• Dean Nachman, Avi Benov, Amiram Shovali, Yavnai Nirit, Roy Nadler, Yitzhak Avraham, and Elon Glassberg.
• Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Military POB 02149 Tel Hashomer, Ramat Gan, Israel, Military Postal Code 01215.
• Mil Med. 2017 Mar 1; 182 (S1): 53-58.

BackgroundThe Combat Application Tourniquet (CAT) is the tourniquet of choice in the Israeli defense forces. Applying the device loosely before windlass twisting is a main pitfall in CAT application. This study objective is to assess the effectiveness of a novel design modification of the CAT, aiming to prevent loose applications, by minimizing the slack.MethodsUsing the HapMed leg tourniquet trainer, an above the knee traumatic amputation was simulated. Active duty combatants and Special Forces basic medics were randomly assigned to apply the modified (n = 67) or conventional CAT (n = 65) once. Applied pressure, hemorrhage control status, time to stop the bleeding, and estimated blood volume loss were measured.ResultsUsing the modified CAT, the mean (±SD) pressure applied was significantly higher compared to the conventional one (231.49 ± 37.84 mm Hg vs. 213.31 ± 45.51 mm Hg, p < 0.05). Hemorrhage control rate was 86.6% in the modified CAT group versus 67.7% in the conventional CAT group (p < 0.05). Analyzing only the applications that succeeded in hemorrhage control, blood loss (171.12 ± 72.43 mL vs.187.75 ± 91.72 mL, p > 0.05) and time to stop bleeding (27.27 ± 13.15 seconds vs. 27.5 ± 11.25 seconds, p > 0.05) were similar.ConclusionsThe modified CAT demonstrated an upgraded pressure profile and hemorrhage control rate, potentially indicating its improved efficacy.Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

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