TOURNIQUETS

[CSEMARTIN]

I'm posting this for anyone looking to buy a tourniquet for themselves or for the range.  As some of you know, I am a surgeon with an extensive background in trauma. I am a member of the teaching faculty at Iowa Methodist in Des Moines, Iowa (also known as Unity Point).

 

One of our Chief Residents, Dr. Mike Valliere, has done extensive research on tourniquets.  Recently, he won a National Championship for his research. ( https://www.journalacs.org/article/S1072-7515(18)30434-4/abstract ).

 

I have spoken with Mike at length about his recommendations.  Basically, there are two tourniquets that he recommends.  The easiest tourniquet (also the cheapest) for people to use is called the SWAT tourniquet (https://www.buyemp.com/product/swat-tourniquet/3442-EACH?gclid=EAIaIQobChMIvtrasdPD4gIVFLbACh3qsQGkEAQYASABEgIREfD_BwE).  It's only about 12 dollars and is very easy for the lay person to use.  It is also reusable.

 

The second tourniquet he personally carries and recommends is called the Tactical RMT tourniquet (https://www.chinookmed.com/item/05182/m2-inc.-tactical-ratcheting-medical-tourniquet-rmt/1.html?source=froogle&gclid=EAIaIQobChMIlpH62dPD4gIVBtbACh2jbwYDEAQYASABEgIVMvD_BwE).  It's around 40 bucks.  It is reuseable as well, however, he recommends that if the tourniquet becomes soiled with blood, it should not be reused.

 

His research focused mainly on the straps and buckles, and he discovered that not all tourniquets generate enough force to stop an arterial bleed.  Some of the buckles are not smooth and therefore generate a lot of friction on the strap preventing enough force from being able to be applied to stop an arterial bleed.

 

Be careful what you buy.  Not all of the tourniquets on the market will get the job done.

 

Thanks!

 

Chris Martin

 

 

[DKorn]

Only buy tourniquets that are on the CoTCCC approved list. Only buy them from reputable vendors (preferably direct from the manufacturer) due to the large number of counterfeits and airsoft replicas on the market. 

 

/thread

[nick779]

Thats definitely interesting. I thought the CAT was the one to go for now. Its definitely the most popular at our ranges.

 

This one:

https://www.amazon.com/dp/B01ITAKG6A/ref=cm_sw_em_r_mt_dp_U_Tvc8CbGE72CA0

Edited May 30, 2019 by nick779

[CSEMARTIN]

3 minutes ago, nick779 said:

Thats definitely interesting. I thought the CAT was the one to go for now. Its definitely the most popular at our ranges.

 

This one:

https://www.amazon.com/dp/B01ITAKG6A/ref=cm_sw_em_r_mt_dp_U_Tvc8CbGE72CA0

 

The Generation 7 CAT Tourniquet is Dr. Valliere's third recommendation.  You will be fine with this one.

 

My two initial thoughts on all of this are: 1)will the tourniquet work and 2)how easy is it to use?  If you ever find yourself in a situation where you have to quickly use a device like this, how successful will you be at getting the bleeding stopped?

 

The SWAT is reportedly very easy to use.  It comes with very straightforward instructions, however, I did start to wonder if the SWAT would be difficult to handle if your hands are bloody.  In other words will you or someone else have trouble getting a good grip on it with wet/bloody hands.  I don't have an answer to that question yet, but I am looking into this.

[CSEMARTIN]

2 hours ago, DKorn said:

due to the large number of counterfeits and airsoft replicas on the market. 

 

Did I read this right?  There are actually counterfeit tourniquets being sold?

 

I'm not sure I'm following you on the "airsoft replicas" comment.

[DKorn]

1 hour ago, CSEMARTIN said:

 

Did I read this right?  There are actually counterfeit tourniquets being sold?

 

I'm not sure I'm following you on the "airsoft replicas" comment.

 

The airsoft replicas are sold to people as essentially toys for realistic-looking airsoft role play. They’re cheaper than the real thing and usually non functional but look very close to the real ones, so someone who doesn’t know better could be fooled into trying to actually use it in an emergency. 

