Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-27T19:43:19.299Z Has data issue: false hasContentIssue false
  • English
  • Français

Extremity Tourniquet Self-Application by Antarctica Zodiac Crew Members

Published online by Cambridge University Press:  08 November 2023

Carlos Yánez Benñitez Open the ORCID record for Carlos Yánez Benñitez [Opens in a new window] ,
Teófilo Lorente-Aznar ,
Idurre Labaka ,
Iñigo Soteras ,
Marta Baselga ,
Koji Morishita ,
Marcelo Ribeiro Jr.  and
Antonio Güemes
Carlos Yánez Benñitez*
Affiliation:
Department of General, GI, and Acute Care Surgery, San Jorge University Hospital, Huesca, Spain
Teófilo Lorente-Aznar
Affiliation:
Department of Primary Care Medicine, Antarctic Expedition, Jaca Health Center, Paseo de la Constitución, Huesca, Spain
Idurre Labaka
Affiliation:
Emergency Medicine, Donostia University Hospital, Donostia, Spain
Iñigo Soteras
Affiliation:
Emergency Medical System (SEM), Department of Medical Science, University of Girona, Girona, Spain
Marta Baselga
Affiliation:
Surgical, Clinical and Experimental Research Group, Institute for Health Research Aragón, University of Zaragoza, San Juan Bosco, Zaragoza, Spain
Koji Morishita
Affiliation:
Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
Marcelo Ribeiro Jr.
Affiliation:
Department of Trauma, Burns, Critical Care and Acute Care Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, U.A.E.
Antonio Güemes
Affiliation:
Department of General Surgery, Lozano Blesa University Hospital, Zaragoza, Spain
*
Corresponding author: Carlos Yánez Benñitez Email: carlosyb1@gmail.com.
Get access Rights & Permissions [Opens in a new window]

Abstract

Search and rescue teams and Antarctic research groups use protective cold-water anti-exposure suits (AES) when cruising on Zodiacs. Extremity tourniquet (ET) self-application (SA) donned with AESs has not been previously studied. Our study therefore assessed the SA of 5 commercial ETs (CAT, OMNA, RATS, RMT, and SWAT-T) among 15 volunteers who donned these suits. Tourniquet‘s SA ability, ease of SA, tolerance, and tourniquet preference were measured. All ETs tested were self-applied to the upper extremity except for the SWAT, which was self-applied with the rest to the lower extremity. Ease- of- SA mean values were compared using the Friedman and Durbin-Conover post hoc tests (P < 0.001). Regarding the upper extremity, OMNA achieved the highest score of 8.5 out of 10, while RMT, and SWAT received lower scores than other options (P < 0.001). For lower extremities, SWAT was found to be inferior to other options (P < 0.01). Overall, OMNA was the best performer. The RATS showed significantly lower tolerance than the other groups in repeated- measures ANOVA with a Tukey post hoc test (P < 0.01). Additionally, out of the 5 ETs tested, 60% of subjects preferred OMNA. The study concluded that SA commercial ETs are feasible over cold-water anti-exposure suits in the Antarctic climate.

