The Tourniquet Controversyhuettenhoelscher / Getty ImagesTheuse of tourniquetswas first documented on the battlefield in 1674. Complications of tourniquet use were said to lead to severe tissue damage. Soldiers had amputations of limbs that were often attributed to the use of tourniquets but could have just as easily been from infection. Eventually, tourniquets developed a bad rap in the field ofemergency first aid.Applying a tourniquet in the civilian world used to be seen as a last resort. It was thought that they made sense for soldiers because combat wounds are severe and a fighter needs to fight. It was a risk worth taking, went the theory. A tourniquet can be applied and ignored.That doesn’t mean tourniquets don’t work. On the contrary, tourniquets can arrest bleeding quite well and are certainly useful in cases of severe bleeding that cannot be stopped any other way. They’re popular on the battlefield because they can be applied quickly and do not need to be constantly monitored once they are in place, allowing even injured soldiers to remain conscious and continue fighting.Civilians, the thinking went, had time. We could go methodically through steps to control bleeding. We were taught to start with direct pressure and if that doesn’t work, elevate. If the bleeding continued, a tourniquet became the dire option. So maligned, tourniquets were thought to guarantee the loss of a limb if they were used. Losing that blood flow would most certainly lead to catastrophic tissue damage.Modern, evidence-based medicine is changing long-held views about tourniquets.Hemorrhageis a serious issue. When it’s present, it needs to be stopped. If not, the patient could die. There’s no time to mess.
The Tourniquet Controversy
huettenhoelscher / Getty Images
Theuse of tourniquetswas first documented on the battlefield in 1674. Complications of tourniquet use were said to lead to severe tissue damage. Soldiers had amputations of limbs that were often attributed to the use of tourniquets but could have just as easily been from infection. Eventually, tourniquets developed a bad rap in the field ofemergency first aid.
Applying a tourniquet in the civilian world used to be seen as a last resort. It was thought that they made sense for soldiers because combat wounds are severe and a fighter needs to fight. It was a risk worth taking, went the theory. A tourniquet can be applied and ignored.
That doesn’t mean tourniquets don’t work. On the contrary, tourniquets can arrest bleeding quite well and are certainly useful in cases of severe bleeding that cannot be stopped any other way. They’re popular on the battlefield because they can be applied quickly and do not need to be constantly monitored once they are in place, allowing even injured soldiers to remain conscious and continue fighting.
Civilians, the thinking went, had time. We could go methodically through steps to control bleeding. We were taught to start with direct pressure and if that doesn’t work, elevate. If the bleeding continued, a tourniquet became the dire option. So maligned, tourniquets were thought to guarantee the loss of a limb if they were used. Losing that blood flow would most certainly lead to catastrophic tissue damage.
Modern, evidence-based medicine is changing long-held views about tourniquets.Hemorrhageis a serious issue. When it’s present, it needs to be stopped. If not, the patient could die. There’s no time to mess.
When to Use a Tourniquet
Tourniquet application should happen in two cases:
Why wait? If direct pressure and elevation can work together, do it together. Raise the arm above the level of the heart as you’re squeezing hard on the laceration to plug the hole. If, at that point, blood is still oozing through the bandage or out from under your fingers, a tourniquet isn’t a bad idea.
Number 2 is a lesson learned from combat. Fighters fight, and tourniquets let them. That applies to civilians, too. Hikers need to hike to get to help. Patients with multiple injuries need treatments that allow the hands to be free. Long waits for the ambulance lead to fatigue in the hands of the rescuer trying to hold direct pressure.
Combat Application Tourniquet (CAT)
When these things first came onto the market, they only came in black, which I don’t recommend for a civilian tourniquet. It totally makes sense in a combat situation not to stand out with a bright orange strap around your bleeding arm, but black hides blood and is difficult to see in low light. Doctors at the hospital could miss the tourniquet if it is black.
SOF TourniquetThe SOF Tourniquet is similar to the CAT, except for the buckle. The CAT has a friction buckle that can be cumbersome during use, especially if you’re wearing any sort of personal protective gloves.The buckle on the SOF Tourniquet snaps together, which allows you to have the end of the strap already fed through the friction slide. In this case, you don’t have to slip a circle of canvas strap over the end of the injured arm or leg. You can simply wrap thetourniquet around the limband snap it into place.This functionality is only helpful if you’re applying the tourniquet to someone else. As far as self-application goes, it’s nearly impossible to snap it together with one hand, so putting it on your own arm is the same as using the CAT.
SOF Tourniquet
The SOF Tourniquet is similar to the CAT, except for the buckle. The CAT has a friction buckle that can be cumbersome during use, especially if you’re wearing any sort of personal protective gloves.
