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MATCombat™ Tourniquet

Training Presentation

© 2014 Pyng Medical Corp. August 2014 PM-181a

Pyng Medical Corp. www.pyng.com 1-604-303-7964

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Why Tourniquets?

• Severe limb trauma is a common cause of moderate to severe extremity bleeding, amputation and fatalities

• Severe hemorrhage is the #1 preventable cause of death on the battlefield

• Tourniquet use controls life-threatening hemorrhage from an extremity injury and increases patient survival

• Tourniquets have been used in the military and civilian pre-hospital care for thousands of years to save lives and limbs

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Why Tourniquets?

• Every service member in the U.S. Military is deployed with a tourniquet as part of their first aid kit

• If applied correctly and efficiently, tourniquets save lives with low incidence of adverse side effects

• Methods to stop moderate to severe bleeding such as pressure points and dressing takes considerably longer and do not ensure that blood loss is completely stopped

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• FAST: application and blood-flow occlusion in under 30 seconds

• SAFE: compression can be applied in small, controlled increments

• EASY TO USE: designed for all levels of medical personnel and can be quickly taught to non-medical personnel

• EFFECTIVE: provides 100% blood flow occlusion (as measured by Doppler, BP and Oximeter sensors)

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• EFFICIENT: can be applied with one hand

• MULTI-PURPOSE: the open C-Cuff design allows MATCombat™ to be applied to both arms and legs, including trapped limbs

• VERSATILE: can be used on limbs as small as a 4” diameter forearm to a 39” circumference thigh

• RAPID RELEASE: easy release and/or re-application in 10 seconds or less

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• SECURE: Mechanical Advantage system ensures that tourniquet does not slip or loosen

• LIGHT-WEIGHT: weighs under 6 ounces and comes in a compact package

• DURABLE: operates in extreme and adverse conditions such as mud and grime submersion, water submersion, sand submersion, extreme cold, ice-encrustment and hard surface (concrete) impact

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Adjustment Buckle

Turn Key

C-Cuff (or) Chassis

Release Button

Adjustment Webbing

Application Time Label

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• Open C-Cuff design (aka Chassis) provides easy application to both arms and legs

• Buckle and Strap design provides fast, trapped limb application

• Turn Key system provides easy and safe tightening of the tourniquet in small, controlled increments, making it adjustable for various body types and sizes

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• Turn Key Mechanical Advantage Mechanism ensures no slipping or loosening of the tourniquet

• Mechanical Advantage Mechanism creates sufficient pressure to occlude arterial blood flow with the slightest user applied force—allowing for one-handed applications with injured hands, or as little as two fingers

• Release Button, along with the buckle, provides for fast loosening, releasing, and re-application of the tourniquet

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Application Procedure

1. PLACEMENT:

Tourniquets in general are to be placed on the injured limb approximately 1-2 inches (2.5-5 cm) above the point of injury, this is true for the MATCombat

Some units have application protocols that direct the placement to be as high on the injured limb as possible—be sure to follow your medical direction and control requirements for tourniquet placement

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Application Procedure

2. ORIENTATION of the CHASSIS HOOK: How the MATCombat is oriented on the casualty depends on where the Provider positions themselves relative to the Casualty This is about getting maximum leverage for tightening while pulling the webbing through the adjustment buckle. You want to PULL, not PUSH, therefore, ALWAYS orient the Chassis Hook toward YOU or your dominant hand The rule is to ALWAYS point the Chassis Hook toward the Provider

Working Across the Casualty Working at Side of Casualty

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Application Procedure

3. OPEN or CLOSED Loop PLACEMENT—There are two techniques for applying the MATCombat. They include (1) slipping the tourniquet on over the injured limb with the buckle already connected, or, (2) positioning the chassis and then wrapping the adjustment end of the webbing around the injured limb, and connecting the buckle to the hook on the chassis—which you use depends on (vehicle, confined space, limb, injury, etc.)

Technique-1 Technique-2

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Application Procedure

4. PULL—Hold the chassis in one hand, and with the other PULL the loose end of the adjustment webbing until the tourniquet is seated tightly against the Casualty’s injured limb. You should not be able to fit more than 1-2 fingers underneath the webbing at this point.

It is important to tightly pull the webbing before rotating the Turn Key

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Application Procedure

5. ROTATE—Begin turning the Turn Key clockwise to tighten the tourniquet. • Continue turning until bleeding stops, or hemorrhage is controlled.

• The patented mechanical application system on the MATCombat allows for fine micro

adjustments in pressure, requiring minimal user applied force by the Provider during application.

• The Turn Key is easy to turn even in one-handed applications with a wounded hand.

