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Randomised controlled trial comparing marksmanship following application of a tourniquet or haemostatic clamp in healthy volunteers
  1. Anthony LaPorta1,
  2. A W Kirkpatrick2,
  3. J L Mckee3,
  4. D J Roberts2,
  5. H Tien4,
  6. A Beckett5,
  7. C G Ball4,
  8. I Mckee6,
  9. D Louw7 and
  10. J B Holcomb8
  1. 1Department of Surgery, Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
  2. 2Department of Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
  3. 3Department of Research, Innovative Trauma Care, Edmonton, Alberta, Canada
  4. 4Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Canadian Forces Health Services Centre, Ottawa, Ontario, Canada
  6. 6City of Edmonton, Edmonton, Alberta, Canada
  7. 7Caleo Health, Calgary, Alberta, Canada
  8. 8Department of Surgery, Center for Translational Injury Research, UT Health, Houston, Texas, USA
  1. Correspondence to Col (Rtd) Anthony J LaPorta MD,FACS, Professor of Surgery and Military Medicine, Rocky Vista University School Medicine, 8401 S Chambers Rd, Parker CO, 80134. 720 875 2800-ext 2401, c-719 339 0177; alaporta{at}


Background In a care under fire situation, a first line response to haemorrhage is to apply a tourniquet and return fire. However, there is little understanding of how tourniquets and other haemorrhage control devices impact marksmanship.

Methods We compared the impact of the iTClamp and the Combat Application Tourniquet (CAT) on marksmanship. Following randomisation (iTClamp or CAT), trained marksmen fired an AR15 at a scaled silhouette target in prone unsupported position (shooting task). Subjects then attempted to complete the shooting task at 5, 10, 15, 30 and 60 min post-haemorrhage control device application.

Results All of the clamp groups (n=7) completed the 60 min shooting task. Five CAT groups (n=6) completed the 5 min shooting task and one completed the 5 and 10 min shooting task before withdrawing. Four CAT groups were stopped due to unsafe handling; two stopped due to pain. When examining hits on mass (HOM) for the entire shooting task, there was no significant difference between tourniquet and iTClamp HOM at 5 min (p=0.18). However, there was a significant difference at 10 min, p=0.003 with tourniquet having significantly fewer HOM (1.7±2.7 HOM) than the iTClamp (8.1±3.3 HOM) group. The total effective HOM for the entire 60 min shooting task showed that the iTClamp group achieved significantly (p=0.001) more HOM than the tourniquet group. Over the entire 60 min shooting exercise, the iTClamp group achieved a median 72% (52/72) of available HOM while the tourniquet group obtained 19% (14/72).

Conclusions Application of a tourniquet to the dominant arm negates effective return of fire in a care under fire setting after a brief time window. Haemorrhage control devices that preserve function may have a role in care under fire situations, as preserving effectiveness in returning fire has obvious operational merits.

  • Marksmanship
  • Military Medicine
  • Hemorrhage Control

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