Simple in design, this small, inexpensive item saves lives. It is estimated that about 13% of the soldiers who died in Vietnam could have been saved with this device, but instead they died from loss of blood.
Several years following its development for use by the United States Military, the C.A.T. (Combat Application Tourniquet) has made its debut in civilian emergency medical care.
As always, the tourniquet is used to treat severe arterial bleeding from an extremity, but with the introduction of a more modern device, there are a few new principles that contradict some of what has been taught over the past century.
Old: A tourniquet is used only as a last resort.
New: Usually true, but in cases of severe arterial bleeding, the time wasted with less effective methods can be fatal. In cases of complete or near-complete amputations, a tourniquet should be applied first, before further blood loss causes shock or death. A patient can lose a fatal amount of blood in as little as a minute.
Old: Once a tourniquet is applied, it should never be loosened except by a doctor.
New: In some cases, after less extreme dressings have been applied, it is acceptable to loosen a tourniquet gradually, and if the bleeding is controlled, it may remain loose. It can always be reapplied with a simple twist. It should not be loosened simply to “check” the extent of the bleeding.
Old: Place the tourniquet two inches above the wound, to minimize the amount of tissue that is destroyed.
New: Place the tourniquet just above the elbow or knee, as applicable. The upper arm or leg has only one bone, rather than two. The artery is compressed directly against that single bone more easily, without the excessive tension that can cause extensive vascular damage.
Tip: The C.A.T. will only tighten about 4 cm, slightly less than two inches, so be sure to secure it firmly with the buckle prior to applying tension.
Old: After two hours, a tourniquet will result in almost certain amputation of the tissues below it.
New: With the less damaging design of the C.A.T. and others like it, along with improved surgical techniques, the chances are much better that a limb can be salvaged, even after several hours.
Tip: Be sure and run the hook-and-loop strap through both sides of the buckle. If only run through one side, it may stay in place during training, but if it is wet with blood, it is more likely to fail.
One last disclaimer – If your department makes use of this device, use it the way you were trained, and as approved by your medical director. It can be very hazardous if used improperly.