If you’re in the military and even law enforcement you have probably been trained in the use of a tourniquet to stop hemorrhaging. Most of us just use what is issued and don’t really look at our gear after yearly refresher training. But have you thought about carrying an Individual First Aid Kit (IFAK) when you’re target shooting outside of work or as accident kit in your POV? What if you’re a civilian, with no hands-on experience with tourniquets, who is trying to figure out which one to carry as part of a first aid or EDC kit?
Looking online I was hard-pressed to find a comparison of more than two of the common tourniquets that are out there. For those of you looking to add a tourniquet to your EDC gear or for a solid piece of kit to ride shotgun with you hopefully the experiences outlined here will help you make an informed decision.
The four tourniquets that we’ll be looking at are the C.A.T. (Combat Application Tourniquet), SOF-T (SOF Tactical Tourniquet), R.A.T.S. (Rapid Application Tourniquet System) and the SWAT (Stretch Wrap and Tuck Tourniquet).
To give a little background, my formal medical training is limited to EMT-B in a past life, the Army’s Combat Lifesaver course and some other medical training along the way. I don’t presume to be an expert or speak with anything other than a passing familiarity of the need to keep the red stuff on the inside. I was aided by a close friend who is a paramedic and has extensive tactical medicine training. The “we” referenced below is the two of us.
While tourniquets are going to be used in less than ideal conditions we chose to test these in a controlled environment for unbiased results across the different systems (read: it was my friend’s living room slumped against a couch). Also while tourniquets are used to control bleeding we couldn’t get Household 6 to sign off on dousing each other in pig blood (or the blood of our enemies) for the sake of a realistic test. With that said the following impressions are just that – our impressions. We applied the tourniquets in a manner that we would expect to see them employed. The times listed are for self-application. Times are measured from the first movement until the tourniquet was secured and blood flow was stopped. We won’t talk about what pouch/holster/tie-down method is best to carry your tourniquet. You know your gear and how you’re going to be carrying it. We only want to look at the system’s practicality, effectiveness and ease of use. The following observations and times are the product of our collective experiences and opinions as well as one day of systematic/side-by-side comparison of the following four systems.
The C.A.T. is one of the most popular tourniquets out there. It is hailed as being one of the fastest tourniquets to employ. Because when you need to stop arterial bleeding you need to stop it right now.
The instructions for the C.A.T. show two different methods of employment – single hand and dual hand. The difference being whether you route the strap through one or two of gates on the system’s buckle. Since the strap is covered in hermaphroditic hook/loop routing it through only one gate allows you to pull the strap out and away from your body pulling out all the slack before your adhere the strap to itself. With the two handed method you can hold the tourniquet in place with one hand while the other pulls the strap up and away to take out the slack. If you try to pull the slack one-handed with the C.A.T. in the two handed configuration you’re in for a frustrating time.
Once the slack is removed and secured you turn the windlass (read: rod shaped handle) until the bleeding stops. You then secure one end of the handle inside a provided open topped cradled that resembles the letter C. The end will fall in and with tension hold itself in place. To prevent the windlass from popping out there is a nylon/Velcro cover that is secured on the top of the cradle once you’re done.
Our average time for self-aid application to the leg was 28 seconds.
Our average time for self-aid application to the arm was 12 seconds in the one-handed configuration. If you change the tourniquet to the two handed application that time ballooned out to over a minute. Trying to manage the strap sticking to itself while pulling slack out of it and maintaining control of the tourniquet was frustrating. As I was struggling with this I couldn’t imagine myself trying to use the two handed configuration on my own arm.
Why even have two different methods? There are anecdotal reports that if the C.A.T. is used on a lower extremity injury in the one-handed configuration the hook/loop strap can loosen during transport and movement thus restarting the flow of blood. Is that going to happen in a vast majority of cases? No, probably not. But it’s a concern.
Well that’s an easy fix you say. Keep it in the one-handed configuration and if you need to you can switch over to the more secure two-handed method. That’s fine if you’re willing to put the time into drilling with the C.A.T. so that when you need it you will remember to route the strap through that extra buckle. If you can train yourself to do that you’re good to go with the C.A.T. On the other hand there is something to be said for a system that works the same way every time.
So that leads us to the SOF-T. This is the other common tourniquet in use. The SOF-T is similar to the C.A.T in that it is also a windlass design, meaning it has a handle that is twisted to apply circumferential pressure. While there are two models of the SOF-T, the Original with a 1”strap and the Wide with a 1.5” strap. Both feature a consistent application routine, regardless of the method you are using it. This was one of the biggest take-aways during the comparison. The SOF-T has one method of application. There is no additional routing through a buckle if you’re using it two handed or applying it to your leg.
One of the complaints on the older SOF-T is the tension thumbscrew that is supposed to keep the tourniquet from loosening once it is tightened down. If you set it up too tight it will bind the strap keeping you from removing slack until the thumbscrew is loosened. The workaround for this has been to keep it just tight enough to offer slight resistance as the strap is fed out. The newer “wide” model does not have this thumb screw and instead has a traditional slip gate type buckle similar to what you would find on an instructor belt.
The application of the SOF-T is very similar to the C.A.T. You place the tourniquet above the injury, pull out the slack and turn the windlass until the bleeding stops. With the SOF-T there is a triangular buckle “catch” that you slip the end of the windlass into.
