So, you’ve decided to carry a tourniquet. You’ve taken a trauma class, or a Stop the Bleed course, or TCCC/TECC, or PHTLS, or wilderness medicine, or some similarly skill-based education in the arena of traumatic injuries, because of course you know that training outweighs gear in terms of importance and you don’t want to look like a T Rex trying to scratch his own back as you’re fumbling around with your brand new TQ as someone’s life’s blood is leaking onto the floor around you.
You’ve decided that you’re going to be an asset; you’re going to be the one to help when someone’s injured instead of the one standing by, mouth-breathing and looking on in consternation as a real human actually dies in front of you.
Time to gear up, right?
“Hold on a hot minute, though,” you say, as you peruse the myriad Gucci IFAKs and urban multi-cam drop-leg pouches pre-stocked for your convenience at amazingly unreasonable prices with all the top-tier latest and greatest in immediate aid medical gear.
“Why are there so many tourniquets to choose from?”
The short answer is twofold.
Lots of medical, tactical, and other companies want to be the ones to get the next U.S. mil contract for their TQ or other piece of kit, because that equals big money, and therefore those companies are constantly trying to redesign, improve, or otherwise "cool-guy up" their current products and/or create new, unique products.
Secondly, research is constantly coming back on the tourniquets that are currently in use, so it stands to reason that either the manufacturers of those tourniquets, or a rival company, are looking for ways to make the product more effective, easier to use, etc., or else creating new products that do the same job in a (one hopes) more efficient fashion. None of which answers the question of which TQ you want to carry.
Again, there’s a short and sweet answer to this: carry one of the TQs that has been extensively field-tested in real world conditions, as well as laboratories, is referenced in well-documented peer-reviewed research, and is recommended or approved for use by august bodies of experts in the field.
That means the CAT or the SOFTT-W, although there are always newer products that bear examination, and are in fact being evaluated by the CoTCCC, as well.
“But I was only trained in homemade tourniquets,” you whine.
You need to get your money back for the training you underwent, have a serious talk with the instructor about evidence-based medicine, and go get trained up in real trauma aid right meow.
The evidence consistently demonstrates that makeshift tourniquets are not only much slower to apply, but most often ineffective after application, and really can’t hold a candle next to commercial TQs for arterial occlusion and hemorrhage control. Which is not to say you shouldn’t learn how to construct one just in case, only that it shouldn’t be your first line of defense against the red tide of blood you’re trying to keep in that meat sack.
Part 1 of our tourniquet exegesis is an at-a-glance reference on some of the tourniquets we see and hear about most often. We’ve included the following, highly scientific and jargon-heavy chart for easy discrimination.
So, what makes a tourniquet worthwhile?
We generally look at several criteria when evaluating tourniquets: first, and easiest, is it recommended by the Committee on Tactical Combat Casualty Care? Because why would I spend time doing research that has already been done when I could be training, or drinking margaritas, or training to drink more margaritas? The CoTCCC, the American College of Surgeons, and other groups put oodle-lally-all-day-long hours into reviewing data that comes back from field use, laboratory trials, and user anecdotes before applying that data towards a recommendation, or lack thereof. It’s generally accepted that if a TQ is recommended by CoTCCC, then it works, at least more efficiently than other models that have either been tested or have yet to be tested.
The research that’s out there demonstrates that a TQ should be at least 1” in width of compression band, in order to avoid the potential for neurovascular damage than can arise with thinner bands. Therefore, another criterium that we look at is the width of the TQ. Additionally, research has shown that elastic, or rubber band style, tourniquets pose a potential hazard to tissue because the force that can be exerted by overtightening the band can exceed that which is considered relatively safe with regards to tissue integrity for short durations. The windlass mechanism employed by some tourniquets appears to be a good replacement for elastic compression bands in terms of avoiding that danger.
An all-important aspect of tourniquet construction and application is how easy it is to employ under stressful conditions, when one’s heart rate is elevated and fine motor skills and/or decision-making processes are potentially impaired. Because you’re not going to put it on when everything’s hunky dory, are you? Complementary to this is the ability to apply the tourniquet to one’s self using only one hand, i.e. in the event that you are injured and require self-aid. On top of that, the ability to retighten a tourniquet without removing it and undoing all the good you might have just done in controlling that bleeding is important: following the initial injury, muscles will contract around the site. But at some point, those same muscles are going to have to relax, thus changing the terrain under your tourniquet and possibly requiring retightening. Sure would suck goat’s balls if you had to take the tourniquet off to do that, since your patient is likely to evince renewed bleeding and any coagulation that’s taken place is pretty certain to be nullified. If the tourniquet has been on for any significant length of time prior to removal, then by removing it you’re also going to release a whole lot of badness in the form of excess potassium and other nasties back into the body.
“Whatever, yabba dabba science-y pseudo-science, don’t patronize me with your bombast,” perhaps you’re thinking. “How much does it cost and will it be a pain in my ass to find a place to carry it?” Okay. The answer to the latter is yes. No matter which tourniquet you get, you’re going to have to arrange your wardrobe and accessories in such a manner as to have it accessible. I’ll leave that up to you. Maybe you can strap it to your hairspray can, since you already found a way to carry that around with you. Or feasibly, you could put it in the same purse pocket as your moustache wax. Not my lookout either way. As for cost, and let’s not even talk about how much you spent on that tattoo, or the moonroof tint for your ride, or your Amazon Prime bill last month; let’s just look at the person sitting next to you and ask, “Is their life worth thirty to ninety dollars on a layaway plan?” If it’s not, then you’re reading the wrong article in terms of self-improvement.
Look for Part 2 of the tourniquet exegesis, in which we begin to compare the finer points of disparate commercial tourniquets, talk about their application techniques, and discuss tasting notes and bouquets of same, coming soon.
CoTCCC: Committee on Tactical Combat Casualty Care
TCCC/TECC: Tactical Combat Casualty Care/Tactical Emergency Casualty Care
PHTLS: Pre-Hospital Trauma Life Support
IFAK: Individual First Aid Kit
CAT: Combat Application Tourniquet (CAT Resources; available via North American Rescue)
SOFTT-W: Special Operations Forces Tactical Tourniquet- Wide (Tactical Medical Solutions)
TMT: Tactical Mechanical Tourniquet (Combat Medical Systems)
SAM XT: SAM Extremity Tourniquet (SAM Medical Devices)
RATS: Rapid Application Tourniquet System (ReFactor)
SWAT-T: Stretch, Wrap, And Tuck- Tourniquet (H&H Medical Corporation)