Tourniquets began to be formally employed among American military personnel starting in 1960. Since then, notably after the beginning of the 21st century, there has been significant evolution in these materials and their field application and testing.
As a result, hundreds of manufacturers worldwide started producing equipment with the goal of stopping hemorrhage in limbs. However, not all of them function as they should.
The Committee for Tactical Combat Casualty Care (CoTCCC), a section of the Joint Trauma System (JTS) under the Defense Health Agency, published initial guidelines for pre-hospital combat care in 1996 and currently lists several approved commercial tourniquets, as follows:
This text provides a brief comparison of the main tourniquets on the market, including those mentioned by CoTCCC. Some of them will be presented in person at the meeting of Projeto Papyrus – the study group of Academia Brasileira de Armas – on May 20, 2020, and can also be analyzed via video.
This material exclusively concerns non-pneumatic tourniquets.
COMBAT APPLICATION TOURNIQUET (CAT) – APPROVED BY COTCCC
Produced by North American Rescue, it is the standard tourniquet of the US Army.
The most modern version is Generation 7, which differs from the previous model by having a thicker windlass and a gray seal strap instead of white.
It seems to be the quickest self-application tourniquet compared to others. It has a red tip for easy identification.
RATCHETING MEDICAL TOURNIQUET (RMT) TACTICAL – APPROVED BY COTCCC
Produced by m2inc, the RMT is applied slightly differently from the CAT, as it operates with a ratcheting system tightened by a lever, as shown in the video.
The usage instructions are permanently written on the tourniquet itself. It requires the operator’s assistance to be self-applied on one of the arms.
SAM EXTREMITY TOURNIQUET (SAM-XT) – APPROVED BY COTCCC
Produced by SAM Medical, the main concept of this tourniquet is to minimize the number of windlass turns required thanks to a system of holes and pins, similar to a belt, which secures when reaching the optimal pressure.
In general, the application is identical to CAT7 tourniquets. However, unlike them, the SAM has a metal (6061 Aluminum) windlass instead of polymer, providing greater robustness.
SOF-TACTICAL TOURNIQUET-WIDE (SOFTT-W) – APPROVED BY COTCCC
The SOF is a tourniquet that appears to be more robust than the others approved by the committee. It is already in its fourth generation, with a buckle system that distinguishes it from others, allowing for faster complete release.
The SOF has two windlass locking systems, one of which is equivalent to the one used in CAT, and the second is a triangle where the aviation-grade aluminum windlass is inserted.
TACTICAL MECHANICAL TOURNIQUET (TMT) – APPROVED BY COTCCC
Produced by Combat Medical, the TMT is a lever tourniquet similar to SOF or CAT, but with some differences. One of them is the locking system: instead of two semicircles like in the other models, the TMT has a snap-fit system that clicks when inserted. It is also wider, minimizing the patient’s pain during compression.
TX2 TOURNIQUET (TX2) / TX3 TOURNIQUET (TX3) – APPROVED BY COTCCC
The TX2 and TX3 tourniquets are produced by RevMedX and have recently been approved by CoTCCC. The two models differ only in band width, with TX2 having 2 inches and TX3 having 3 inches. They function similarly to RMT, using a ratcheting system instead of the levers of CAT or SOF, thus requiring the operator’s assistance for self-application on one of the arms.
The usage instructions are permanently engraved on the tourniquet. The width of the tourniquet helps minimize the injured person’s pain.
Recon Tourniquet – Not approved by CoTCCC
Although not recommended by CoTCCC, the Recon Tourniquet, made by Recon Medical, seems to be sufficiently reliable. In some aspects, it may even be more so than the classic CAT.
It is the least expensive tourniquet on this list, selling for half the price of CAT, for example.
It operates with a metal lever and has a hole near the end to assist the operator in pulling the strap. The application is performed in the same way as CAT, TMT, or SOF.
DESMODUS T-APH – The Brazilian Tourniquet – Not approved by CoTCCC
Desmodus is a Brazilian company that recently started producing its own tourniquet, called T-APH. It has a strong structure and has being tested specially in Brazil for the last years.
Although it isn’t approved by the CoTCCC, T-APH seems to be liable and suitabe for use.
Regardless of the tourniquet you choose, training with the selected model is crucial.
When recommending equipment for use in combat, unusual questions for the average user must be asked:
- Does it have quick application?
- Does it work with different types of people with diverse physical constitutions?
- Does the equipment withstand extreme temperatures?
- Will it continue to function when the casualty is moved, dragged, or needs to keep on fighting?
- Can it be applied with gloves or bloodied hands?
- Can it be used in the dark?
It is impossible to know all types of tourniquets produced in the market. Obviously, the CoTCCC does not test each one of them. There are good tourniquets that may not be recognized by the committee and were not covered in this text.
Also, remember that unfortunately, there are counterfeit products available in the market that do not meet any standard norms and should, therefore, be rejected outright.