| Tags : tourniquet

24/09/2016

Tourniquet: Entretien 3/mois mieux qu'1/mois

Does practice make perfect? Prospectively comparing effects of 2 amounts of practice on tourniquet use performance

---------------------------------------------

L'entretien des compétences et en particulier des gestes apparaît fondamentale et nécessite un suivi chiffré pour garantir un niveau suffisant d'expertise pour une projection opérationnelle. Ceci est parfaitement mis en avant dans le travail de schaeur et Al. (1) qui porte sur des gestes de réanimation préhospitalière. Le document proposé à votre lecture porte sur un geste essentiel: La pose du garrot. Une pratique plus régulière limite le désapprentissage.

---------------------------------------------

Although a lifesaving skill, currently, there is no consensus for the required amount of practice in tourniquet use. We compared the effect of 2 amounts of practice on performance of tourniquet use by nonmedical personnel.

METHODS:

Israeli military recruits without previous medical training underwent their standard tactical first aid course, and their initial performance in use of the Combat Application Tourniquet (CAT; Composite Resources, Rock Hill, SC) was assessed. The educational intervention was to allocate the participants into a monthly tourniquet practice program: either a single-application practice (SAP) group or a triple-application practice (TAP) group. Each group practiced according to its program. After 3 months, the participants' tourniquet use performance was reassessed. Assessments were conducted using the HapMed Leg Tourniquet Trainer (CHI Systems, Fort Washington, PA), a mannequin which measures time and pressure.

RESULTS:

A total of 151 participants dropped out, leaving 87 in the TAP group and 69 in the SAP group. On initial assessment, the TAP group and the SAP group performed similarly. Both groups improved their performance from the initial to the final assessment. The TAP group improved more than the SAP group in mean application time (faster by 18 vs 8 seconds, respectively; P = .023) and in reducing the proportion of participants who were unable to apply any pressure to the mannequin (less by 18% vs 8%, respectively; P = .009).

CONCLUSION:

Three applications per monthly practice session were superior to one. This is the first prospective validation of a tourniquet practice program based on objective measurements.

| Tags : tourniquet

04/09/2016

Garrot: Mais l'occlusion dans le temps ?

Different Width and Tightening System: Emergency Tourniquets on Distal Limb Segments

Wall PL et Al. J Spec Oper Med. 2015 Winter;15(4):28-38
 
--------------------------------------
On s'interesse le plus souvent lors de la mise en place d'un tourniquet à son efficacité immédiate. Mais que se passe-t-il dans les minutes qui suivent ? Il est montré et notamment par ce travail que la pression sous le garrot diminue très rapidement. aussi le risque de resaignement est il grand et oblige à recontr^pler l'efficacité du garrot très régulièrement. C'est un des principes du garrot tactique. Ce travail suggère également que cette baisse de pression d'occlusion est moindre avec une bande de compression élastique. ceci milite pour l'adjonction d'une telle bande à peu près systématiquement soit du moins quand une réévaluation s'avère difficile à conduire dans de bonnes conditions. Ceci est connu (1) mais souvent non appliqué; De telles bandes sont représentées par la SWAT tourniquet, des bandes spécifiques, le pansement OALES Modular bandage et depuis peu par un produit très intéressant le Battle Wrap
--------------------------------------

BACKGROUND:

Tourniquets are used on distal limb segments. We examined calf and forearm use of four thigh-effective, commercial tourniquetswith different widths and tightening systems: 3.8 cm windlass Combat Application Tourniquet® (CAT, combattourrniquet.com) and Special Operations Forces® Tactical Tourniquet-Wide (SOFTTW, www.tacmedsolutions.com), 3.8 cm ratchet Ratcheting Medical Tourniquet - Pediatric (RMT-P, www.ratchetingbuckles. com), and 10.4 cm elastic Stretch-Wrap-And-Tuck Tourniquet® (SWATT, www.swattourniquet.com).

METHODS:

From Doppler-indicated occlusion, windlass completion was the next securing opportunity; ratchet completion was one additional tooth advance; elastic completion was end tucked under a wrap.

RESULTS:

All applications on the 16 recipients achieved occlusion. Circumferences were calf 38.1±2.5 cm and forearm 25.1±3.0 cm (p<.0001, t-test, mean±SD). Pressures at Occlusion, Completion, and 120-seconds after Completion differed within each design (p<.05, one-way ANOVA; calf: CAT 382±100, 510±108, 424±92 mmHg; SOFTT-W 381±81, 457±103, 407±88 mmHg; RMT-P 295±35, 350±38, 301±30 mmHg; SWATT 212±46, 294±59, 287±57 mmHg; forearm: CAT 301±100, 352±112, 310±98 mmHg; SOFTT-W 321±70, 397±102, 346±91 mmHg; RMT-P 237±48, 284±60, 256±51 mmHg; SWATT 181±34, 308±70, 302±70 mmHg). Comparing designs, pressures at each event differed (p<.05, one-way ANOVA), and the elastic design had the least pressure decrease over time (p<.05, one-way ANOVA). Occlusion losses differed among designs on the calf (p<.05, χ²; calf: CAT 1, SOFTT-W 5, RMT-P 1, SWATT 0; forearm: CAT 0, SOFTT-W 1, RMT-P 2, SWATT 0).

