Abstract:
A portable pneumatic abdominal aortic tourniquet for occlusion of the abdominal descending aorta to restrict blood supply to a non-compressible arterial hemorrhage in or below the inguinal region is presented. The tourniquet includes an adjustable waist strap for securing it around the abdomen of a patient and a windlass rod connected to the waist strap to selectively tighten the strap as needed to tightly secure it to patient. A directed air bladder is mounted to the waist strap having a generally “V” shaped construction and is expanded for exerting directed pressure against the abdomen. Upon inflation of the air bladder and adjustment of the windlass, occlusion or restriction of blood flow through the abdominal descending aorta will occur which will achieve cessation of hemorrhage in or below the inguinal area or achieve other therapeutic effects like elevated blood pressure to enhance CPR or blood flow control to the lower extremities.

Description:
This application claims the benefit of filing priority under 35 U.S.C. §119 and 37 C.F.R. §1.78 of pending U.S. patent application Ser. No. 12/150,728 filed Apr. 30, 2008 which, in turn, claims priority to U.S. Provisional Application Ser. No. 60/915,642 filed May 2, 2007 both of which are incorporated herein by reference. This application also claims priority to pending U.S. application Ser. No. 13/983,500 received Aug. 2, 2013 in the USPTO which is the national stage entry of PCT Application Serial No. PCT/US2012/023886 which, in turn, claims priority to U.S. Provisional Application Ser. No. 61/439,628 filed Feb. 4, 2011 which is also incorporated herein by reference. All information disclosed in those prior pending applications is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates generally to tourniquets. In greater particularity, the present invention relates to field dressings that utilize mechanical pressure to achieve homeostasis at the site of an injury. In even greater particularity, the present invention relates to strap-on tourniquets positioned to apply pressure on the body to stop bleeding. 
     BACKGROUND OF THE INVENTION 
     Various tourniquet devices that use a wide variety of clamping and/or pneumatic means to apply pressure to various limbs on the body have been attempted. However, prior attempts at cessation of hemorrhage from the major blood vessels of the body at or below the inguinal area have not been no completely successful, especially if attempted on gross battle-field wounds such as leg amputations due to anti-personnel mines or high velocity bullet percussion wounds to the lower extremities. Quite often, such wounds do not provide a satisfactory compressible site to stop arterial hemorrhages and require occlusion of the abdominal descending aorta to cut-off the blood supply to the wound in order to protect the patient&#39;s life. 
     However, compressing the abdominal descending aorta is a difficult exercise. One of the major obstacles to providing an effective portable abdominal aortic tourniquet is in providing a focused compression force over the targeted area on the abdomen to achieve aorta occlusion. Typically, most tourniquets apply a constricting force around the circumference of a limb or over a broad area to reduce total blood flow through the limb. Such a broad application of force is ineffective to reduce or occlude blood flow through the descending aorta proximal to the bifurcation in the abdomen due to the deep location of the aorta in the body. A strong focused pressure is required to reach the descending aorta and reduce blood flow. Prior inventions fail to show or disclose a technique for focusing a compression force in the abdomen to operate as an abdominal aortic tourniquet. 
     For example, US Patent Application Publication No. 2007/0191881 A1 (Amisar et al.) shows a tourniquet that includes a pressure source and a selector leaver attached to a cam to facilitate manual selection of a designated pressure. This tourniquet is designed to apply pressure around a limb. There is no teaching in the patent that this device would be effectively useable as an abdominal aortic tourniquet. Further, the air bladder is not a directed air bladder that would focus the compression force, but is rounded to wrap around the limb and spread the pressure force over a broad area. Such a broad application of constricting force is unusable if intended to reduce or occlude circulation through the descending aorta for a non-compressible arterial hemorrhage in the abdominal region. 
     U.S. Pat. No. 5,234,459 (Lee) shows an inflatable balloon for use in a tourniquet. The patent discloses a manual pump for inflating the balloon. There is no disclosure of the balloon having a directed shape for focusing a compression force, or that the tourniquet is in any way designed to work as an abdominal aortic tourniquet. This tourniquet is representative of a vast majority of pneumatic prior art tourniquet devices which completely fail to address the specific problems associate with providing an effective abdominal aortic tourniquet 
     U.S. Pat. No. 6,884,254 (Brooks) shows a tourniquet system that includes a leverage assisted clamp means for tightening the strap around a limb. This patent is representative of a large section of the prior art that uses mechanical means, as opposed to pneumatic to provide a constricting force around a limb. Again, such devices fail to provide the directed compression force required to restrict blood flow through the descending aorta. 
