title: Effect of Uniform Design on the Speed of Combat Tourniquet Application: A Simulation Study.
abstract: Tourniquets are issued to deployed members of both the United States (U.S. military and the Australian Defence Force (ADF). The ease of removing the tourniquet from the pocket of the combat uniform may influence its time to application. The ADF uniform uses buttons to secure the pocket, whereas the U.S. uniform uses a hook and loop fastener system. National differences in training may influence the time to and effectiveness of tourniquet application.
  
  
  
  To compare the time taken to retrieve and apply a tourniquet from the pocket of the Australian and the U.S. combat uniform and compare the effectiveness of tourniquet application.
  
  
  
  Twenty participants from both nations were randomly selected. Participants were timed on their ability to remove a tourniquet from their pockets and then apply it effectively.
  
  
  
  The U.S. personnel removed their tourniquets in shorter time (median 2.5 seconds) than Australians (median 5.72 seconds, p < 0.0001). ADF members (mean 41.36 seconds vs. 58.87 seconds, p < 0.037) applied the tourniquet more rapidly once removed from the pocket and trended to apply it more effectively (p = 0.1).
  
  
  
  The closure system of pockets on the combat uniform might influence the time taken to apply a tourniquet. Regular training might also reduce the time taken to apply a tourniquet effectively.
authors.affiliation: NATO Role 3 Multinational Medical Unit, APO AE09355, Kandahar Airfield, Afghanistan.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Higgs
authors.affiliation: NATO Role 3 Multinational Medical Unit, APO AE09355, Kandahar Airfield, Afghanistan.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Maughon
authors.affiliation: NATO Role 3 Multinational Medical Unit, APO AE09355, Kandahar Airfield, Afghanistan.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ruland
authors.affiliation: NATO Role 3 Multinational Medical Unit, APO AE09355, Kandahar Airfield, Afghanistan.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Reade
mesh_terms: D000328:Adult; D001315:Australia; D003020:Clothing / Q000592:standards*; D004867:Equipment Design / Q000592:standards*; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D016544:Patient Simulation; D013997:Time Factors; D014111:Tourniquets; D014481:United States