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Application Procedure

6. RECORD—A critical step in any tourniquet application is to record the time of application, or, any adjustments made while the Casualty is wearing the tourniquet The MATCombat provides a label for this, it is on the upward face of the Turn Key A sharpie or ink pen is best for this step

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Secure Webbing Procedure

SECURE Excess Webbing before TACEVAC:

Depending on the injured limb size, the MATCombat may have excess adjustment webbing that could become entangled releasing tourniquet pressure and causing a potentially fatal rebleed This excess webbing should be secured before attempting to move of evacuate the Casualty Any number of methods will work, however, this is one we have found works well and is easily removed when needed

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Secure Webbing Procedure

SECURE Excess Webbing before TACEVAC

NOTE: Teaching you how to secure the excess webbing, is very much like trying to teach you to tie a knot. It is the same level of complexity when using words, therefore, we’ll combine the photos with the descriptions—the bottom-line, any method used to secure the excess webbing is all that is important. This is just one technique!

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Secure Webbing Procedure

#1 Wrap—following the webbing around the limb

#2 The webbing should wrap over the turnkey

#3 push the end of the webbing under the wrap and pull tight

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Secure Webbing Procedure

FINISH securing the webbing with a quick-release tab. This permits rapid release of the tie when needed yet will keep the excess webbing secure during transport

Q-Release facing up

Q-Release facing down

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Adjustment/Removal Procedure NOTE: ADJUSTMENT or REMOVAL—There may be occasion where the tourniquet will require adjustment, or, removal. Following are the recommended steps for this procedure. They are shown with the MATCombat not on a Casualty to increase clarity of the process.

After loosening the adjustment webbing so that it is free standing, flip up the Turn Key so that it can rotate freely—PUSH the RELEASE button. IMPORTANT—if you hold the Turn Key in your other hand, you can control the counterclockwise unwinding of the mechanism; otherwise, the release will be rapid and could cause a hazardous rebleed on the casualty. It is always best to control the release of pressure on a tourniquet

CAUTION: As soon as you press the RELEASE button the turnkey will spin counterclockwise and release tourniquet pressure

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Adjustment/Removal Procedure

After loosening the adjustment webbing so that it is free standing: (1) flip up the Turn Key so that it can rotate freely—PUSH the RELEASE button. (2) IMPORTANT—if you hold the Turn Key in your other hand while you press the RELEASE button, you can control the counterclockwise unwinding of the mechanism; otherwise, the release will be rapid and could cause a hazardous rebleed on the casualty. It is always best to control the release of pressure on a tourniquet

#1

#2

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Adjustment/Removal Procedure

PUSH the BUCKLE: Another way to loosen pressure on the MATCombat for adjustments or removal is the press the spring loaded gate on the Adjustment Buckle Doing this will lift the teeth from the adjustment webbing, and the webbing will release circumferential pressure Be certain this is what you want to accomplish before pressing on the buckle gate

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Adjustment/Removal Procedure

UNHOOK BUCKLE—To remove or effect the final release of the tourniquet, you can unhook the buckle and remove the MATResponder altogether. NOTE: If the tourniquet is going to be moved and reapplied on the same patient, remember it must be placed in the READY mode again. To do this, extend the buckle to the far end of the adjustment webbing, then push the RELEASE button, and while grasping the near end of the webbing, pull the webbing all the way out of the chassis again. (See Instructions Slide 26)

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CLINICAL USE WARNING:

Re-use of MATCombat™ is not recommended once it has been used on an injured person, due to the potential of cross-contamination. Serious injury or death may result.

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TRAINING USE:

MATCombat™ can be used multiple times for training purposes, as long as it is properly RESET each time (see next slide).

WARNING:

If the MATCombat™ device is not properly reset, there is a risk that the Turn Key mechanism may bind or fail to work properly.

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To RESET the MATCombat for reapplication:

(1) Pushing the RED RELEASE button

(2) Simultaneously PULL the webbing out of the C-Cuff or Chassis with your other hand

#1 #2

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To RESET the MATCombat for reapplication:

(3) PULL the adjustment webbing out until the Turn Key stops rotating

(4) PULL until you can see the stitching and polycarbonate webbing attachment point, shown here

#3 #4

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To RESET the MATCombat for reapplication:

(5) PULL the BUCKLE out to the end of the adjustment webbing—as shown

(6) The MATCombat is now READY for reapplication or storage for future (TRAINING) use

#5 #6

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References

• Doyle, GS, Tailac, PP, Tourniquets: A review of Current Use with Proposals for Expanded Prehospital Use. Prehospital Emergency Care 2008, 12:2, 241-256

• Richey, SL, Tourniquets for the Control of Traumatic Hemorrhage: A Review of the Literature, World Journal of Surgery, 2007, 2:28

• Mabry, RL, Tourniquet Use on the Battlefield, Military Medicine 2006; 171:352-356

• Kalish, J. Burke, P. Feldman, J. The Return of Tourniquets, JEMS, AUG 2008, Vol. 33:8

• Army Medical Training Center Test 4/8/2005

• NEDU ONR/MARSYSCOM Test 6-8/2005

• NEDU ONR/MARSYSCOM Test 8-11/2006

• Navy Trauma Training Center Test 7-9/2005