3D printed open source tourniquet: Rationale, failure analysis and proposed next steps of the Glia tourniquets during the Gaza protests (May 11)

Tourniquets ready for packaging. Source: Glia. License: CC-By-SA

Why we need a 3D printed tourniquet

A terrible decision to deal with a terrible situation: Why we deployed before we were ready

Tourniquet training at Hayat Center. Gaza, 2018. Source: Glia. License: CC-By-SA
Left: Obvious lower limb injury with marked blood loss in patient Abdulrahman Nofal in Gaza, April 17, 2018. This patient had hemorrhagic shock upon arrival at the ED. He survived with an amputation. Photo from Alray. Right: Distribution of injuries by location. Source: Palestinian Ministry of Health
Improvised tourniquet, Gaza 2018. Source unknown

Deployment on May 11, 2018

Field training on the use of trauma tourniquets. Gaza, 2018. Source: Glia Project. License: CC-By-SA

Failure #1: There are no ideal operating conditions

Left: Israelis launch teargas at protestors using a vehicle-mounted launcher. Right: A gunshot victim with an open tib-fib fracture and partial amputation of his left leg proximal to the ankle is being lifted by his friend. His friend was stopped from lifting him so we could deliver rapid primary treatment before evacuation. Source: AFP via El Comercio[1][2]

Failure #2: The packaging was designed badly

Failure #3: We deployed an old model we knew had the potential for internal belt failure

New model tested to failure on manikin. Source: Glia. License: CC-By-SA
Top: Recovered windlass of old model used on patient that failed catastrophically. Note sharp edge in belt slot. Bottom: New model. Note curved edges.
First responder applying manual pressure after catastrophic tourniquet failure in patient with left proximal thigh gunshot wound. Source: Glia. License: CC-By-SA

Failure #4: An unexpected buckle failure

Conclusions

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Tarek is an emergency physician at London Health Sciences Centre (Canada) and Shifa Hospital (Gaza). He is a member of the Glia team making open medical devices

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Tarek Loubani

Tarek Loubani

Tarek is an emergency physician at London Health Sciences Centre (Canada) and Shifa Hospital (Gaza). He is a member of the Glia team making open medical devices

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