What are the different types of Tourniquet

The importance of tourniquet which are indispensable first aid tools used in combat and emergencies cannot be over emphasized. These tools have been used since the early days in its crude form. However, they have become more refined and offer so many benefits in different situations.

This article takes a critical look at the different types of tourniquets and their unique features.

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Types of Tourniquets

CAT Tourniquet With Plastic Rod

The Combat Application Tourniquet is one of the oldest tourniquets in existence and mostly utilized by the military. It comes in numerous variations or generations. However, the newer models are recommended.

Besides being one of the oldest tourniquets, the CAT is the most effective commercial tourniquet available. In fact, according to the US Army’s Institute of Surgical Research, the CAT is 100% effective and has reduced the mortality rate due to extreme exsanguination by 85% since its introduction in combat in 2005.

CAT tourniquets with plastic rods are one of the few categories of the CAT model. It is easy to use, a one-handed constricting device that can be applied to extremities to control blood loss, consisting of a strap, buckle and a plastic windlass system. The plastic windlass is its most defining feature. This device comes in three different colors: blue, orange and black - each offering unique features and functions.

CAT Tourniquet With Metal Rod

The Combat Application Tourniquet with the metal rod has all the features of the previously discussed CAT save the plastic rod: Velcro strap with red tip, single plastic buckle (Gen 7) and a windlass system comprising a metal windlass rod, a windlass clip and a windlass reinforcement strap. Thanks to the metal windlass, this type of CAT is stronger than other variations. This device is also effective in preventing haemorrhages from both upper and lower extremities.

SOF Tourniquet

The Special Operation Forces Tactical Tourniquet is one of the top-performing medical tourniquets currently available. It is also of only two windlass tourniquets approved for use by the Department of Defense, the Committee on Tactical Combat Casualty Care, and the tourniquet of choice for the American Red Cross.

The SOF ability to control massive extremity haemorrhage and save lives, high level of reliability, and ease of application makes it the ideal choice for elite military operators around the world, large police departments, fire and EMS paramedics on the streets and civilians in everyday public places.

With a true 1.5-inch tourniquet strap the SOF Tactical Tourniquet provides superior compression than most standard tourniquets or tourniquets with a 1-inch constricting band moving through a 1.5-inch sleeve. This broader compression pattern allows for additional arterial compression and increased patient comfort.

High strength and lightweight alloy components (such as the metal windlass) make this tourniquet reliable in the most challenging of circumstances and on the largest of limbs.

Instead of Velcro, the Special Operation Forces Tourniquet relies on a strong hook and buckle interface, designed for security, strength and ease of application.

Its design allows for rapid disconnection and reconnection of the tourniquet strap around the limb while eliminating the need for re-threading the webbing through a buckle. By eliminating the requirement to re-route the webbing the tourniquet is easier to operate under stressful conditions and reduces application time, both of which can result in reduced levels of blood loss and better quality patient care.

As an additional feature, each tourniquet comes with two UV-resistant black rubber bands for mounting on individual equipment.

Like the CAT tourniquets, SOF Tactical Tourniquet is categorized by generations, the latest and most effective generation being the Gen 4. Gen 4 SOF tourniquets are available in various colors: black, blue, rescue orange, tan and red – they all have the same functions and application method.

Junctional Tourniquets

Junctional tourniquets are devices used to control bleeding in junctional injuries, which occur at the junction of the trunk, limbs and neck. These injuries are not easily controlled, thus standard tourniquets would not be effective. In other words, junctional tourniquets are external compression devices that occlude blood flow from arteries and prevent haemorrhages in areas where standard tourniquets would be less effective such as pelvic, inguinal, axillary and even abdominal bleeding and IED/Blasts or high-level amputations.

Before the introduction of this type of tourniquets in 2010, digital pressure, compression bandages and pneumatic garments were some of the pre-hospital options available. However, they were not considered effective for the US military resulting in the use of hemostatic bandages. While this device demonstrates some efficacy in controlling junctional haemorrhage, it had its limitations Junctional tourniquets (JTQ) were developed to fill this gap.

