Studies Show that Current Military Tourniquets are Inherently Flawed

[DocGKR]

As noted, bad, flawed, biased article. SOFTT-W definitely works. Period. Current version of CAT would be my close second choice.

[PNWTO]

Big fan of the SOFTTW, especially for its footprint while carried in jeans vs the CAT.

A recent Jocko Podcast had a SEAL with some complaints about CATs failing, although I don’t remember the time frame.

[AMC]

Just completed my CPR/First Aid, First Responder Medical re-cert this week. Covered tourniquet use, including self application. We're issued two tourniquets, the SWAT-T and the Gen 7 CAT, along with a HALO chest seal in an IFAK. Officers are trained with Quick-Clot Combat Gauze but it isn't supplied yet. Several officers have also self-purchased SOFT-Ws, and carry them, so the training addressed them as well. Agree with the above comment that a properly applied tourniquet hurts like hell, be we were definitely trained to crank until the bleeding stops, no more. Advantages of both the Gen 7 CAT and SOFT-W were discussed, as well as the shortcomings in the SWAT-T (though it's versatility in many uses was also covered). We've had multiple tourniquet saves here, including of officers (shot in brachial artery). I've personally applied both the SWAT-T and the CAT.....the CAT was clearly easier to use and more effective as a tourniquet. The SWAT-T became slicker than snot when bloody, and trying to grip it with bloody gloves was....interesting. This was on a brachial artery bleed. A drunk came home and went to the wrong apartment. When his key didn't work, he punched through the door glass to reach in and unlock the door, with messy results. It was quite a bloody scene, and the paramedics (who were very limited on what they could do at the time) could not stop the bleeding with DP, and were starting to worry the guy wouldn't make it to the ER. I offered that I had a tourniquet and Quick-Clot, and offered to help. Eventually got the SWAT-T on and applied the Combat-Gauze and stopped the bleed. Our medics now carry exactly what you'd hope they would.

One thing brought up in the training was that the SOFT-W is much harder to self apply to the arm, due to the D-Ring type windlass closure. It was also noted that it's the best thing going for a thigh wound.

[HCM]

Big fan of the SOFTTW, especially for its footprint while carried in jeans vs the CAT.

A recent Jocko Podcast had a SEAL with some complaints about CATs failing, although I don’t remember the time frame.

One of our neighboring offices had a CAT break while transporting a GSW victim, luckily they had a second TQ with them. I don't recall if it was determined to be a failure of the TQ itself or over-tightening.

[UNM1136]

My 11B son has had a good bit of training in the use of these and has passed on to me that they've been admonished that the failures in tightness are often/usually(?) due to not winching down the strap extremely tight BEFORE even starting to use the windlass. The live training they do is rather uncomfortable.

Yup. Recently did a very uncomfortable week with a retired JSOC guy and a Team 5 guy. Despite paying the former ST5 HCM in sardines at the suggestion of the JSOC guy it was a painful week. TQ on,then extract...on foot...at least one of us took a couple of winds out of the windlass for the sake of the victim while the other (deputy) guys fumble fucked the on-foot extraction. During the debrief, not all of the AIs thought to release the tension on the victim's TQ.

"TQs need to go high and tight. When it starts to hurt, you got it just right."

pat

[ST911]

I'm concerned about the frequency in which instructors teach and students describe tourniquet application as painful.

I find the pain associated with tourniquet application to be a lot of self-fulfilling prophecy. Like taser exposures, if students are primed with descriptors or told that they will feel pain, "this will suck/hurt like hell", etc, they will indeed self report it. When I describe feeling and function of the limb post-application to students as "uncomfortable", "throbbing", or other descriptors, they will self-report those terms and demonstrate greater dexterity and mobility in subsequent exercises.

While individual tolerance varies, along with tissue type and density in the extremity, tightening to occlusion needn't be universally "painful" until some time has passed. If TQ application is painful, and consistent in a student/user group, instructional technique should be examined carefully. We need to be teaching TQ application with pulse checks and use of pulse ox or doppler.