     Therefore, what is needed is a portable abdominal aortic tourniquet that can be rapidly applied under field conditions that includes a means for tensioning the tourniquet upon a patient rapidly and with sufficient force to ensure abdominal aortic occlusion. 
     SUMMARY OF THE INVENTION 
     The invention is a pneumatic abdominal aortic tourniquet that has an adjustable waist strap for securing it around a patient&#39;s abdomen. A rigid base plate is carried by the waist strap having a width greater than the waist strap so that the base plate extends laterally outward from the waist strap to provide a stable base for positioning over a selected area of the patient&#39;s abdomen. An air bladder is affixed to the underside of the base plate. Initially, the air bladder is kept in a deflated condition collapsed against the base plate, but is upon actuation of the tourniquet expands to an inflated condition and extends outwardly from the bottom side of the base plate. The directed air bladder has a generally “V” cuneiform shaped construction so that a wide end of the directed air bladder is generally carried on the bottom side of the base plate and a narrow end of the directed air bladder presses against the abdomen when in the inflated condition. The narrow end of the bladder extends into the abdomen of the patient so that a constricting force is focused against a narrow defined area within the abdomen causing restriction of blood flow through the abdominal aorta. The tourniquet includes an air source operatively connected in fluid communication with the directed air bladder for operating the directed air bladder between the deflated condition and the inflated condition. The tourniquet also includes a tensioning means comparable to a mechanical “windlass” that allows a user to further tighten the base of tourniquet against the patient thereby facilitating effective aorta occlusion. 
     Other features and objects and advantages of the present invention will become apparent from a reading of the following description as well as a study of the appended drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       A tourniquet incorporating the features of the invention is depicted in the attached drawings which form a portion of the disclosure and wherein: 
         FIG. 1  shows a perspective view of a pneumatic abdominal aortic tourniquet attached in an operative condition to a patient according to the present invention; 
         FIG. 1A  shows a representative human form indicating where the pneumatic abdominal aortic tourniquet is to be applied according to the present invention; 
         FIG. 2A  shows a perspective view of the pneumatic abdominal aortic tourniquet in a deflated condition being secured around a patient&#39;s lower abdomen according to the present invention; 
         FIG. 2B  shows a perspective view of the waist strap for the pneumatic abdominal aortic tourniquet being tightened around a person&#39;s lower abdomen according to the present invention; 
         FIG. 2C  shows a perspective view of the pneumatic abdominal aortic tourniquet in an inflated condition according to the present invention; 
         FIG. 3  shows a detailed perspective view of the pneumatic abdominal aortic tourniquet according to the present invention; 
         FIG. 4A  shows a top plan view of the base plate of the pneumatic abdominal aortic tourniquet according to the present invention; 
         FIG. 4B  shows a front elevation view and cut-away of the base plate carrying the inflatable air bladder and protective sleeve covering the air bladder according to the present invention; 
         FIG. 4C  shows a side elevation view of the base plate carrying the inflatable air bladder according to the present invention; 
         FIG. 5A  shows a detailed exploded view of the air source, elbow connector and inflation control valve according to the present invention; 
         FIG. 5B  shows an alternative embodiment of the elbow connector according to the present invention; 
         FIG. 6  shows an alternative embodiment of the pneumatic abdominal aortic tourniquet having a bulb type inflation pump according to the present invention; 
         FIG. 7  shows an alternative embodiment of the pneumatic abdominal aortic tourniquet according to the present invention; 
         FIG. 8  shows an alternative embodiment of the pneumatic abdominal aortic tourniquet according to the present invention in partial exploded view; 
         FIG. 9  shows an alternative embodiment of the pneumatic abdominal aortic tourniquet according to the present invention as in use; 
         FIG. 10  shows an alternative embodiment of the pneumatic abdominal aortic tourniquet according to the present invention as in use; 
         FIG. 11  shows a magnified view of a portion of the embodiment shown in  FIG. 10 ; and, 
         FIG. 12  shows an expanded view of the manual inflation system of the embodiment shown in  FIG. 10 . 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring to the drawings for a better understanding of the function and structure of the invention, and starting with  FIG. 1 , a pneumatic abdominal aortic tourniquet, designated generally as  10 , is shown secured around the lower abdomen of a person  12  for restricting blood flow through the descending aorta proximal to its bifurcation in the lower abdomen to deal with a non-compressible arterial hemorrhage. Referring to  FIG. 1A , the tourniquet is arranged over the abdomen to apply localized pressure across a pressure point  14  to restrict blood flow in downstream hemorrhage locations from the point of application. 