 

I don't know details regarding counterfeits - I’m assuming that they’re knock-offs made in China or elsewhere overseas. I don’t think they’re intended to be nonfunctional but, as with any non-genuine product, you have no guarantee that it’ll work as advertised. 

 

I haven't personally run into either (every TQ that I’ve carried was a CAT directly from North American Rescue), but I’ve read enough people mention them that it seems worth it to just buy directly from the manufacturer or another reputable source. 

 

[CSEMARTIN]

25 minutes ago, DKorn said:

 

The airsoft replicas are sold to people as essentially toys for realistic-looking airsoft role play. They’re cheaper than the real thing and usually non functional but look very close to the real ones, so someone who doesn’t know better could be fooled into trying to actually use it in an emergency. 

 

Just so I'm understanding this correctly, are you saying there are "toy" tourniquet replicas used in airsoft role play?

[Joe4d]

Thank you Csemartin for pointing out your credentials so I feel good about answers you give.
My understanding is a tourniquet is pretty much a last ditch effort to save a life ?
My army combat lifesaving taught us,,, yes use one, put a T on the forehead, but make sure you need it, cause a tourniquet pretty much means they are losing that limb.
So basically NO dont go to a touniquet first,, bandage, direct pressure and pressure bandage.. Tourniquet as last resort if you cant control bleeding.
Can you comment on this for us folks out in the field ? Lets say 2 hours from actual medical help ?

[MemphisMechanic]

31 minutes ago, CSEMARTIN said:

 

Just so I'm understanding this correctly, are you saying there are "toy" tourniquet replicas used in airsoft role play?

 

All you had to do was google.

 

(Yeah I’m that this is a thing, too.)

 

http://m.airsoftmegastore.com/14451-uk-arms-airsoft-relica-combat-application-tourniquet-kit-black.aspx

[lfine]

So those would be ...toyniquets?

 

But seriously. I just came today from a simulated shooting drill at my high school.  All responders I saw and asked had CATs. Don't know what gen or make.  I was glad to see the Medical personnel who talked about, and showed the use of a CAT (on me), pointed out how the acceptance of the use of tourniquets has changed from long ago.

 

In regards to the RMTs, I see there are a few. The one you link to directly and then some "civilian" ones.  Should I assume the one you link to (tactical) would be the one to get?

 

Thanks for all this.

[DKorn]

3 hours ago, MemphisMechanic said:

 

All you had to do was google.

 

(Yeah I’m that this is a thing, too.)

 

http://m.airsoftmegastore.com/14451-uk-arms-airsoft-relica-combat-application-tourniquet-kit-black.aspx

Yep, exactly like these are the ones I’ve heard of. I don’t participate in any kind of airsoft so I don’t know exactly why they want them - maybe to make their gear look complete, or maybe there’s some version of airsoft where you have to drag your teammate to safety and put tourniquets on them? Like I said, I don’t get it, but the reason I guess that they use these and not the real ones is that these are waaaay cheaper. 

[hitman_usmc]

5 hours ago, Joe4d said:

Thank you Csemartin for pointing out your credentials so I feel good about answers you give.
My understanding is a tourniquet is pretty much a last ditch effort to save a life ?
My army combat lifesaving taught us,,, yes use one, put a T on the forehead, but make sure you need it, cause a tourniquet pretty much means they are losing that limb.
So basically NO dont go to a touniquet first,, bandage, direct pressure and pressure bandage.. Tourniquet as last resort if you cant control bleeding.
Can you comment on this for us folks out in the field ? Lets say 2 hours from actual medical help ?

 

 

The Dr. can add more than I can I'm sure, but this is old training.  It's the same thing they told me in my early days in the Marines.  However, it's now the opposite. My last few years in the Corps as well as my current TCCC training in SWAT pretty much dictates a severe bleed in a limb equals a tourniquet every time.  Better to play it safe.  A tourniquet does not mean you're going to get the limb cut off.  Because of this, patrol officers are commonly seen with tourniquets on their duty belts these days.    