Junctional tourniquets have made their way onto the civilian market by way of military applications and research from the U.S. Army Institute of Surgical Research.

Until recently, only three junctional tourniquet models were approved for use by The Food and Drug Administration and available in the market: The Junctional Emergency Treatment Tool (JETT), the SAM Junctional TQ, and the Combat Ready Clamp (CRoC). The Abdominal Aortic & Junctional Tourniquet (AAJT), previously only indicated for truncal use to stop inguinal bleeding, can be now added to this list since it has recently received FDA clearance for junctional use.

This means that these four FDA-approved devices can achieve vascular occlusion in severe and difficult injuries. While the CRoC - which resembles a vice -, can be applied to a single inguinal or axillary wound, it does not stabilize the pelvis.

Both the JETT and the SAM JTQ are pelvic binders that can be used on inguinal and axillary injuries (groin and armpit respectively). However, they differ in their design, The Junctional Emergency Treatment Tool has built-in bilateral compression devices while the SAM tourniquet comes with detachable, pneumatic compression pieces.

Studies reveal that SAM junctional tourniquets are among the easiest and fastest to apply – 78 seconds. They are small, lightweight, easy for soldiers to carry and use on the battlefield and they are incredibly effective when used correctly - the only device to reach 100% effectiveness in stopping blood flow distal to the groin.

According to American Committee of Tactical Combat Casualty Care (TCCC), for a tourniquet to pass a junctional tourniquet it must have the following critical traits: effective control of haemorrhage from junctional areas, safety, amenable to the battlefield and tactical situations, low weight, low cost, ease of use, speed of application and stability.

While the appropriate use of junctional tourniquets has the potential to save many lives, they haven’t been used in real-world scenarios yet.

RATS Tourniquets

RATS is the shorthand for Rapid Application Tourniquet System. It is an emergency tourniquet that uses elastic strength to prevent blood loss instead of the windlass system. RATS tourniquets are designed to be used for real-life situations, under stress and even at night. They do not require fine motor skills, enabling ease of use and faster applications during stress. Since Rapid Tourniquets leverage an elastic system, threading, locks and other complex procedures are eliminated.

RATS tourniquets are also effective in stopping bleeding. When an elastic band is stretched around a limb, it increases the pressure force on the soft tissue underneath by about 2 to 3 times depending on how far it’s stretched. This large increase in pressure causes the bleeding to cease faster.

However, the use of elastic tourniquets in the real world has one major flaw. Unlike in the hospital where the pressure applied on the extremity can be monitored, in real life, the pressure can’t be easily determined and excessive pressure can lead to permanent nerve and soft tissue damage to the limb.

So, if the tourniquet is wrapped too tightly it can cause permanent neurovascular damage and wrapping it too loosely will not stop the bleeding. Then, failure to hit that sweet spot will require a rewrap of the entire RATS tourniquet which restarts the bleeding.

Buckle Tourniquets

Buckle type tourniquets are different from tourniquets with buckles like the CAT and SOFT. The buckle is the only fastening system this tourniquet has. Buckle tourniquets are small, lightweight one-handed tourniquets with a woven and elastic strap and a solid plastic catch with a plastic buckle or clamp. The button on the buckle allows for quick release and immediate removal. Most buckle tourniquets are latex-free and offer high-quality materials, making them ideal for both children and adults. Like other tourniquets, they can be used to limit blood flow and prevent blood loss.

There are two ways to apply a buckle tourniquet: First place the tourniquet with both clips facing upwards and clip the ends together around the limb. Pull the end of the strap to tighten the tourniquet. To unclip simply press the button.

You can also apply this tourniquet by clipping the ends together to form a loop. Place the limb through the loop and fasten by pulling the strap until snug or the blood flow stops.

Conclusion

Tourniquets are very essential emergency tools. They help to prevent excessive blood loss from a severe injury which might light lead to shock and eventually death. However, it is imperative to note that tourniquets can only save limbs and lives if they are correctly applied. This is why you need to understand the various types of tourniquets and how to use them.