     Referring to  FIGS. 1 through 3 , pneumatic abdominal aortic tourniquet  10  includes an adjustable waist strap  16  for securing the tourniquet around the abdomen of a patient  12 . A rigid base plate  18  is carried on waist strap  16 . Base plate  18  is constructed and arranged to have a width greater than waist strap  16  so that base plate  18  extends laterally outward from waist strap  16  to provide a stable base for positioning over and across a selected area, such as a preferred pressure point  14  ( FIG. 1A ) of the abdomen. 
     A directed air bladder  20  is carried on a bottom side  22  of base plate  18 . As shown in  FIGS. 2A and 2B , directed air bladder  20  has a deflated condition, designated generally as  21 , for initial application to a patient wherein directed air bladder  20  is generally collapsed against base plate  18 . As shown in  FIG. 2C , directed air bladder  20  is then operated to an inflated condition designated generally as  23 , wherein the directed air bladder  20  is expanded to extend outwardly from bottom side  22  of base plate  18  to exert pressure on a localized area of the abdomen. Referring to  FIG. 4C , directed air bladder  20  is constructed and arranged to have a generally “V” shaped construction so that a wide end, designated generally as  24 , of directed air bladder  20  is carried on bottom side  22  of base plate  18 . A narrow end  26  of directed air bladder  20  presses against the abdomen in a generally parallel orientation relative to the base plate, when in the inflated condition so that a constricting force caused by inflation of the directed air bladder  20  against the abdomen is focused against a narrow, elongated defined area to penetrate the patient&#39;s abdomen and restrict blood flow through the abdominal aorta. 
     Referring to  FIG. 3 , an air source  28  is operatively connected in fluid communication with directed air bladder  20  for operating the directed air bladder between the deflated condition  21  and inflated condition  23 . In one embodiment the air source  28  comprises a compressed gas cartridge, such as a CO 2  cartridge, known to those skilled in the art. As seen, tourniquet  10  may include a compression latch  30  affixed to base plate  18  and operatively associated with waist strap  16  for tightening waist strap  16  around the abdomen. Preferably, compression latch  30  includes a latch base  32  mounted to a top portion  33  of base plate  18  in a fixed arrangement. 
     Referring now to  FIG. 4A , openings  34  may be included in base plate  18  for receiving rivets, screws or the like for mounting latch base  32  to top side  33  of base plate  18  in a secure arrangement. A first distal end  36  of waist strap  16  is disposed between latch base  32  and top side  33  (see  FIGS. 4B-4C ) of base plate  18  to secure base plate  18  to waist strap  16 . A latch arm  38  is pivotally mounted to latch base  32  and is operable between a closed position, designated generally as  40 , wherein latch arm  38  is adjacent latch base  32 , and an open position, designated generally as  42  (see  FIG. 2A ), extending upward from latch base  32 . A terminal pivot arm  44  is pivotally carried by latch arm  38  having a second distal end  46  of waist strap  16  secured thereto. Terminal pivot arm  44  moves from a relaxed position ( FIG. 2A ) when latch arm  38  is in open position  42 , to a tightened position ( FIGS. 2B and 2C ) when latch arm  38  is moved to closed position  40  so that waist strap  16  is shortened to tighten around the abdomen. 
     Referring to  FIGS. 4A-4C , a foam pad  48  may be carried on the bottom side  22  of base plated  18  disposed between directed air bladder  20  and base plate  18  to cushion base plate  18  against the abdomen when the directed air bladder is in a deflated condition  21 . Preferably, a peripheral edge of foam pad  48  extends beyond a peripheral edge of base plate  18  on all sides for cushioning against the abdomen before inflation of directed air bladder  20 . A foam pad which is about 0.5 cm thick and extends beyond the edges of the base plate by 1 cm is suitable for operation. 
     Focusing on  FIG. 4B , a protective bladder sleeve  50  may be provided surrounding directed air bladder  20  suitable for both inflated and collapsed conditions  21  and  23 , to resist puncture and protect against environmental exposure of directed air bladder  20 . Preferably, protective bladder sleeve  50  is attached to directed air bladder  20 , such as by using an adhesive or making protective bladder sleeve  50  form fitting so that protective bladder sleeve  50  is collapsed against directed air bladder  20  when in a deflated condition  21 . 