The buckle on the SOF Tourniquet snaps together, which allows you to have the end of the strap already fed through the friction slide. In this case, you don’t have to slip a circle of canvas strap over the end of the injured arm or leg. You can simply wrap thetourniquet around the limband snap it into place.
This functionality is only helpful if you’re applying the tourniquet to someone else. As far as self-application goes, it’s nearly impossible to snap it together with one hand, so putting it on your own arm is the same as using the CAT.
SWAT-TThe SWAT-T is a different kind of tourniquet than either the CAT or the SOFTT. Aimed more at civilian populations, it uses thick rubber to accomplish the same thing as the windlass does for the other two. The SWAT-T can’t be self-applied, but it can be applied to children and very small adults.Tourniquets with a windlass must have apinch plate, a thick area of fabric below the windlass that blocks the skin from being pulled into the twisted strapping. Without a pinch plate, skin and soft tissue can be twisted and pulled, causing pain and, in patients with delicate skin, further injury.Pinch plates on the CAT and the SOFTT make it difficult for them to cinch down small enough for young children, infants, and very small, usually elderly, adult patients.An extra plus for small patients: the SWAT-T can be cut into two tourniquets for multiple injuries or multiple patients.
SWAT-T
The SWAT-T is a different kind of tourniquet than either the CAT or the SOFTT. Aimed more at civilian populations, it uses thick rubber to accomplish the same thing as the windlass does for the other two. The SWAT-T can’t be self-applied, but it can be applied to children and very small adults.
Tourniquets with a windlass must have apinch plate, a thick area of fabric below the windlass that blocks the skin from being pulled into the twisted strapping. Without a pinch plate, skin and soft tissue can be twisted and pulled, causing pain and, in patients with delicate skin, further injury.
Pinch plates on the CAT and the SOFTT make it difficult for them to cinch down small enough for young children, infants, and very small, usually elderly, adult patients.An extra plus for small patients: the SWAT-T can be cut into two tourniquets for multiple injuries or multiple patients.
Common Tourniquet Mistakes
The most common problem with tourniquets is putting them on too loosely. If a tourniquet isn’t so tight that it’s uncomfortable, it’s not working.
Improvised tourniquets have a very high failure rate, so you should always keep a commercial tourniquet in yourfirst aid kitfor severe bleeding.More than one, in fact, because a single tourniquet—even when applied correctly—might not be enough to stop the bleeding. Don’t be afraid to apply two or three tourniquets, especially on legs and tooverweightpatients.
2 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.El-Sherif N, Lowndes B, Franz W, Hallbeck MS, Belau S, Sztajnkrycer MD.Sweating the little things: tourniquet application efficacy in two models of pediatric limb circumference.Mil Med. 2019;184(Suppl 1):361-366. doi:10.1093/milmed/usy283McCarty JC, Hashmi ZG, Herrera-Escobar JP, et al.Effectiveness of the American College of Surgeons bleeding control basic training among laypeople applying different tourniquet types: a randomized clinical trial.JAMA Surg. 2019;154(10):923-929. doi:10.1001/jamasurg.2019.2275
2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.El-Sherif N, Lowndes B, Franz W, Hallbeck MS, Belau S, Sztajnkrycer MD.Sweating the little things: tourniquet application efficacy in two models of pediatric limb circumference.Mil Med. 2019;184(Suppl 1):361-366. doi:10.1093/milmed/usy283McCarty JC, Hashmi ZG, Herrera-Escobar JP, et al.Effectiveness of the American College of Surgeons bleeding control basic training among laypeople applying different tourniquet types: a randomized clinical trial.JAMA Surg. 2019;154(10):923-929. doi:10.1001/jamasurg.2019.2275
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
El-Sherif N, Lowndes B, Franz W, Hallbeck MS, Belau S, Sztajnkrycer MD.Sweating the little things: tourniquet application efficacy in two models of pediatric limb circumference.Mil Med. 2019;184(Suppl 1):361-366. doi:10.1093/milmed/usy283McCarty JC, Hashmi ZG, Herrera-Escobar JP, et al.Effectiveness of the American College of Surgeons bleeding control basic training among laypeople applying different tourniquet types: a randomized clinical trial.JAMA Surg. 2019;154(10):923-929. doi:10.1001/jamasurg.2019.2275
El-Sherif N, Lowndes B, Franz W, Hallbeck MS, Belau S, Sztajnkrycer MD.Sweating the little things: tourniquet application efficacy in two models of pediatric limb circumference.Mil Med. 2019;184(Suppl 1):361-366. doi:10.1093/milmed/usy283
McCarty JC, Hashmi ZG, Herrera-Escobar JP, et al.Effectiveness of the American College of Surgeons bleeding control basic training among laypeople applying different tourniquet types: a randomized clinical trial.JAMA Surg. 2019;154(10):923-929. doi:10.1001/jamasurg.2019.2275
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