title: Randomised controlled trial comparing marksmanship following application of a tourniquet or haemostatic clamp in healthy volunteers.
abstract: BACKGROUND
  In a care under fire situation, a first line response to haemorrhage is to apply a tourniquet and return fire. However, there is little understanding of how tourniquets and other haemorrhage control devices impact marksmanship.
  
  
  METHODS
  We compared the impact of the iTClamp and the Combat Application Tourniquet (CAT) on marksmanship. Following randomisation (iTClamp or CAT), trained marksmen fired an AR15 at a scaled silhouette target in prone unsupported position (shooting task). Subjects then attempted to complete the shooting task at 5, 10, 15, 30 and 60 min post-haemorrhage control device application.
  
  
  RESULTS
  All of the clamp groups (n=7) completed the 60 min shooting task. Five CAT groups (n=6) completed the 5 min shooting task and one completed the 5 and 10 min shooting task before withdrawing. Four CAT groups were stopped due to unsafe handling; two stopped due to pain. When examining hits on mass (HOM) for the entire shooting task, there was no significant difference between tourniquet and iTClamp HOM at 5 min (p=0.18). However, there was a significant difference at 10 min, p=0.003 with tourniquet having significantly fewer HOM (1.7±2.7 HOM) than the iTClamp (8.1±3.3 HOM) group. The total effective HOM for the entire 60 min shooting task showed that the iTClamp group achieved significantly (p=0.001) more HOM than the tourniquet group. Over the entire 60 min shooting exercise, the iTClamp group achieved a median 72% (52/72) of available HOM while the tourniquet group obtained 19% (14/72).
  
  
  CONCLUSIONS
  Application of a tourniquet to the dominant arm negates effective return of fire in a care under fire setting after a brief time window. Haemorrhage control devices that preserve function may have a role in care under fire situations, as preserving effectiveness in returning fire has obvious operational merits.
authors.affiliation: Department of Surgery, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: LaPorta
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: A W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Department of Research, Innovative Trauma Care, Edmonton, Alberta, Canada.
authors.forename: J L
authors.initials: JL
authors.lastname: Mckee
authors.affiliation: Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: D J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: H
authors.initials: H
authors.lastname: Tien
authors.affiliation: Canadian Forces Health Services Centre, Ottawa, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Beckett
authors.affiliation: Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: C G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: City of Edmonton, Edmonton, Alberta, Canada.
authors.forename: I
authors.initials: I
authors.lastname: Mckee
authors.affiliation: Caleo Health, Calgary, Alberta, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Louw
authors.affiliation: Department of Surgery, Center for Translational Injury Research, UT Health, Houston, Texas, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D064368:Healthy Volunteers; D006470:Hemorrhage / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D013647:Task Performance and Analysis; D014111:Tourniquets
keywords: ACCIDENT & EMERGENCY MEDICINE; EXTREMITY INJURY; Hemorrhage Control; Marksmanship; Military Medicine; PAIN MANAGEMENT