Keywords

tourniquetsimmersion suitsextreme cold weatherAntarctic regions
Type
Concepts in Disaster Medicine
Information
Disaster Medicine and Public Health Preparedness , Volume 17 , 2023 , e561
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Iserson, KV. Remote healthcare at U.S. Antarctic stations: a comparison with standard emergency medical practice. J Emerg Med. 2019;56(5):544-550. doi: 10.1016/j.jemermed.2019.01.009 CrossRefGoogle Scholar
World Atlas. Countries with Antarctic research stations. www.worldatlas.com/articles/30-countries-with-antarctic-research-stations.html. Accessed November 10, 2020.Google Scholar
Secretariat of the Antarctic Treaty. The Antarctic Treaty. https://www.ats.aq/e/antarctictreaty.html. Accessed November 10, 2020.Google Scholar
Muir, S, Barnes, D, Reid, K. Interactions between humans and leopard seals. Antarctic Sci. 2006;18(1):61-74. doi: 10.1017/S0954102006000058 CrossRefGoogle Scholar
Golden, FSC, Tipton, MJ. Essentials of Sea Survival. Human Kinetics; 2002. ISBN: 0-7360-0215-4.Google Scholar
Tipton, MJ. The initial responses to cold-water immersion in man. Clin Sci. 1989;77(6):581-588. doi: 10.1042/cs0770581 Google Scholar
Tipton, MJ, Collier, N, Massey, H, et al. Cold water immersion: kill or cure? Exp Physiol. 2017;102(11):1335-1355. doi: 10.1113/EP086283 Google Scholar
Brooks, CJ. Ship/ rig personnel abandonment and helicopter crew/ passenger immersion suits: the requirements in the North Atlantic. Aviat Space Environ Med. 1986;57(3):276-82.Google Scholar
Rutty, GN. Pathological findings of a fatal leopard seal attack. Forensic Sci Med Pathol. 2007;3(1):57-60. doi: 10.1385/FSMP:3:1:57 CrossRefGoogle ScholarPubMed
Kornblith, AE, Budak, JZ, Simeone, CA, et al. Severe sea lion bites in urban cold-water swimmers. J Emerg Med. 2019;57(6):859-865. doi: 10.1016/j.jemermed.2019.09.009 Google Scholar
Goodwin, T, Moore, KN, Pasley, JD, et al. From the battlefield to main street: tourniquet acceptance, use, and translation from the military to civilian settings. J Trauma Acute Care Surg. 2019;87(1S Suppl 1):S35-S39. doi: 10.1097/TA.0000000000002198 CrossRefGoogle ScholarPubMed
Inaba, K, Siboni, S, Resnick, S, et al. Tourniquet use for civilian extremity trauma. J Trauma Acute Care Surg. 2015;79(2):232-237.Google Scholar
Teixeira, PGR, Brown, CVR, Emigh, B, et al. Civilian prehospital tourniquet use is associated with improved survival in patients with Peripheral Vascular Injury. J Am Coll Surg. 2018;226(5):769-776.e1. doi: 10.1016/j.jamcollsurg.2018.01.047 CrossRefGoogle ScholarPubMed
Kragh, JF Jr, Dubick, MA. Bleeding control with limb tourniquet use in the wilderness setting: review of science. Wilderness Environ Med. 2017;28(2S):S25-S32. doi: 10.1016/j.wem.2016.11.006 CrossRefGoogle ScholarPubMed
Littlejohn, L, Bennett, BL, Drew, B. Application of current hemorrhage control techniques for backcountry care: part two, hemostatic dressings and other adjuncts. Wilderness Environ Med. 2015;26:246-254.CrossRefGoogle ScholarPubMed
Butler, FK, Bennett, B, Wedmore, CI. Tactical combat casualty care and wilderness medicine: advancing trauma care in austere environments. Emerg Med Clin North Am. 2017;35(2):391-407. doi: 10.1016/j.emc.2016.12.005 CrossRefGoogle ScholarPubMed
Geers, D. Special operations individual medical equipment: part I--the major trauma kit. J Spec Oper Med. 2009;9(4):43-52.Google Scholar
Schauer, SG, Naylor, JF, Uhaa, N, et al. An inventory of the combat medics’ aid bag. J Spec Oper Med. 2020;20(1):61-64.Google Scholar
Castellani, JW, Tipton, MJ. Cold stress effects on exposure tolerance and exercise performance. Compr Physiol. 2015;6(1):443-69. doi: 10.1002/cphy.c140081 Google Scholar
Cheung, SS, Montie, DL, White, MD, et al. Changes in manual dexterity following short-term hand and forearm immersion in 10 degrees Celsius water. Aviat Space Environ Med. 2003;74(9):990-3.Google Scholar
Pedrero, RA. Temperatura del aire en las islas Livingston y Decepción, Antártida, en el periodo 2006–2021, y análisis de las tendencias de evolución [bachelor’s thesis]. Madrid, Spain: Universidad de Alcalá; 2022.Google Scholar
Lankford, HV, Fox, LR. The Wind-Chill Index. Wilderness Environ Med. 2021;32(3):392-9. https://doi.org/10.1016/j.wem.2021.04.005 Google Scholar
The JAMOVI project. Jamovi (Version 1.2) [Computer Software]; 2020. https://www.jamovi.org. Accessed November 10, 2020.Google Scholar
Wall, PL, Buising, CM, Hingtgen, E, et al. Clothing effects on limb tourniquet application. J Spec Oper Med. 2020;20(2):83-94.Google Scholar
McCarty, JC, Hashmi, ZG, Herrera-Escobar, JP et al. Effectiveness of the American College of Surgeons bleeding control basic training among laypeople applying different tourniquet types: a randomized clinical trial. JAMA Surg. 2019;154(10):923-929. https://doi.org/10.1001/jamasurg.2019.2275 Google Scholar
Beaven, A, Sellon, E, Ballard, M, et al. Combat Application Tourniquet fares well in a chemical, biological, radiological, or nuclear dress state. BMJ Mil Health. 2021;167(2):75-79. doi: 10.1136/jramc-2019-001261 Google Scholar
Lechner, R, Beres, Y, Oberst, A, et al. Analysis of tourniquet pressure over military winter clothing and a short review of combat casualty care in cold weather warfare. Int J Circumpolar Health. 2023;82(1):2194141. doi: 10.1080/22423982.2023.2194141 Google Scholar
Kragh, JF Jr, Moore, VK 3rd, Aden, JK 3rd, et al. Short report comparing Generation 6 versus Prototype Generation 7 Combat Application Tourniquet® in a Manikin Hemorrhage Model. J Spec Oper Med. 2016;16(1):14-7.Google Scholar
Hingtgen, E, Wall, PL, Buising, CM. OMNA Marine Tourniquet Self-Application. J Spec Oper Med. 2020;20(3):52-61. doi: 10.55460/6KC3-CFTS Google Scholar
Wall, PL, Sahr, SM, Buising, CM. Different width and tightening system: emergency tourniquets on distal limb segments. J Spec Oper Med. 2015;15(4):28-38.CrossRefGoogle ScholarPubMed
Peponis, T, Ramly, E, Roth, KA, et al. Tourniquet effectiveness when placed over the Joint Service Lightweight Integrated Suit Technology. J Spec Oper Med. 2016;16(2):17-9.Google Scholar
Chan, ED, Chan, MM, Chan, MM. Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med. 2013;107(6):789-99. doi: 10.1016/j.rmed.2013.02.004 CrossRefGoogle ScholarPubMed
Hingtgen, E, Wall, PL, Buising, CM. OMNA Marine Tourniquet Self-Application. J Spec Oper Med. 2020;20(3):52-61.Google Scholar
Graham, B, Breault, MJ, McEwen, JA, et al. Occlusion of arterial flow in the extremities at sub-systolic pressures through the use of wide tourniquet cuffs. Clin Orthop. 1993;286:257-261.CrossRefGoogle Scholar