[Image: AFP via El Comercio]

Since the end of March, Palestinian protests have been held in the Gaza Strip to demand that Palestinian refugees be allowed to return to Israel, and also to protest the blockade of the Gaza Strip by Israel and Egypt as well as the moving of the United States embassy in Israel from Tel Aviv to Jerusalem. While many protested peacefully, they were met with violence, with 60 people being killed so far and many, many others injured. It was this situation that Dr. Tarek Loubani of the Glia Project entered with the intention of preventing more deaths if possible.

Dr. Loubani is known for creating a 3D printed stethoscope that recently received clinical validation and was made for about 30 cents. Because of the blockade, hospitals in the Gaza region have faced a critical shortage of medical supplies, even simple ones like stethoscopes. The goal of the open source Glia Project is to create those much-needed medical supplies using 3D printing and make them available to whoever needs them. As Dr. Loubani, along with Dr. Mohammed Al-Attar and 25 other trained first responders entered the field at the protest site, they brought with them hundreds of 3D printed tourniquets, ready to attend to those with severe limb injuries.

“Reducing hemorrhagic deaths from limb exsanguination became a cornerstone project of the newly formed Hayat Center for Emergency and Crisis Management, based at the Islamic University of Gaza,” Dr. Loubani said. “The center has been engaged in projects like Advanced Cardiac Life Support (ACLS), Basic Life Support (BLS) and Trauma Life Support (TLS). When the center tried to obtain CAT tourniquets for its new ‘Stop Bleeding’ campaign, they were almost impossible to obtain.”

[Image: Glia Project]

This was due to the high cost of the tourniquets as well as the blockade – however, as Dr. Loubani points out, even if they could obtain Combat Application Tourniquets, CATs are specifically designed for soldiers, grown men with larger limbs. The Gaza population is mostly children, with nearly 45% under the age of 14.

“CATs do not work on a pediatric population, which would have automatically excluded most of the patient population we expect,” Dr. Loubani said.

So when the Glia Project team was approached by the Hayat Center and members of Gaza’s disaster committee, they readily agreed to develop a tourniquet using their locally manufactured, solar powered Prusa i3 MK2 3D printers and locally available and recycled filament. The team created the tourniquet for both adult and pediatric use, beginning about a year ago and reaching the field trial stage by early 2018.

Third prototype of the tourniquet [Image: Glia Project]

“By February 2018, it was obvious that a mix of economic and political factors would make this year’s peaceful protests leading up to May 15th larger than ever before, which raised the potential of violent Israeli suppression of the protests,” said Dr. Loubani. “Our team decided to produce the latest prototype design in quantity and stop work on all other projects.”

[Image: AFP via El Comercio]

Between March 30th and May 4th, the Palestinian Ministry of Health in Gaza indicates that there have been 2,842 injuries to the lower and upper limbs, representing 59.6% of all injuries. No deaths have occurred from limb exsanguination thanks to the excellent training of first responders, but as those first responders were using inadequate tools and makeshift tourniquets, more blood loss was occurring than necessary. The Glia team prepared 350 of the 3D printed tourniquets, with 100 used in field testing, 100 delivered to the Hayat Center, and 150 deployed to the field.

On May 11th, each first responder received two 3D printed tourniquets. Ten were deployed altogether – three failed while seven worked as intended. A total of 197 people were wounded that day. While the majority of the tourniquets worked, Dr. Loubani pointed to several reasons why a few of them failed.

“We dry-tested the tourniquets in laboratory conditions. Even in initial paramedic field trials, tourniquets were generally deployed in single-victim situations with controlled scenes,” he said. “In the field, we were trying to put tourniquets on patients while literally running, under live fire, being teargassed, or occasionally all three. This was suboptimal.”

[Image: Glia Project]

Opening the packaging of the tourniquets also cost critical seconds in some cases. In addition, one-quarter of the deployed tourniquets were an older model with a defect that, nevertheless, field testing showed would survive a single use. This did not turn out to be the case, however, and Dr. Loubani himself broke one of the tourniquets while trying to stabilize a man with a partially amputated leg. The man was stabilized with a makeshift tourniquet, but the older model has been pulled from inventory.

A second patient was shot in the thigh, and a well-meaning first responder turned the windlass (the stick) too many times until it broke. As of now, Dr. Loubani is unaware of the patient’s outcome.

“This is the case I will lose sleep over,” he said.

Another tourniquet experienced an unexpected buckle failure, which will be studied in the lab. This patient was stabilized with a second tourniquet.

The team returned to the field on May 14th, armed with 200 tourniquets. The old models were pulled, and the 100 units at the Hayat Center were recovered for field use. 78 of the tourniquets were used on patients whose injuries met the criteria, and not a single one failed. That didn’t mean it was a good day, though – 17 paramedics from the team were wounded and one was killed, and Dr. Loubani himself sustained a gunshot wound to the leg. Overall, 52 people were killed and 2,410 wounded on May 14th.

The pain and violence happening in Gaza are ongoing, and no one can say how long the crisis will stretch on, or how many more lives will be lost. But because of brave and resourceful individuals like those working on the Glia Project, the number of lives lost is fewer than it would have been without them and their 3D printed medical tools.

“If you would like to participate in this project, please don’t hesitate to contact us at info@glia.org. If you are more technically inclined, check out the tourniquet project’s Github page, where you can file issues or make pull requests,” Dr. Loubani concludes, as more help is always needed.

You can read Dr. Loubani’s full account of May 11th here, and May 14th here.

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