CAT Tourniquet on upper thigh
(NOTE: Data used in this article was first published in the Summer 2023 issue of The Journal of Special Ops Medicine.)
For more than a decade, I’ve designed medical kits for survival scenarios. In these kits, I always use “brand-name” items because I felt it was important in terms of reliability, especially for potential life-savers like tourniquets, hemostatic dressings, and compression bandages. Aside from field case reports, however, I had little data to support my opinion. Now, a study in The Journal of Special Ops Medicine (JSOM) compares the well-known Combat Application Tourniquet (CAT) to a much cheaper look-alike that occupies space in many thousands of medical kits: the Military Tactical Emergency Tourniquet (MTET). These are commonly found on third party sites such as eBay, Amazon and online medical kit stores with low pricing.
(Disclaimer: I have no financial interest in any company that manufactures tourniquets.)
The current design of the CAT tourniquet involves a hook-and-loop fastening strap tightened with a thick plastic rod known as a “windlass.” The MTET is very similar in appearance and mechanics to the CAT, but available at approximately one-third to half the cost. It has been so successful in sales that it has been the “Amazon’s Choice” in the category. Made overseas, the MTET and a number of other tourniquets are marketed in English for the American/Canadian consumer. Given the visual similarity, discount price, and quality claims, the MTET is a tempting option for anyone on a budget.
To compare the look-alike MTET to the CAT, The researchers of the JSOM study took a group of 50 combat medics (68W) that served as instructors at Joint Base San Antonio-Fort Sam Houston, Texas. They were told to self-apply either a MTET or CAT tourniquet on their mid-thigh area. They were timed using one tourniquet on one leg, and then the other on the other leg. Placement time target was 60 seconds, with a successful application confirmed by sonogram showing cessation of arterial flow in the dorsalis pedis artery located on the top of the foot.
All 50 study volunteers were successful in applying the CAT tourniquet in under 60 seconds. With the MTET, only 40 combat medics (80%) succeeded, with the MTET requiring a longer median time overall to complete the task. In addition to failing the 60-second test, mechanical failures (14%) were encountered in the form of a bent windlass rod, ripped stitching, and a deformed buckle. I don’t need to tell you that mechanical failure of a tourniquet can mean the difference between life and death.
This study provides evidence that not all tourniquets are created equal, even when applied by experienced professionals. It’s true that combat medics may be more familiar with the CAT tourniquet, which could possibly explain some of the time difference in application; but, more importantly, the popular look-alike did not appear to be equally effective in stopping blood flow in a significant number of cases. This leads a reasonable person to suspect that production or material flaws may be to blame.
The CAT, as well as the SOF-T-wide and the Tactical Mechanical Tourniquet have all received the blessing of the Committee on Tactical Combat Casualty Care, a recommendation not given lightly. Don’t assume that the lower-cost imitations, although popular, are equivalent to those that have been thoroughly tested in both the lab and the battlefield. This study is rare proof that you get what you pay for.
Joe Alton MD
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Hey, don’t forget to check out our entire line of quality medical kits and individual supplies at store.doomandbloom.net. Also, our Book Excellence Award-winning 700-page SURVIVAL MEDICINE HANDBOOK: THE ESSENTIAL GUIDE FOR WHEN HELP IS NOT ON THE WAY is now available in black and white on Amazon and in color and color spiral-bound versions at store.doomandbloom.net.