CONCLUSIONS:

All four designs can be effective on distal limb segments, the SWATT doing so with the lowest pressures and least pressure losses over time. The pressure change from Occlusion to Completion varies by tourniquet tightening system and can involve a pressure decrease with the windlass tightening systems. Pressure losses occur in as little as 120 seconds following Completion and so can loss of Occlusion. This is especially true for nonelastic strap tourniquet designs.

| Tags : tourniquet

2 garrots: Côte à côte SVP, mais attention

Pressures Under 3.8cm, 5.1cm, and Side-by-Side 3.8cm-Wide Tourniquets

-----------------------------

Plus un garrot est large et plus efficace il est. parmi les garrots en dotation le Garrot Delfi est le plus performant en terme d'occlusion. Néanmoins son emploi en première intention et hors un vecteur d'évacuation est difficilement envisageable. Aussi l'association de deux garrots apparaît elle très pertinente surtout si ces derniers sont posés côte à côte. Ce n'est pas pour autant une sécurité car en permettant l'obtention d'une pression d'occlusion plus basse, cette méthode expose à une occlusion insuffisante . Cette publication  a par ailleurs comme intérêt de montrer que la pression d'occlusion baisse avec le temps et ce dès les premières minutes. Il est fondamental d'apprécier TRES régulièrement  l'efficacité du garrot. Donc plutôt un garrot large d'emblée mais si l'on doit compléter poser le second à côté du premier. A noter que le garrot utilisé n'est pas en dotation dans l'armées US mais qu'il s'agit d'un des meilleurs garrots de dernière génération.

----------------------------- 

BACKGROUND:

Applications of wider tourniquet are expected to occlude arterial flow at lower pressures. We examined pressures under 3.8cm-wide, 5.1cm-wide, and side-by-side-3.8cm-wide nonelastic strap-based tourniquets.

METHODS:

Ratcheting Medical Tourniquets (RMT) were applied mid-thigh and mid-arm for 120 seconds with Doppler-indicated occlusion. The RMTs were a Single Tactical RMT (3.8cm-wide), a Wide RMT (5.1cm-wide), and Paired Tactical RMTs (7.6cm-total width). Tightening completion was measured at one-tooth advance past arterial occlusion, and paired applications involved alternating tourniquet tightening.

RESULTS:

All 96 applications on the 16 recipients reached occlusion. Paired tourniquets had the lowest occlusion pressures (ρ < .05). All pressures are given as median mmHg, minimum-maximum mmHg. Thigh application occlusion pressures were Single 256, 219-299; Wide 259, 203-287; Distal of Pair 222, 183-256; and Proximal of Pair 184, 160-236. Arm application occlusion pressures were Single 230, 189-294; Wide 212, 161-258; Distal of Pair 204, 193-254, and Proximal of Pair 168, 148-227. Pressure increases with the final tooth advance were greater for the 2 teeth/cm Wide than for the 2.5 teeth/cm Tacticals (ρ < .05). Thigh final tooth advance pressure increases were Single 40, 33-49; Wide 51, 37-65; Distal of Pair 13, 1-35; and Proximal of Pair 15, 0-30. Arm final tooth advance pressure increases were Single 49, 41-71; Wide 63, 48-77; Distal of Pair 3, 0-14; and Proximal of Pair 23, 2-35. Pressure decreases occurred under all tourniquets over 120 seconds. Thigh pressure decreases were Single 41, 32-75; Wide 43, 28-62; Distal of Pair 25, 16-37; and Proximal of Pair 22, 15-37. Arm pressure decreases were Single 28, 21-43; Wide 26, 16-36; Distal of Pair 16, 12-35; and Proximal of Pair 12, 5-24. Occlusion losses before 120 seconds occurred predominantly on the thigh and with paired applications (ρ < .05). Occlusion losses occurred in six Paired thigh applications, two Single thigh applications, and one Paired arm application.

CONCLUSIONS:

Side-by-side tourniquets achieve occlusion at lower pressures than single tourniquets. Additionally, pressure decreases undertourniquets over time; so all tourniquet applications require reassessments for continued effectiveness.

| Tags : tourniquet