[tact]

Thank you Csemartin for pointing out your credentials so I feel good about answers you give.
My understanding is a tourniquet is pretty much a last ditch effort to save a life ?
My army combat lifesaving taught us,,, yes use one, put a T on the forehead, but make sure you need it, cause a tourniquet pretty much means they are losing that limb.
So basically NO dont go to a touniquet first,, bandage, direct pressure and pressure bandage.. Tourniquet as last resort if you cant control bleeding.
Can you comment on this for us folks out in the field ? Lets say 2 hours from actual medical help ?

That info is about 15 years old. Tourniquets have saved many lives. I’d recommend some training and carrying a couple.

[CSEMARTIN]

20 hours ago, Joe4d said:

My understanding is a tourniquet is pretty much a last ditch effort to save a life ?
My army combat lifesaving taught us,,, yes use one, put a T on the forehead, but make sure you need it, cause a tourniquet pretty much means they are losing that limb.
So basically NO dont go to a touniquet first,, bandage, direct pressure and pressure bandage.. Tourniquet as last resort if you cant control bleeding.
Can you comment on this for us folks out in the field ? Lets say 2 hours from actual medical help ?

 

Joe,  

A tourniquet is used to save someone from bleeding to death.  Whether or not to say it is a last ditch effort would depend on the person and their background.  There are situations where I would feel very comfortable attempting to control bleeding without a tourniquet.  Others may not or probably won't be able to control bleeding without a tourniquet.

 

I don't believe a tourniquet means they will automatically lose a limb.  Timing is a factor.  Getting someone to the hospital will become a top priority after a tourniquet is applied.

 

19 hours ago, lfine said:

In regards to the RMTs, I see there are a few. The one you link to directly and then some "civilian" ones.  Should I assume the one you link to (tactical) would be the one to get?

 

 

Yes, the link to the tactical tourniquet is the one to get.

 

15 hours ago, hitman_usmc said:

 

 

The Dr. can add more than I can I'm sure, but this is old training.  It's the same thing they told me in my early days in the Marines.  However, it's now the opposite. My last few years in the Corps as well as my current TCCC training in SWAT pretty much dictates a severe bleed in a limb equals a tourniquet every time.  Better to play it safe.  A tourniquet does not mean you're going to get the limb cut off.  Because of this, patrol officers are commonly seen with tourniquets on their duty belts these days.    

 

When I was in my surgical training, we did not use tourniquets.  There has been a paradigm shift in recent years.  "Playing it safe" is valid argument for using a tourniquet in my opinion.

[CSEMARTIN]

Here is a link for more information:

 

https://www.bleedingcontrol.org/ 

 

 

[rustychev]

All my training is done with a CAT so that is what I carry.  I would like to play with a few of the RMT to get a feel for them.  I however am not a fan of the swat TQs as they are just about impossible to put on your self and in my experience are much harder to apply to someone correctly and effectively.

 

I have two things I require from a TQ 

It must work as tested by ultra sound.

I must be able to put in on my arm by me self.

[Nevadazielmeister]

On 5/30/2019 at 9:44 AM, CSEMARTIN said:

One of our Chief Residents, Dr. Mike Valliere, has done extensive research on tourniquets.  Recently, he won a National Championship for his research. ( https://www.journalacs.org/article/S1072-7515(18)30434-4/abstract ).

 

His research focused mainly on the straps and buckles, and he discovered that not all tourniquets generate enough force to stop an arterial bleed.  Some of the buckles are not smooth and therefore generate a lot of friction on the strap preventing enough force from being able to be applied to stop an arterial bleed.

 

Be careful what you buy.  Not all of the tourniquets on the market will get the job done.

 

Thanks!

 

Chris Martin

 

 

 

Dr. Martin,

 

Thank you for sharing this information. I just wanted too clarify a couple of things. 

 

I understand this was only a test of buckle and strap tourniquets, correct? Also, the test was "examined effects of buckle and strap features on converting pulling force to strap pressure." but did not seem to cover the actual effects on blood circulation, yes? While I see that this was probably a good test, I still do not think it can be used to make purchase decisions to ALL tourniquets, correct?

 

In my review of the abstract of the study, there was no mention of the windlass type tourniquets, so where do those stand in comparison? Or maybe I missed something?