     Referring again to  FIGS. 4A-4C , an inflation control valve  52  is carried by directed air bladder  20  and is in fluid communication with air source  28  and an interior cavity of directed air bladder  20 . Valve  52  controls the flow of air into and out of directed air bladder  20  for operation between inflated condition  23  and deflated condition  21 . Preferably, inflation control valve  52  is a Presta valve or a Schrader valve. Valve  52  extends through base plate  18  for cooperating with air source  28  on top side  33  of base plate  18 . A pressure gauge may also be operatively associated with directed air bladder  20  for warning if the pressure is dropping in the bladder or if a maximum pressure has been reached. A guide marker  64  may further be carried on base plate  18  for helping align base plate  18  on the abdomen over and across the abdominal aorta as indicated by pressure point  14  of  FIG. 1A . 
     Referring to  FIG. 5A , an elbow connecting valve  54  is preferably disposed between inflation control valve  52  and air source  28 , in the form of a compressed gas cartridge, extends generally parallel to base plate  18  when engaged with elbow connecting valve  54 . This provides a lower profile to the design to help avoid accidental contact with air source  28  that may result in disengagement and deflation of directed air bladder  20 . 
     Referring now to  FIG. 5B , in a further embodiment, a pressure relief valve  56  is carried by elbow connecting valve/conduit  54  which is operatively associated with directed air bladder  20  through inflation control valve  52  for adjusting an air pressure within directed air bladder  20  when in inflated condition  23 . Pressure relief valve  56  may alternatively be carried at an alternative location such as directly on air bladder  20 , and is not limited to being disposed on elbow connecting valve  54 , which is illustrated as the preferred location in the present embodiment. 
     Referring to  FIG. 6 , in a further embodiment, air source  28  is replaced by a manual bulb pump  58  and an air supply line  60  extending from bulb pump  58  to directed air bladder  20  through base plate  18  for injecting air into directed air bladder  20  when bulb pump  58  is operated. Preferably, a pressure relief valve  62  is carried by air supply line  60  for adjusting the air pressure within directed air bladder  20  when in inflated condition  23 . 
     Preferably, waist strap  16  is constructed of 4 cm wide, 120 cm long, nylon webbing. Cooperating hook and loop fasteners  66  ( FIG. 2A ) may also be provided for securing loose ends of strap  16  onto itself once the strap is drawn tight around the patient&#39;s abdomen. Waist strap  16  is of sufficient length to go around the torso just above the iliac crest and includes enough slack or extra length to facilitate tightening. A quick connect buckle  68  is provided on waist strap  16  for quickly attaching and detaching waist strap  16  around the torso. 
     Base plate  18  is preferably made of injected molded ridged plastic material. Base plate  18  serves two primary purposes: first, it connects the pressure application mechanism—the directed air bladder  20 —to waist strap  16 ; and second, base plate  18  provides a stable platform for anchoring air bladder  20  on the abdomen to prevent pivotal movement when in an inflated condition  23 . 
     As may be more easily seen in  FIGS. 2A-2C , in use waist strap  16  is fed around the patient&#39;s body  12  with waist strap  16  lying above the iliac crests. Buckle  68  is then connected to secure waist strap  16  around the torso and base plate  18  positioned just left of midline aligned with marker  64  such that the apex of the bladder extends across pressure point  14  ( FIG. 1A ). The slack is then removed from waist strap  16  and the extra strap  16  is secured onto itself using hook and loop connectors  66 . Compression latch  30  is operated from open position  42  to closed position  40  to further tighten waist strap  16 . Air source  28  is applied to elbow  54 , typically by screwing a threaded end of a CO 2  cartridge into a complementary threaded receiver on elbow connector valve  54 . The cartridge  28  is screwed to its maximum depth to penetrate the cartridge. The cartridge is gently unscrewed slightly to release the compressed gas into directed air bladder  20  through inflation control valve  52 . Pressure relief valve  56  may be operated to fine tune the application of force by directed air bladder  20  and the flow of CO 2  can be stopped by screwing the cartridge into elbow connector valve  54 . A pressure indicator may be incorporated on the device to warn if high pressure exists in the bladder or if pressure falls unacceptably. Generally the bladder is inflated until the desired effect of cessation of bleeding occurs, or the desired effect of preload return to the heart is achieved. A manual bulb pump may also be utilized and would be operated in the same way as with a blood pressure cuff system. 
