In the olden days, the tourniquet got a bit of a bad name. Medics used the phrase “save a life, lose a limb,” which translates to “this thing will save my patient, but their limb is gonna go.” This mindset has led to the tourniquet being a weapon of last resort in the fight against exsanguination, but new research shows that tourniquets are far more useful than you think.

Combat Application Tourniquets are being added to the jump kits on my ambulance sometime this month, and you should put one in your range bag as well. Here’s why.

Even if you’re the safest shooter in the world, the possibility exists for an accident on the range. One malfunction or inattentive shooter and suddenly the day goes from a relaxed fun event to a race for your life. If that negligent discharge hits your head, neck or torso, the combination of a tampon, a pressure dressing, and diesel therapy (driving really fast)  is about the only option available. If that round hits an extremity, however, the options are a lot better.

In the old mindset, a tourniquet was the option of last resort. As soon as that thing goes on it’s a fight against time to get into the operating room or else the patient is going to fit right in at the next pirate’s convention. New research based on experiences in the military has provided some insightful statistics about the use of tourniquets in real life situations and has changed the minds of my medical director enough to move them up in our algorithm. So what are the numbers?

When a tourniquet is used in the pre-hospital setting:

  • 87% of patients with a tourniquet applied (in the study) survived
  • 96% survival rate if applied before shock
  • 4% survival rate if applied after shock presents
  • 0.4% of patients underwent “limb shortening” (amputation), usually unassociated with the tourniquet
  • Permanent nerve damage in 1.5% of patients. (Temporary in 98%)

From the numbers, it looks like (A) tourniquets are not a guarantee for amputation or nerve damage as previously thought, and (B) the survival rate when a tourniquet is applied is much higher when applied quickly. Hypovolaemic shock can set in very rapidly when a patient is leaking, and once it sets in it’s almost impossible to reverse.

The moral of the story seems to be that tourniquets need to be applied faster in the field, and are safe to use without fear of amputation or nerve death in the future. The fear is still there, but not as overwhelming as it used to be.

What does this have to do with guns? As shooters, the possibility of being injured is always present. One of the first articles I wrote for this site was about making an emergency medical kit for yourself, and while I discussed tourniquets I placed them pretty low on the list. Armed with this new information it seems that tourniquets should be more important than they have been in the past.

Further testing has shown that tourniquets are more effective when the band of material is 2 inches wide, rather than the shoestring size footprint of the standard EMS cravat. The increased importance of the tourniquet coupled with the need for a larger surface area created a demand in the military and EMS fields for a solution that’s easy to apply and effective against appendage wounds.

That’s where the Combat Application Tourniquet (CAT) comes into play. The CAT was designed to be applied quickly either by the injured person themselves or another rescuer, as well as provide that even 2 inch band of pressure required to properly cut off circulation. The company making the CAT has a couple videos showing how to apply the CAT on their website, and it looks pretty damned easy.

OK, so now we know that tourniquets are extremely effective in stopping bleeding and preserving life, they’re relatively safe to use, and have a low probability of causing amputations or nerve damage. So what’s the procedure?

According to the new protocols handed down from Medical Control on high, my indications for using a tourniquet on an extremity other than the head are (bold indicate the ones you’ll probably see):

  • Amputation or traumatic extremity injury with extensive bleeding
  • Unable to control bleeding with pressure dressing
  • Significant bleeding with the need for other interventions (CPR, etc)
  • Bleeding from multiple locations
  • Impaled / foreign body with bleeding
  • Under fire / dangerous situations
  • Total darkness
  • Mass casualty event

Basically, if the thing is bleeding a lot slap a tourniquet on it. Our Medical Control made a point to not dictate what “extensive bleeding” actually means, instead leaving up to the individual rescuer to determine. So use your judgement.

What’s the procedure for properly applying a tourniquet?

  1. Visualize the wound. Tear off the patient’s clothes if need be, but actually get a look at the wound. This is important for figuring out the proper placement of the tourniquet.
  2. Apply tourniquet 2-3 inches proximal to the wound. You want the tourniquet to cut off circulation to as little as possible of the limb. Increase the pressure until you can no longer feel a pulse in the extremity.
  3. Mark the patient with “TK: [Time Applied].” Even though tourniquets are safer than once believed, there still is a ticking clock element the second the tourniquet goes on. Note the time and write either on the tourniquet itself or the patient’s forehead “TK,” which is the abbreviation for tourniquet, and then the time it was applied.
  4. Add tourniquets, not pressure. If the bleeding doesn’t stop with the application of the first tourniquet apply a second. See the picture above, on the right? That soldier has two tourniquets on his leg. The medic didn’t simply tighten down the first one, as that would not work as well as adding another. Surface area is more important than pressure, it turns out.