 

Sincerely,

 

Neil (not a doctor)

 

 

[rustychev]

Last time I looked tccc had only approved tq with windless as proven to be a effective at stopping blood flow.  But in full disclosure I have not read the most recent review that just came out in the last few months.

 

ETA

 

I went to find the C-TCCC update and here are the approved/recommend TQs 

• Combat Application Tourniquet (C-A-T) Gen 7 and Gen 6
• Ratcheting Medical Tourniquet -Tactical(RMT-T)
• SAM Extremity Tourniquet (SAM-XT)
• SOF Tactical Tourniquet – Wide (SOFTT-W)
• Tactical Mechanical Tourniquet (TMT)
• TX2” Tourniquet (TX2) and TX3” Tourniquet (TX3)

 

I would argue that if is not on the list you should be rethinking using it.  Prior to the update only the cat and sof-t tq had been on the list.  You will note the swat tq did not make the cut.

 

All the above tq are proven to be able to stop blood flow in field conditions.

 

The fact that the swat is cheaper isn't a good argument as it is used to save a life spend the extra 20.00 bucks.

Edited June 3, 2019 by rustychev
Add more information

[tact]

What? No RATS?.........,.haha

[CSEMARTIN]

8 hours ago, rustychev said:

It must work as tested by ultra sound.

I must be able to put in on my arm by me self.

 

I agree with this.

 

6 hours ago, Nevadazielmeister said:

 

Dr. Martin,

 

Thank you for sharing this information. I just wanted too clarify a couple of things. 

 

I understand this was only a test of buckle and strap tourniquets, correct? Also, the test was "examined effects of buckle and strap features on converting pulling force to strap pressure." but did not seem to cover the actual effects on blood circulation, yes? While I see that this was probably a good test, I still do not think it can be used to make purchase decisions to ALL tourniquets, correct?

 

In my review of the abstract of the study, there was no mention of the windlass type tourniquets, so where do those stand in comparison? Or maybe I missed something?

 

Sincerely,

 

Neil (not a doctor)

 

 

 

Yes, Mike's research focused on the buckle and strap tourniquets.  I agree this research should not be used to make purchase decisions on all tourniquets.  I have no opinoin on windlass tourniquets.

 

6 hours ago, rustychev said:

The fact that the swat is cheaper isn't a good argument as it is used to save a life spend the extra 20.00 bucks.

 

I can't argue with that logic.  Spend the extra 20 bucks.

[Zincwarrior]

On 5/30/2019 at 9:22 PM, hitman_usmc said:

 

 

The Dr. can add more than I can I'm sure, but this is old training.  It's the same thing they told me in my early days in the Marines.  However, it's now the opposite. My last few years in the Corps as well as my current TCCC training in SWAT pretty much dictates a severe bleed in a limb equals a tourniquet every time.  Better to play it safe.  A tourniquet does not mean you're going to get the limb cut off.  Because of this, patrol officers are commonly seen with tourniquets on their duty belts these days.    

AS part of out training on putting on tourniquets, we put them on each other-full strength.  Other than some mild bruising, it was not an issue (other than it hurt like hell).

[CSEMARTIN]

30 minutes ago, Zincwarrior said:

AS part of out training on putting on tourniquets, we put them on each other-full strength.  Other than some mild bruising, it was not an issue (other than it hurt like hell).

 

 

I think it is a good idea to practice with one first rather than go live when it really matters.  Reminds me of this skit: 

 

 

 

[Steve RA]

Makes you wonder how all the others are when they are off the camera ???   

[CSEMARTIN]

On 6/12/2019 at 3:25 PM, Steve RA said:

Makes you wonder how all the others are when they are off the camera ???   

 

Yes it does make you wonder.

 

One thing I wanted to add to this thread was that I discovered tourniquets do come in orange.   Last weekend, one of the range officials had a tourniquet attached to his range bag.  It was a darker color similar in color to his range bag.  I got to thinking that in the event of an emergency, it might be better to be able to quickly find the tourniquet.  I would think that an orange tourniquet would be easier to quickly find. Just a thought.

[lstone]

I thank you as a Range Officer I had always wondered what and how to go about treating someone had they needed blood control treatment. I thank you for shining a light on this.