title: Evaluating new types of tourniquets by the Israeli Naval special warfare unit.
abstract: BACKGROUND
  Extremity injuries, which accounts for 20% of all battlefield injuries, result in 7-9% of deaths during military activity. Silicone tourniquets were used, by the Israeli Defense Force (IDF) soldiers, for upper extremity and calf injuries, while thigh injuries were treated by an improvised "Russian" tourniquet (IRT). This is the first study, performed in the IDF, comparing the IRT with Combat Application Tourniquets (CAT) and Special Operations Force Tactical Tourniquets (SOFTT). 23 operators from the Israeli Naval Unit (Shayetet 13) were divided into two groups according to their medical training (11 operators trained as first-responders; 12 operators as medics). Repetitive applications of the three tourniquets over the thigh and upper arm, and self-application of the CAT and SOFTT over the dominant extremity were performed using dry and wet tourniquets (828 individual placements) with efficacy recorded. Cessation of distal arterial flow (palpation; Doppler ultrasound) confirmed success, while failure was considered in the advent of arterial flow or tourniquet instability. Satisfaction questionnaires were filled by the operators.
  
  
  RESULTS
  CAT and SOFTT were found to be superior to the IRT, in occluding arterial blood flow to the extremities (22%, 23% and 38%, respectively, failure rate). The application was quicker for the CAT and SOFTT as compared to the IRT (18, 26, 52 seconds, respectively). Wet tourniquets neither prolonged application nor did they increase failure rates. Similarly, medics didn't have any advantage over non-medic operators. No findings indicated superiority of CAT and SOFTT over one another, despite operators' preference of CAT.
  
  
  CONCLUSIONS
  CAT and SOFTT offer an effective alternative to the IRT in stopping blood flow to extremities. No difference was observed between medics and non-medic operators. Thus, the CAT was elected as the preferred tourniquet by our unit and it is being used by all the operators.
authors.affiliation: Department of Vascular Surgery, Assaf Harofeh Medical Center, affiliated to the Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Eitan
authors.initials: E
authors.lastname: Heldenberg
authors.affiliation: Israeli Naval Special Warfare Unit, Israeli Navy, Isreal Defence Forces, Kragujevac, Israel.
authors.forename: Shahar
authors.initials: S
authors.lastname: Aharony
authors.affiliation: Israeli Naval Special Warfare Unit, Israeli Navy, Isreal Defence Forces, Kragujevac, Israel.
authors.forename: Tamir
authors.initials: T
authors.lastname: Wolf
authors.affiliation: Department of Psychiatry, Maayanei Hayeshouha Medical Center, Bnai Berak, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Vishne
keywords: Combat application tourniquet; External bleeding; Special operations force tactical tourniquet; Tactical combat casualty care