     Another embodiment of the invention is illustrated in  FIG. 7 . Strap  16 , base plate  18 , air bladder  20 , air source  28 , compression latch  30 , foam pad  48  and quick connect buckle  68 , are as described above. A compartment  59  (not shown) protects the connection between the air source  28  and the bladder  20 . A closure  53  such as a zipper closes the compartment and a lanyard  51  provides assistance in rapidly accessing the connection. An adaptor  57  provides for an alternative access to the air bladder  20  such as for connecting an auxiliary air pump, an auxiliary pressure relief valve, or for manually blowing up the bladder in the case of air source inoperability. 
     The tourniquet of the present invention is intended for use in field trauma situations in and under extreme conditions. In such environments, timing is of the utmost importance and mere seconds can determine whether a wounded individual survives. As a result, rapid deployment of the tourniquet is critical. Further, embodiments of the invention will be described with reference to  FIGS. 8 ,  9 ,  10 ,  11 , and  12  that provide features for rapidly securing the tourniquet and expanding the bladder to a desired pressure. 
     In  FIG. 8  a further embodiment is illustrated in partially exploded view and in use in  FIG. 9 . A storage device, consisting of a pad  82  and cover  81 , provides a storage area for the manual bulb pump  58 , the air supply line  60  and a pressure relief valve  80  which can all be gathered in serpentine fashion, laid on the pad and covered with the cover which preferable forms a closure. The closure can be secured by a hook and loop system such as Velcro®. In one embodiment the tourniquet is intended for one time use and the cover can be irreversibly removed from the pad for access to the contents of the storage area formed by the pad and cover. A connector  83  connects the air bladder to the manual bulb pump and allows the bladder to be replaced in the case of failure. A windlass rod  84  is connected to a portion of the strap  85  to allow for rapid tightening of the device. Once the tourniquet is applied and the bladder expanded it is difficult to tighten the strap through normal means like pulling a free end of strap  16  beyond buckle  68 . It is also not desirable to remove or loosen the tourniquet once it is in place. However, the windlass rod  84  can easily be rotated thereby drawing the strap tighter around the patient to place more pressure on the abdomen. When the appropriate pressure is achieved the windlass rod can be inserted into a retention means  86 , such as for example a simple loop, thereby securing the windlass rod in place (see  FIG. 9 ). The windlass rod  84  includes a center slot or eyelet through which strap  16  may be routed. A seamless portion of strap  85  travels through grommet  90  in the center of the front shroud  89  of the device and then through the windlass rod and back through the grommet  90  again. The windlass rod may then be turned either clockwise or counter clockwise until the device is firmly tightened around the waist of the patient and secured with the retention means  86  affixed to the top of the device. As shown, rod  84  may have an enhanced surface texture to facilitate griping while turning, and it may have an enlarged end portion around which the retention means may pass to ensure the rod  84  does not disengage from its tightly wound state. The retention means may also be segmented with a segment sewn onto one end of the top portion of the shroud and the other end secured around a portion of the windlass rod by either a snap or buckle. 
     An alternative embodiment of the tourniquet device may include a three piece shroud to aid in routing of the waist strap through its top. Such a configuration also allows for labeling and enhanced functionality of the windlass rod. For example, the shroud may be made from 1.2 mil thick reinforced plastic weave sheeting that is water gel cut to form. The three pieces may be made up of a center shroud covering the top/front of the tourniquet with two side pieces serving as covers or “wings” on the device. The top-center shroud portion provides for labeling and for holding a windlass grommet, windlass retention strap, and an elbow connector from the bladder to the inflation system. The shroud would be typically sewn onto the device, with portions of the perimeter of the shroud sewn to form a channel through which the waist strap  16  may travel. 
