Uncontrolled bleeding is the number one cause of preventable death from trauma. Approximately 20 percent of people who have died from traumatic injuries could have survived with quick bleeding control.1 The only thing more tragic than a death is a death that could have been prevented. Civilians are often the first responders in hemorrhage control. No longer considered a last resort, tourniquets have emerged as the standard of care due to their ease of use, rapid application and complete stoppage of blood loss. And current protocol considers the tourniquet an initial lifesaving intervention to control massive hemorrhage from an extremity. So whether it’s a gunshot, deep laceration or an amputation, a tourniquet can be a lifesaver. The old dogma of “save a life, lose a limb” has been proven to be false.
Study Finds Tourniquets Save Lives
Although there have been several studies in the past that have looked at tourniquet use in civilian settings, the survival benefit for patients has been unclear. However, new research shows that for civilian patients with peripheral vascular injuries (wounds caused by penetrating trauma or blunt force trauma to extremities), prehospital tourniquet use is associated with dramatically improved odds of survival.
The study, titled “Civilian Prehospital Tourniquet Use is Associated with Improved Survival in Patients with Peripheral Vascular Injury,” was published in March 2018 and reported in the May 2018 issue of the Journal of the American College of Surgeons (JACS). It was a multi-institutional retrospective review of all patients sustaining peripheral vascular injuries admitted to all 11 urban Level I trauma centers in the state of Texas from January 2011 to December 2016.2
And the study found that “Although still underused, civilian prehospital tourniquet application was independently associated with a 6-fold mortality reduction in patients with peripheral vascular injuries. More aggressive prehospital application of extremity tourniquets in civilian trauma patients with extremity hemorrhage and traumatic amputation is warranted.”2 Simply put: tourniquets save lives.
Tourniquets Available Today
Tourniquets should be part of everyone’s everyday carry (EDC). Improvised tourniquets are recommended only when a commercial tourniquet isn’t available. Popular commercial tourniquets include the Combat Application Tourniquet (CAT) SOF Tourniquet, RevMedx TX Series, Ratcheting Medical Tourniquet – Tactical (RMT-T), SAM Extremity Tourniquet (SAM-XT), Tactical Mechanical Tourniquet (TMT), SWAT-T and RATS Tourniquet. Each has its pros and cons.
The CAT, RMT-T, SAM-XT, SOF Tourniquet, TMT and TX Series (TX2 and TX3) are the only limb tourniquets the U.S. military Committee on Tactical Combat Casualty Care (CoTCCC) currently recommends.3 But keep in mind the CoTCCC is looking at tourniquets for adults in a combat setting. The CoTCCC review evaluated a total of 19 tourniquets.
I have chosen to go with the current generation (Gen 7) CAT. I chose the CAT due to its ease of one-handed application and the fact that more people have trained with it. It’s the most recognizable and widely issued tourniquet worldwide.
The CAT, SAM-XT, SOF Tourniquet and TMT are windless tourniquets. The TX and RMT-T are ratcheting tourniquets. The SWAT-T and RATS are elastic wrap tourniquets.
Elastic Wrap Tourniquets
Elastic wrap tourniquets pack down into a significantly smaller size, making them easier to carry. And they’re considerably less expensive than windless and ratcheting tourniquets. They tend to be more difficult to apply with one hand and slower to apply than windless and ratcheting tourniquet designs in my experience.
The SWAT-T (Stretch, Wrap and Tuck Tourniquet) is a medical multi-tool that may be employed as a tourniquet, pressure dressing, occlusive device, elastic bandage, sling and swathe, and more. It can be successfully employed for higher axillary and groin applications. The latter should be true for the RATS, as well.
The SWAT-T and RATS can be employed for pediatric and K-9 applications where adult windlass and ratcheting tourniquets cannot. However, prospective testing of a cohort of school-aged children 6 to 16 years revealed the CAT to be suitable for use in both the upper and lower extremity.4 Additionally, the TX and RMT ratcheting tourniquets are available in a pediatric model designed specifically for children.
Finding the Best Tourniquet for Your Kit
The best tourniquet is the one you have with you when you need it and the one that you have trained with. I recommend carrying at least two tourniquets (and protective gloves). This will leverage your capability in a trauma incident. Use a dedicated training tourniquet for training/practice. Save the one(s) you carry for use in actual emergencies.
Use without formal training yields poor results. The time to learn to use a tourniquet is not during an emergency. Free online training is available from Dark Angel Medical and from the American College of Surgeons STOP THE BLEED program.
Disclaimer: This article is not intended as medical advice or to replace appropriate training in the selection, safe use and application of a tourniquet or any other medical device.
 Peter T. Pons, MD, FACEP, Lenworth Jacobs, MD, MPH, FACS; “What Everyone Should Know to Stop Bleeding After an Injury”; BleedingControl.org; https://www.bleedingcontrol.org/~/media/bleedingcontrol/files/stop%20the%20bleed%20booklet.ashx; Accessed 9 July, 2022.
 Teixeira PGR, Brown CVR, Emigh B, Long M, Foreman M, Eastridge B, Gale S, Truitt MS, Dissanaike S, Duane T, Holcomb J, Eastman A, Regner J; Texas Tourniquet Study Group. “Civilian Prehospital Tourniquet Use Is Associated with Improved Survival in Patients with Peripheral Vascular Injury.” J Am Coll Surg. 2018 May;226(5):769-776.e1. doi: 10.1016/j.jamcollsurg.2018.01.047. Epub 2018 Mar 29. PMID: 29605726. https://pubmed.ncbi.nlm.nih.gov/29605726/; Accessed 9 July 2022.
 Joint Trauma System (JTS) / Committee on Tactical Combat Casualty Care (CoTCCC). “CoTCCC Recommended Devices & Adjuncts” Updated 15 December 2021. https://www.deployedmedicine.com/market/11/content/100: Accessed 9 July 2022.
 H. Theodore Harcke, Luke L. Lawrence, Emily W. Gripp, Heidi H. Kecskemethy, Richard W. Kruse, Stephen G. Murphy; “Adult Tourniquet for Use in School-Age Emergencies”. Pediatrics June 2019; 143 (6): e20183447. 10.1542/peds.2018-3447, https://publications.aap.org/pediatrics/article/143/6/e20183447/76825/Adult-Tourniquet-for-Use-in-School-Age-Emergencies?autologincheck=redirected; Accessed 9 July 2022.