History of tourniquets evolution
Etienne Morel, Jean-Louis Petit, Johannes Friedrich and Bernhard Rudolf Konrad von Langenbeck…
The names of these gentlemen are not widely known. But millions of people who have survived thanks to the tourniquets should be very grateful, first of all, to these four people.
Starting from the 17th century and till the Second World War each of them greatly contributed to development of any instruments for bleeding control.
The first samples of modern tourniquets with crowfoot mechanism (something like improved boxes by Etienne Morel) appeared in the late nineties. Americans were the first in this process. The prototypes were extensively improved and modified, and they started to be more and more popular among military and medical men, and soon among civil people as well.
For the last three decades while performing some missions in the countries of Middle East the NATO military forces have gained both fighting experience and very important medical experience in urgent prehospital help.
On analyzing statistical information, health professionals found out that about 75 per cent of battlefield casualties was caused by extensive bleeding, and the most of the injured with any damages of great vessels had very high chances to survive in case of timely bleeding control.
Later these statistical data and economical statistical information were combined.
The NATO country-members spent from one million to some dozens of USD millions on training one highly qualified military specialist, and it took approximately from 5 to 20 years (subject to the military branch). Soldier’s death caused by failure to stop bleeding undermined the chances to perform the tasks almost to zero, moreover, it tactically made any military unit weaker, and achievement of strategic goals was under the threat of failure, it brought to naught all the enormous financial resources spent by any country on military specialist training.
Ideological factor was one of the constituent too. The democratic countries – members of the NATO which declared person’s life as the highest value, could not bear with such defect in the military medical pack. The military officer’s image was on the line.
It was high time for urgent need in tourniquets and hemostatic agents which are reliable and fast in use at the same time, but also it needed correction and improvement of available battle site rescue protocols.
And at last in 2004 as a result of wholescale battle site and laboratory experiments carried out by the military institute of surgery of the USA (USAISR), the old rubber Esmarch’s tourniquets were substituted by new tourniquets recommended for using by military and rescue officers:
SWAT-Tourniquet (Stretch Wrap And Tuck / Розтягни Підверни Та Оберни)
SWAT-Tourniquet (Stretch Wrap аnd Tuck).
This device is just a piece of elastic rubber of 130 cm wide and 10,5 cm long with imprinted rhombic symbols and ovals along the whole length. One should stretch the tourniquet to the moment when rhombic symbols turn to squares. It means the proper application of the tourniquet. The tourniquet is fixed by tucking the edge under the loop.
CAT-Tourniquet (Combat Application Tourniquet) .
This is the improved sample of classical tourniquet with plastic windlass.
Turning of the stick increases the pressure on the limb and on great vessels. It consists of synthetic adhesive tape, internal sling, buckle, fixing bracket of the windlass, and the windlass itself. It is possible for any experienced user to stop bleeding within 30 seconds with just one hand.
CAT-Tourniquet (Combat Application Tourniquet / Джгут Бойового Застосування)
SOF-Tourniquet (Special Operation Forces Tourniquet / Джгут Сил Спеціальних Операцій)
SOF-Tourniquet (Special Operation Forces Tourniquet).
It is an enhanced sample of classical tourniquet with metal lever rod. It consists of wide synthetic tape, V-type buckle with a wide hook and a sliding bar, triangular fixing unit for level rod and the lever rod itself. The peculiar features of this construction enable to fix the tourniquet quickly on the limp and to block bleeding with just one hand.
MA-Tourniquet (Mechanical Activated Tourniquet).
This tourniquet was designed upon the request of the Ministry of Defense of the USA, and later the first responding services accepted this device for usage. It is made as C-shaped hook. The tourniquet consists of synthetic tape, buckle, turning mechanism and lever rod in the form of semicircle. It is applied around a limb by one hand. Thanks to special turning mechanism it is possible to regulate the pressuring force and to unfasten the tourniquet quickly, if necessary.
MA-Tourniquet (Mechanical Activated Tourniquet / Механічно Активований Джгут)
RATS (Rapid Application Tourniquet System / Джгут із Системою Швидкого Накладання)
RATS (Rapid Application Tourniquet System)
The tourniquet is designed as a flat lacing from a resistant vulcanized rubber with nylon cover which is 121 cm long, 0,6 cm wide, and it is fixed on the aluminum block with one end. The tourniquet is fixed by its wrapping around a limb and drawing a loose end into the hole of aluminum fixing block by forming a self-tightening loop. The pressure increases with each new turn of the tourniquet around a limp (Esmarch type).
In 2011 a special investigation was carried out for analyzing 79 tourniquets applied on 64 limps of 54 injured people:
— the tourniquet was applied by paramedics of special purpose forces in 47 cases (59%),
-by paramedics from aviation department in 17 cases (22%),
— by military doctors in 12 cases (15%),
— by surgeons in 3 cases (4%).
It should be noted that in 71 cases (90%) of 79 it was the tourniquets of САТ type.