Our application times averaged 20 seconds for a self-aid leg application and 16 seconds for the arm. Again this isn’t as fast as the C.A.T. for the arm when it is configured with the one handed application method. While seconds are critical we see the value in having a system that has the same application methodology regardless of how it is used. This is one less thing to forget under the stress of a traumatic injury.
A quick aside here – there are guys out there that are carrying a CAT up high and a SOF-T down low, catering to the strengths of each. If you train to switch it up depending on where you’re shot then good on you.
While I tend to cross my eyes at anything labeled “SWAT or “tactical” the SWAT tourniquet actually contains instructions for usage in its name. Stretch, Wrap and Tuck describes the application methodology for this tourniquet. The SWAT is a four inch wide strap of rubber that when wrapped on itself will provide enough compression to stop arterial bleeding. Of the tourniquets tested the S.W.A.T. had the widest footprint which, with an extended application time, would reduce the risk of permanent tissue damage. While most stateside usage will have the victim delivered to advanced care within an hour that is still a positive of this system.
A feature of the S.W.A.T. worth mentioning are the “tightness indicators” (my term, not the manufacturer’s). There are a series of geometric shapes on the band that will stretch to a different shape when the tourniquet is properly stretched and tightened. Regardless of the shapes you will be making the thing as tight as you possibly can so take it as you will.
As for self-aid application, well, it was rough. Our average times for arm and leg application was 40 seconds. This system can be prone to the tail slipping out if you don’t tuck it in correctly. You need to have enough slack in the last wrap to put the tail under. It’s food for thought.
To be fair we tried it in a buddy aid capacity for the leg and our results were much better. A successful application took 35 seconds. It’s still slower than the other systems out there but not by much.
Another thing that we found was that this tourniquet works much better when you take your time and make the wraps neatly and laying on top of one another. I know all things can be trained but in the heat of the moment it is easy to get sloppy and have what looks like a blown out tire wrapped around your limb.
We came away from our experience with the S.W.A.T. less enthusiastic about it as a tourniquet but we both loved it as a piece of gear. “Whoa whoa, you just got done ripping it. How can you love it?” While I might not love the S.W.A.T. as my go-to self-aid tourniquet I can think of a dozen other uses for it. It would hold a pressure dressing in place. It could be used to secure a splint. The rubber could be chopped up and added to a fire for signaling smoke. You can use it as a loop to hang an I.V. bag from. Seriously, the thing is versatile. So versatile in fact that there are medics that carry a few of these in their kit for all of the other things you can do with it.
On top of all of this the S.W.A.T. is the least expensive of the tourniquets we tested. It’s not going to break the bank if you buy one and toss it in your pack to make an improvised water balloon slingshot.
The final tourniquet we’ll look at is the R.A.T.S. or Rapid Application Tourniquet System. The R.A.T.S. is made of a ½” flat bungee cord with a metal cleat that serves as the locking device. Using this system is easy. The bungee is attached to a lower corner of the metal cleat. There is a slot on the opposite corner that the bungee is then run through, forming a small arch or loop. You pull enough slack to fit three fingers in the loop. Run the free running end under or around the injured limb, feed the free running end of the bungee back through the loop you made, pull back and begin wrapping. It is recommended that you get at least three sequential wraps (not directly on top of one another) to spread the force out over two to three inches to prevent tissue damage. (NOTE: Guys with THICK legs will barely able to get two complete wraps on their thighs.) Once you’ve got your wraps you just tug the bungee into the locking cleat to secure it. That’s it.
Our average time for self-aid application to the leg was 22 seconds. Average time for the arm was 35 seconds.
The negatives that we found with this system was the potential for tissue damage if the wraps are spaced too close (on top of one another) or too far (inches between wraps). In fairness that is true of any tourniquet system applied inappropriately. It really comes down to “Follow the manufacturer’s directions.”
Another negative was that wrapping and stretching the R.A.T.S. requires a fairly wide range of motion. While we didn’t conduct this test in armor we could see how wearing an IOTV or other tactical body armor could hinder your movement enough to frustrate your application. The same would be true of the S.W.A.T. tourniquet. The C.A.T. and SOF-T only require movement of your hand to turn the windlass.
On a positive note the R.A.T.S. has a very minimal footprint allowing you to tuck this thing in places your other tourniquets won’t go. I originally bought one to try with the Ricci Ankle Medical System to replace a bulkier SOF-T.
In all honesty I was a little skeptical of the R.A.T.S. and the big claims of it being the fastest tourniquet out there. Our testing didn’t bear that particular claim out. But after testing it out and carrying it around for over five months I’m pretty confident in this system, especially as a small EDC tourniquet.
Again we wanted to compare more than the two really popular tourniquets that are out there. Our testing methodology was that of two grunts who carry these items as part of their job and wanted to see how things stacked up. We aren’t trying to tell you what system to use or what product to buy. If your experiences with any of these tourniquets is radically different than ours, rock on. Drop a note in the comments section below. We’d love to hear what works for you and why. Hopefully this article will give those who don’t have a preferred system a place to start.
Before I end, let me just say that if you’ve been carrying a tourniquet and are trained in its use, drill with the thing. Practice using it in situations that are similar to what you’re likely to face. Then toss in some wild cards. Just like shooting, practice primary and support side applications. Mr. Murphy is lurking and he’s a jerk.
If you’re reading this and are looking to add a tourniquet to your gear for the first time, get training. The “how” I leave up to you, your budget and your learning style. The tourniquet is a tremendous life-saving tool when used correctly. Thankfully, with the four systems we looked at, you’ve got some really good options from which to choose.
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