title: Role of the Windlass in Improvised Tourniquet Use on a Manikin Hemorrhage Model.
abstract: BACKGROUND
  In emergencies when commercially designed tourniquets are unavailable, hemorrhage may need to be controlled with improvised tourniquets. In the aftermath of the Boston Marathon bombing, no improvised strap-and-windlass tourniquets were used to treat casualties; tourniquets without windlasses were used. The purpose of the present study is to determine the effectiveness of improvised tourniquets with and without a windlass to better understand the role of the windlass in tightening the tourniquet strap.
  
  
  METHODS
  An experiment was designed to test the effectiveness of improvised strap-and-windlass tourniquets fashioned out of a tee shirt on a manikin thigh. Two users conducted 40 tests each with and without the use of a windlass.
  
  
  RESULTS
  Without a windlass, improvised tourniquets failed to stop bleeding in 99% of tests (79 of 80 tests). With a windlass, improvised tourniquets failed to stop bleeding in 32% of tests (p < .0001). In tests with no windlass, attempts to stop the pulse completely failed (100%, 80 of 80 tests). With a windlass, however, attempts to stop the pulse failed 31% of the time (25 of 80 tests); the difference in proportions was significant (p < .0001).
  
  
  CONCLUSIONS
  Improvised strap-and-windlass tourniquets were more effective than those with no windlass, as a windlass allowed the user to gain mechanical advantage. However, improvised strap-and-windlass tourniquets failed to control hemorrhage in 32% of tests.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Altamirano
authors.forename: John F
authors.initials: JF
authors.lastname: Kragh
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Michael A
authors.initials: MA
authors.lastname: Dubick
mesh_terms: D004867:Equipment Design; D005392:First Aid / Q000295:instrumentation* / Q000379:methods*; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008348:Manikins; D008954:Models, Biological; D014111:Tourniquets