Survival - All tourniquets are not created equal

As the modern tourniquet establishes its rightful position as the gold standard of pre-​hospital bleeding control, manufacturers race to establish a foothold as "the" go-​to unit. There are some great items on the market that, when needed, can drastically change the outcome of an otherwise fatal event. For little impact on your wallet, you can save lives, possibly your own. But take note, not all tourniquets are created equal.

I recently had an exchange with an individual on the topic of building your personal medical kit. This is a vitally important dialogue for anyone interested in proactively managing the emergent situation. When the topic of tourniquets came up, this person who has no trauma management training or experience, boldly stated, "The ABC tourniquet is the best tourniquet on the market." I was somewhat surprised by the proclamation and had to ask him what experience he was basing this upon. The short version of the story sounded like a well-​articulated argument of a 14-​year-​old girl. "A friend of mine knows a (insert impressive credential here) that said so."

As a proud practitioner of critical thought, as I hope we all are, this dog simply doesn't hunt. Don't be pulled into the fan-boy standards of doctor, medic or instructor idol worship; we are talking about life or death here. To truly appreciate the market choices available, and make kit purchases tailored to your needs, we must understand the differing types, qualities and applications of the modern tourniquet.

It is, in my opinion, irresponsible to suggest that the TK4 is superior to the SOFT-​T, or the C-A-T is inferior to the SWAT. These are apples to oranges statements. This article is not about which you should buy, or what I prefer. This article is about what tourniquets you should evaluate for a specific use. Saying whatever tourniquet is the only option for you is great until that one isn't around and you're bleeding to death. I most certainly have my preferences, which are based on years of training and experiences on the street. I have very intelligent counterparts that disagree with my position. This is fine, as we train on what we use.

With years of experience as an instructor and fire lieutenant, I feel it best and more descript to break tourniquets into unofficial classifications. Placing tourniquets into one of the following categories best summarizes your options: Primary, Secondary and Improvised/Field Expedient.

PRIMARY 

A primary tourniquet will be the one most commonly used for pre-​hospital or military operations. The TCCC (Tactical Combat Casualty Care) standards designate recommended tourniquets, which represent the highest success potentials for pre-​hospital care options. These tourniquets will almost always, when applied quickly and appropriately, insure a stoppage of blood loss from arms or legs. (It should be observed that larger legs might require two tourniquets) It is a requirement that these tourniquets be designed for self-​application using one arm. Common examples of primary tourniquets would be C-​A-​T, SOFT-​T and the SOFT-​T Wide. These are generally the most expensive selections and will take up more room in storage than other types of tourniquet, but they unquestionably ensure the highest probability of success. Most reported failures of any model described in this category are the direct result of improper application, so be wary of overly disparaging positions. If you have room in your bag, or better yet on your belt, this is the direction to go.

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Please remember that the C-​A-​T and SOFT-​T offerings, in almost all use potentials, represent the best possible tool for stopping of life-​threatening bleeding. Through clinical trials and field applications, the efficacy of these devices is known, which is why they are the only tourniquets recommended by the CoTCCC (Committee on Tactical Combat Casualty Care). Before making your tourniquet decision, beware of companies using creative wordsmithing in the representation of their product. "TCCC Approved" is not the same as "CoTCCC Recommended." Stick to the tourniquets mentioned above and you'll avoid this unfortunate issue altogether.

SECONDARY

Next comes the secondary tourniquet. It is fair to say the secondary tourniquet represents the "it's better than nothing" option, akin to carrying a tiny .380 when you'd rather have a full-​size pistol. Much like the aforementioned handgun selection, if it's appropriate for your situation, the secondary tourniquet can meet the needs of uncontrolled extremity bleeding if you've mastered the device in training. Examples of these devices would be the TK4 or the SWAT-​T. These secondary tourniquets can be easily obtained for less than $10 and have a much smaller storage footprint than primary tourniquets.

Limitations for these devices will be immediately noted in one-​handed application or when applying to the leg. "Secondary" is an appropriate term because these options can act as a positive back-up to the C-​A-​T or SOFT-​T. In training, I pay a great deal of attention to the ability of a tourniquet to achieve blood flow stoppage, but I also work with each tourniquet to see how well it maintains the initial application. A patient drag, crawl, or continuance of previous action should not cause a tourniquet to release. Accidental release is a definite concern in the use of any secondary tourniquet, but I find it to be particularly concerning with the SWAT-​T product.

One manner in which the secondary tourniquets come into their own is concerning life-​threatening hemorrhage (otherwise not controllable) in a pediatric patient. For my personal gear selection, this is the only reason to carry a secondary tourniquet.

Improvised/Field Expedient

Your improvised or field expedient options are pretty commonly known. These are the tourniquets that many of us engineered for merit badges in our youth. There are some tricks that can result in a well-​crafted, highly-​functional tourniquet. My personal favorite is a standard ratchet strap, of which four are stored in the rear of my truck. Because I've trained on the ratchet straps, I know they could be pressed into service if the situation presented itself. The reality is, improvised tourniquets rely on you having specific items on your person at the time of injury or very soon thereafter. This is most often not practical. Betting a person's life on your ability to find that perfect strap or super-strong windlass at the most stressful moment of your life is a fool's wager. A belt, shirt or narrow piece of cordage applied to such wounds will almost always be fruitless. I mention this category of tourniquets primarily to convey a message that your other options are too simple, affordable and available to ignore.

I leave you with a final (and unsettling) thought. At the worst moment of your life, when you call 911 and expect a Paramedic or EMT to arrive and stop the blood flow, know that the vast majority of EMS agencies are forbidden to apply tourniquets.

My hope is that the information provided here will encourage everyone to seek knowledge through training and experience. In order to save lives, we must be proactive, not reactive.