     An example of such a described embodiment may be seen in  FIGS. 10-12 . Shroud  104  is an integral piece of material typically made from resilient, woven nylon material, such as Cordura®, which is gel cut to form and has seams RF welded together to shape the shroud. The shroud extends over the top of base  18  and depends downward on each side to form triangular wings or sections. The top center panel of the shroud  104  supports a top panel  91  and the shroud side sections support delta shaped panels  92   a,b  made of resilient plastic. The top and side panels are stitched onto the shroud and provide additional shape and support to the shroud to allow for the functioning of other features. Certain portions of the perimeter stitching on the panels are absent which allows for strap  16  to travel underneath the panels as shown. Strap  16  travels through a lower edge of each side panel  92   a,b  between the shroud and each panel at  107   a,b , and travels up through center panel  91  to a grommet  103  formed at its center. A preferred thickness for belt/strap  16  is 2 inches. A seamless portion  85  of the belt  16  is threaded through grommet  103  and through a slot  102  formed in windlass rod  93 . A retention means  94 , such a short belt having quick-connectors at each end, is positioned adjacent to rod  93  and affixed to the top surface of panel  91  with stitching. Such a configuration allows for bilateral rotation  99  of rod  93  along axis  101  to tighten belt  16  around patient  12 . Retention means  94  is connected around an end of rod  93  to prevent loosening of strap  16  once tightened. As may be understood, retention means  94  may include any number of securing strategies, such as for example material loops, ties, a short strap with a snap buckle, etc. 
     In embodiment  90 , base plate  18  is made of rigid material and is affixed to the underside of shroud  104  to resiliently support its center upper portion and the center panel  91 . Satisfactory dimensions for base plate  18  are 17 cm by 16 cm. Additional shroud material depends downward from the center upper portion to surround and support bladder  20 . Quick connect buckle  68  has one side affixed directly to side panel  92   b  by having a short portion of strap  16  stitched to side panel  92   b  at  111  and the other end of the strap threaded underneath the side panel and underneath central panel  91  as already described. This allows for the strap  16  to be rapidly fastened around a patient  12  at  68  and a free end of strap  16  pulled to tighten. 
     Central panel  91  includes another aperture in a corner at  106  through which a sheathed air supply line  60  travels. Another aperture is formed at the same location in base plate  18  and the underlying shroud material to permit supply line  60  to connect to bladder  20 . The aperture allows for the supply line to connect to an air supply system  96  as shown in  FIG. 12  as will be described. 
     The air supply system  96  includes a hand bulb pump  97 , which is of typical construction for blood pressure cuffs but which is preferably of a larger 5 oz capacity. A supply line  60  connects the pump  97  to a monometer  80  having an integrated manifold and cap/clasp  108  at its end proximal to the pump  97 . A second clasp  109  aligns supply line  60  along the side of the monometer proximal to the aperture  106  in the central panel  91 . A screw valve  98  is positioned proximal to bulb pump  97  to allow for deflation of bladder  20  and in order to more finely control the pressure applied to the patient  12 . 
     To ensure that bladder  20  inflates in an orientation with its “V” shaped lower edge pointing downward toward a patient  12 , a shock cord is placed along the bladder apex surface and a channel formed within a shroud seam at midline to prevent bladder slippage within the shroud material during inflation. The shock cord ends have tied knots which are sewn into the seam between the side  92  and central  91  panels to secure the cord to the shroud. This allows for biasing of the lower edge of the bladder within its surrounding shroud material during inflation. 
     In operation of embodiment  90 , the inflation shape and positioning of the bladder relative to the patient  12  are the same as previously described in the other embodiments. The tourniquet is fastened around the patient such that the bladder lower edge is positioned to target location  14  such that the bladder lower edge bisects location  14 . Strap  16  is pulled tight around the patient and bulb  97  is compressed by hand to inflate bladder  20  to a desired pressure. Windlass rod  93  may then be rotated to further tighten strap  16  until the desired occlusion of the abdominal aorta occurs. Retention means  94  is then be fastened around one end of rod  93  to secure the windlass and stabilize the achieved pressure. 
     While I have shown my invention in one form, it will be obvious to those skilled in the art that it is not so limited but is susceptible of various changes and modifications without departing from the spirit thereof. For example, tourniquet can be repositioned to occlude axial blood vessels in the abdomen leading to the arms, or blood vessels into the neck. The device may be lowered to surround the inguinal area of the body to occlude blood vessels in that area, or further, a re-sized version of the tourniquet might be utilized on a thigh or leg portion, or an arm portion to effect homeostasis in blood vessels in those areas. In all cases, however, occlusion of a targeted blood vessel achieves cessation of hemorrhage in an injury site different from the point of blood vessel occlusion. 
     It will also be seen that the tourniquet may be utilized to restrict blood flow at a downstream location rather than total cessation of blood flow, or for other therapeutic purposes. For example, the device may utilized to restrict blood flow through the aorta in order to “reduce” blood flow to lower the extremities during various medical procedures, and occlusion of the aorta may be utilized in order to prevent blood from leaving the patient&#39;s core to elevate the patient&#39;s blood pressure in order to enhance CPR.