[UNM1136]

I agree with you for the most part....the saying I provided is largely for self aid, since pain is subjective and I would rather crank a TQ on myself ro the point of pain rather than risk my subjective assessment of my bleeding stopping not being adequate. By definition, judging when a TQ starts to hurt on someone who has a bad enough injury to require a TQ is not likely a helpful metric. Maybe a distinction without a difference in the end.

The fact remains that while training others in a somewhat austire environment and wanting to get good reps in we gonna crank. Care under fire. Better to err on too tight than too loose. To your point though, maybe verballizing "tightening the windlass until the bleeding stops" as the training TQ is tightened might be helpful. And maybe checking radial or pedal pulses at the start of the debrief would make a good metric for a properly applied TQ in a larger format class. Any other ideas on how to ingrain the concept? I am all ears, since this is pretty important to me. The X-ray Tom posted occurred in my town, and the whole pursuit, which ended in a couple TQ applications started and ended within a couple of miles of my jurisdiction. The suspect was shot blocks from my church, and my kids' school mates were in the gas station at the pursuit's termination point when the suspect was killed. My guys and I helped provide guard details at the hospital to the injured, and the event was in the area command that bordered our jurisdiction. A right turn during portions pursuit would likely have included us...

My point was reinforcing the idea that a TQ should be snug (tight, after high) before the windlass gets cranked.

pat

[runcible]

Disclaimer: I’m not a TCCC/EMS Instructor, nor do I possess any relevant medical certifications.

The presence or absence of pain during field tourniquet application is kind of unimportant, as I understand it. The absence of a distal pulse and/or bleeding stopping is the standard to be met; though some will use “tension sufficient that fingertips can’t be pushed beneath the band” in some training environments.

Neither SOFTT-Ws nor CATs are extremely uncomfortable to apply until full occlusion is achieved; they don’t feel great, but they are sufficiently tolerable that it is not unreasonable for it to be a monthly sustainment activity. For reference, TK4s may be less comfortable depending on the wraps and if the elastic folds; and a NATO TQ will outright be significantly more uncomfortable to tension until occlusion. (TK4s were pretty iffy when I was still AD, and the compensating methodology that went with that could get a bit, uh, creative.)

Where this becomes important is recurrent and unodious training with whatever the organizationally issued TQ is. I’ve known a few folks whom carry NATO TQs; but I’ve never me one whom willingly practices with it, or practices at all. No one has blinked about a spontaneous TQ application after they’ve done it once. This lets you get users well practiced in such nuances as pulling out the slack from a CAT’s windlass before beginning to turn it, and how to keep the excess band material from interfering with that rotation.

That said, regularly being an adjunct for such events, neither I nor the leads describe the experience nor the goal in terms of discomfort, so perhaps we’re not providing a conducive environment for such thoughts.

[2xAGM114]

Good example of why that's not the solution, and actually part of the problem. The windlass should be tightened until the arterial bleeding stops.

At the other extreme, the USAF's Self Aid Buddy Care (SABC) curriculum teaches to tighten the windlass no more than three times. Three might work on a decent application to certain arms. I don't remember it ever occluding on a leg. It also won't work when airman makes one of the leading errors in TQ application- failure to pull enough tension on the strap itself, leading to the ball of ribbon/strap under the windlass.

Summary: Like much else, it's not the gear that's failing as much as the training and leadership. Gear mitigates and aggravates, but people continue to fail people.

Shack. I literally just had SS02 Land Survival refresher about a month ago. The TACP washout SERE instructor had us "tighten until the bleed stops, then three add'l turns" of the windlass. "Hands-on" SABC is worse with very little mention of TQ application other than to show what it looks like, wrapped in plastic. Zero TCCC trained instructors in the wing (AMC base). Everything used in class was gen 3 CATS I believe.

[Super77]

Current SOP for Army is 2 CAT or SOFT TQs (doesn’t matter which) high and tight (tightened until arterial bleeding stops), then secure with tape and mark time on the tape. The bungie cord was reviewed by COTC3 and didn’t meet the standard. Current TC3 guidelines are available on the deployed medicine ap and website.