title: Emergency tourniquet effectiveness in four positions on the proximal thigh.
abstract: OBJECTIVE
  The purpose of the present study is to determine the performance of tourniquet use by the placement of the tourniquet's windlass on the extremity in four positions--medial, lateral, anterior, and posterior--to inform tourniquet instructors and develop best tourniquet practices.
  
  
  METHODS
  A HapMed™ Leg Tourniquet Trainer was used as a manikin to test the effectiveness of an emergency tourniquet, the Special Operations Forces Tactical Tourniquet. Two users made 10 tests, each in four positions.
  
  
  RESULTS
  Effectiveness rates of tourniquet use were 100% in all four positions. The two tourniquet users were both right-hand dominant and used their right hand to turn the windlass. One user turned the windlass clockwise, and the other turned it counterclockwise. The association between time to stop bleeding and tourniquet position was statistically significant but associations between time to stop bleeding and the user, user-by-position, and windlass turn number were not statistically significant. The association between tourniquet position and pressure under the tourniquet was statistically significant, and the association between user and pressure under the tourniquet was statistically significant, but the user-by-position and windlass turn number were not statistically significant. The associations between tourniquet position and blood loss volume, user and blood loss volume, and user-by-position and blood loss volume were statistically significant.
  
  
  CONCLUSIONS
  The present study found that tourniquet effectiveness rates were uniformly 100% irrespective of whether the windlass position was medial, lateral, anterior, or posterior. These excellent clinical and statistical results indicate that users may continue to place the tourniquets as they prefer upon the proximal thigh.
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Wallum
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.forename: Smiley
authors.initials: S
authors.lastname: Billings
mesh_terms: D000673:Amputation, Traumatic / Q000628:therapy*; D001810:Blood Volume; D004638:Emergency Treatment / Q000379:methods*; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008348:Manikins; D013848:Thigh; D014111:Tourniquets; D014857:Warfare