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C. med. s. Nazymok Ye. V., C. med. s. Biryuk I. G., ٭ C. med. s. Protsak T. V., ٭٭ C. med. s. Zinevych Ia. V.

Higher State Educational Establishment of Ukraine Bukovinian State Medical University, Department of Disaster medicine and military medicine (Head of department, Assistant of professor, I. G. Biryuk), Chernivtsi, Ukraine;

٭Assistant of professor, Department of Human Anatomy named after M. H. Turkevych, Higher State Educational Establishment of Ukraine Bukovinian State Medical University, Chernivtsi, Ukraine;

٭٭Assistant of professor, Department of Medical and Biological disciplines, National University of Physical Education and Sport of Ukraine Kyiv, Ukraine.

 

Different techniques of applying tourniquets

 

The technique of application of the Tourniquet has been an established many years ago as a means to affect blood supply to a distant part of a limb.

In 1593, Wilhelm Fabry of Hilden (Fabricius Hildanus), often called the father of German surgery, described use of a stick to twist a circumferentially constrictive bandage in amputation surgery. The stick, sometimes called a Spanish windlass, acted as a means to gain mechanical advantage in tightening (Pilcher L.S., 1899).

The most spread method of a temporary arrest of arterial bleeding is applying tourniquet. Esmarchs bandage (Johannes Friedrich August von Esmarch (1823-1908), a German surgeon) is a strong rubber tube 1,5 m long with a metal chain on one end and a hook on another one. The tourniquet can be applied on the upper arm, forearm, ankle, femur etc.

Of a large number of versions of existing tourniquets drew the attention to the Emergency Medical Tourniquet (EMT). It was designed and distributed by Delfi Medical Innovations (Vancouver, BC, Canada). It was invented by a team led by James A. Mc-Ewen and made by a company with extensive organizational expertise in designing tourniquets for elective use in the operating room.

The EMT device is a pneumatic tourniquet that has a bladder that goes around the limb, a clamp that limits the inflated portion while holding the bladder close to the limb, and an inflator bulb with connector tube and twist cap. The bladder, 88 mm wide, has midpoint spot welds so that the cuff lies flat and wide on the skin. These features make it similar to a blood pressure cuff except for the clamp. The EMT clamp is precision-milled; has individual device serial numbers; and is designed for use in hospitals, clinics, or ambulances (Naimer S.A., 2014).

The Combat Application Tourniquet (CAT) was invented by military medics in an Afghanistan (Shipman N. et al., 2009). CAT utilizes a durable windless system with a free-moving internal band with a Velcro fastening system providing circumferential pressure to the extremity. Once adequately tightened a hook and loop windless retention strap is then applied, securing the it to maintain pressure during casualty evacuation. The CATs dual securing system avoids the use of screws and clips which can become difficult to operate under survival stress or where fine motor skills are compromised.

The CATs effectiveness rate was the highest of the field tourniquets at 79% in stopping compressible bleeding on the battlefield (Kragh et al., 2008) and therefore this is the device of choice in this class.

Israeli Bandage designed to increase the pressure under pressure applicator (pressure bar). The bandage is similar to elastic bandage used for wrapping sprained ankle, knees, elbows or wrists. Three special components have been included in this they are: the dressing, pressure bar, closure bar. The dressing is a non adhering dressing that allows removing the bandage without reopening the wound. The pressure bar improves the pressure under the pressure bar to stop bleeding. The closure bar secures the bandage with sliding motion. Additional pressure can be build up by sliding the closure bar under the surface dressing layer.

The bandages are provided in various sizes such as: 4-inches wide, 6-inches wide, 8-inches wide.

The tourniquets should be used at the right time in the right way for the right casualties saved lives!