If you took a first aid course a few years ago, you might have learned all about the dangers of tourniquet use: How they increase the risk of tissue death (“necrosis”) due to lack of blood flow, how they cause nerve damage, and much more. Indeed, 100 years ago, the Journal of the Royal Army Medical Corps called them an “invention of the devil”.
Recently, however, the tourniquet has risen from the ashes as a medical tool, and is particularly useful in austere settings. The military, for example, has revised their stance and now actively promotes the use of tourniquets as the first step to stop major hemorrhage. Proper application greatly decreases the risk of complications.
For the civilian, accidents can happen when people are performing activities that they’re not accustomed to, such as chopping wood for fuel. In true survival settings, there may be hostile environments where gunshot and other bleeding wounds are not uncommon.
Inadequate measures to control hemorrhage were a cause of many fatalities during the Vietnam War. Even in Iraq and Afghanistan, 8% of preventable deaths were related to severe loss of blood (also called “exsanguination”). In the later stages of these conflicts, tourniquets began to be recognized as a significant aid in saving lives.
Tourniquets made a big difference in civilian settings as well, most notably the Boston Marathon bombings. Given the increase in shootings in the news, it may be time for tourniquets (and training in their use) to be become standard items in school and business medical kits.
BOTTOM LINE: TOURNIQUETS ARE AN EFFECTIVE WAY TO CONTROL BLEEDING WHEN DIRECT PRESSURE, ELEVATION, AND PRESSURE POINTS FAIL. For a discussion on general steps to stop bleeding, see my article on the subject:
Situations in survival when the tourniquet will come in handy:
• Injuries where transport is difficult or just not possible.
• Homestead or camp accidents.
• Gunshot or stab wounds from hostile encounters.
So, let’s review some of the tourniquets commercially available for inclusion in your survival medical storage. Note: All of the below require practice to place appropriately.
These are generally grouped in two categories: Inflatable (pneumatic) and Non-Inflatable (most commonly found in medical kits). Your choices include:
The CAT (Combat Application Tourniquet): CAT tourniquets have a wide Velcro band and a one-handed plastic bar called a “windlass”. The windlass tightens the band, which should be placed 2-3 inches or higher above the wound. The windlass can be secured into place to allow the caregiver use of both hands.
The SOF-T (Special Operations Forces Tourniquet): Developed in response to concerns about the sturdiness of the plastic windlass in the CAT tourniquet, the SOF-T has a windlass made of fuselage-grade aluminum and can be purchased with a wider band than the standard CAT. The increased width decreases the risk of damage to skin from the “ligature” effect you might see in other types. Although a little bulkier than the CAT, it is my favorite and is included in many of our more advanced medical kits.
The RAT (Rapid Application Tourniquet): The RAT tourniquet is essentially a bungee cord that is wrapped around the extremity above the wound and then fitted into a metal clip to maintain pressure. Relatively inexpensive, it has been rumored to be gaining ground among the military, but must be placed appropriately to avoid ligature effects. Each successive coil of the cord must be placed next to, not on top of, the first coil around the extremity.
The MAT (Mechanical Advantage Tourniquet): This tourniquet is a cuff with a “key” that you wind like an old-fashioned wind-up toy. There is a spot on the MAT that, when pressed, releases pressure instantly. Pressure may also be released by disengaging the buckle (which must be clipped into place at the beginning of the procedure). Although I have no experience with this tourniquet, it seems to be best used when you have two free hands. Also, the band is long and can become entangled.
The TK4 (Tourni-Kwik): The TK4 tourniquet, when unfolded, is essentially an elastic band with hooks on each end. Placing one hook on the skin above the wound, wrap the band over the hook and tighten in the opposite direction. Then, wrap several times around the extremity; use the second hook to secure. This is one of the least expensive tourniquets and is a feature of some of our more compact kits.
The Pneumatic Tourniquet (sometimes called the EMT or Emergency and Military Tourniquet): Commonly used in operating rooms, pneumatic tourniquets are reminiscent of a blood pressure cuff and are inflated until bleeding stops. It is important to make sure the application avoids crinkling or folding of the cuff to avoid skin damage and other issues. This item is generally the most expensive of the tourniquets, and has more components that could malfunction. Having said that, it gives the ability of knowing exactly how much pressure is being applied.
Of course, necessity is the mother of invention, and you can improvise a tourniquet with a bandanna and a stick. Wrap the bandanna or other wide strip of cloth above the wound and tie the stick in place with a knot. Twist the stick until adequate pressure is applied and then tie another knot to secure it. This is less effective than the commercial models, but it may be all you have.
For the survival medic, a supply of tourniquets is an effective way to save a life that would otherwise be lost due to bleeding. Make sure you’ve got them in your medical storage.
Joe Alton, MD
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