One last pearl of wisdom: avoid using a tourniquet on the knee. There’s a structure in the knee through which the blood vessels pass and it is incompressible. Apply the tourniquet above the knee when required.

Remember, tourniquets are not always the best solution. Little cuts and bleeds are still probably better served by a pressure dressing and some gauze. But if you’re bleeding heavily and help is still a few minutes away, a tourniquet can be your best friend.

Stay safe, shooters.

Combat Application Tourniquet

 

 

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25 COMMENTS

  1. Tourniquets are amazingly effective in stopping bleeding. Orthopaedic surgeons use them all the time to prevent blood loss in limbs during surgery. They are usually applied for 0-90 minutes and when released you can see the tissue go from a pale pink to “whoops, forgot to ligate that vessel” red.

  3. At the NRA Show, I found a supplier for those treated sponges that have coagulant in them. I got some for my dad, who was on so much Coumadin, he could have bled out from a shaving cut. The tourniquet sounds like a good idea, too. (Although less useful for shaving cuts. Unless you’re a Progressive.)

  4. For $20 you can get a pack of QuickClot, which will do the same thing, but can be applied to more places than just limbs.

    • There’s issues with QuickClot, not the least of which is it burns like a motherf***er. Tourniquets are a lot easier to put on, work all the time every time, and the local emergency room will know exactly how to deal with it once it’s on.

      For head / neck / torso wounds, a clotting agent would be perfect. I actually think Celox would work better, though. Similar idea, different compound. There’s some debate over that, though, so YMMV.

  5. Rebecca and Ralph, thanks for the laugh.

    Seriously though, I recently read a novel in which the good/bad guys, they were CIA types, wore tactical pants with built in tourniquets. Of course I though of you guys.

    Stop fuckin’ around, will ya? Tactical tourniquet pants for the lower extremities, body armor for the torso, some kind of helmet, of course, and never, ever take the stuff off. Just like home carry, you never know when you’re gonna need it.

    • Mikey:

      +1

      I don’t know what anybody else thinks but aside for your odd aversion to guns and gun nuts you are pretty good guy with ability to laugh at yourself unlike some others.

    • That is standard in some units when you roll out the wire (One on each arm and leg). Have you ever tried to apply a tourniquet with one hand? With a CAT all you need to do is pull and give it a twist. You can perform self aid while your buddies can continue the fight.

  6. I could see those being a useful addition to pretty much any first aid kit, not just a range bag. Back when I used to work in a shipping department we had to construct pallets for some of the larger items which meant using a radial arm saw, saw a guy almost take his hand off with it once, he survived because we were able to get him help immediately. But if something like that had occurred on second or third shift where the nearest person could be half way across the plant being able to tourniquet the wound could be the difference between life and death.

    • There’s a difference in the construction between the one listed and the ones you linked to. Check out the nifty “windlass clip” thinger on the one I show – it hols the windlass in place without needing to lash it down. From the one time I had to attempt a TK, I will have you know it’s a very desirable feature.

      One would think you shouldn’t cheap out on a TK…

    • MaddMedic, It’s nothing personal but I’m afraid under the one-strike-you’re-out rule, you will be disqualified from owning machetes, effective immediately.

      I agree with Ralph. I’m glad you recovered from that terrible accident (or was that negligence).

  9. I really don’t understand why these are so darn expensive. It’s just a strap of nylon w/ some hook and loop and a couple of plastic bits.

    • The CAT is patent pending and the SOF Tac TK is patented. That may contribute to the seemingly high price.

  10. Great post Nick, much appreciated. The tourniquet controversy has been getting a fair amount of attention in a number of circles recently and I’m very glad that you’re bringing it to light here. Also, thank you for linking to your previous post on preparing an emergency medical kit.

    In the spirit of semper paratus, it has always been my conviction that, among the many responsibilities of citizenship, one must learn to be capable of giving first and secondary aid when called upon. As the Boy Scout motto says, “Be Prepared”. One never knows when one will be called upon to help one’s brother or sister in a time of need.

    For those interested and living in the greater Providence, RI area, the American Firearms School in Attleborough, MA, is sponsoring a course in Basic Trauma Management for Shooters on Saturday, August 13th. If you’re at all involved using firearms, a course like this would be a good addition to your skill set.

      • Hi Ralph, I’m signed up for 8/13 and I will surely be glad to introduce myself. I look forward to meeting you. Until then, Sláinte! Are you taking the course?

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