title: Which Improvised Tourniquet Windlasses Work Well and Which Ones Won't?
abstract: OBJECTIVE
  Improvised tourniquets in first aid are recommended when no scientifically designed tourniquet is available. Windlasses for mechanical advantage can be a stick or pencil and can be used singly or multiply in tightening a tourniquet band, but currently there is an absence of empiric knowledge of how well such windlasses work. The purpose of the present study was to determine the performance of improvised tourniquets in their use by the type and number of windlasses to improve tourniquet practice.
  
  
  METHODS
  A simulated Leg Tourniquet Trainer was used as a manikin thigh to test the effectiveness of improvised tourniquets of a band-and-windlass design. Two users made 20 tests each with 3 types of windlasses. Tests started with 1 representative of a given type (eg, 1 pencil), then continued with increasing numbers of each windlass type until the user reached 100% effectiveness as determined by cessation of simulated blood flow. Windlass types included chopsticks, pencils, and craft sticks.
  
  
  RESULTS
  Effectiveness percentages in stopping bleeding were associated inversely with breakage percentages. Pulse stoppage percentages were associated inversely with breakage. The windlass turn numbers, time to stop bleeding, the number of windlasses, and the under-tourniquet pressure were associated inversely with breakage. The windlass type was associated with breakage; at 2 windlasses, only chopsticks were without breakage. Of those windlass types that broke, 20.7% were chopsticks, 26.1% were pencils, and 53.2% were craft sticks.
  
  
  CONCLUSIONS
  A pair of chopsticks as an improvised tourniquet windlass worked better than pencils or craft sticks.
authors.affiliation: Damage Control Resuscitation, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (Drs Kragh and Dubick). Electronic address: john.f.kragh.civ@mail.mil.
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.affiliation: Burn Center, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (Mr Wallum).
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Wallum
authors.affiliation: Statistics Department, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (Dr Aden).
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: Damage Control Resuscitation, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (Drs Kragh and Dubick).
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
authors.affiliation: Research Directorate, US Army Institute of Surgical Research, JBSA Fort Sam Houston, TX (Dr Baer).
authors.forename: David G
authors.initials: DG
authors.lastname: Baer
mesh_terms: D004867:Equipment Design; D006470:Hemorrhage / Q000517:prevention & control*; D006801:Humans; D007866:Leg; D008348:Manikins; D014111:Tourniquets / Q000592:standards*; D055813:Wilderness Medicine / Q000295:instrumentation*
keywords: damage control; first aid; hemorrhage; resuscitation; shock; trauma