Tourniquet Selection

From a reader: 

"I saw a video recently from a training company that likes RATS tourniquets. At your classes, the medical instructor recommends the CAT tourniquet or the SAM-XT. How do you come to that conclusion? Or do you disagree with your medical instructor?"

The Patriot Training head medical instructor works for one of the largest EMS departments in the southeast. As of this writing, he used just shy of 10 tourniquets just last week to save lives. He has taught Stop the Bleed on many occasions, and several of those students have gone on to save lives with those skills. He has been in EMS for a decade. Even if I disagreed with him (and I don't), I would not have a leg to stand on. 

Understand first that there are no solutions in life - only trade offs. 

Patriot Training only recommends CoTCCC recommended tourniquets. The RATS tourniquet is not CoTCCC recommended. In practice, self-aid with a RATS TQ is nigh impossible for many women, most children, and men in a weakened condition, or a person who cannot move the injured arm. 

Over a series of weeks, this author used a pulse oximeter to determine TQ effectiveness with many models. The RATS was unreliable, until the author made sure to perform two tasks when applying them: 

1. The author had to make sure the bands of the RATS  TQ were right next to each other. Even a quarter-inch gap would prevent the RATS from occluding a pulse. 
2. The author had to apply the TQ above or below the bicep. On the bicep meant ineffectiveness. 

Further, the author was completely unable to get the RATS to work on his own thigh. The thigh was large enough to prevent a third wrap, and it was usually the third wrap on the arm that occluded the pulse. 

Additional findings:

• The TK4 tourniquet was similarly ineffective as the RATS. This author believes for much the same reasons. 
• The SWAT tourniquet could be effective - if the person using it has a fair amount of strength. The author could make it work on arms and legs. The author's daughter could not make it work on either arms or legs. 
• The CAT tourniquet is very quick and very effective. About the only weakness is that the TQ must be strapped tight prior to spinning the windlass. 
• The SAM-XT tourniquet is a game changer. The "click" into place is solid, and it only requires a twist and a half to shut off pulse in the author's arm, and only 2 twists to shut off pulse in the author's legs. 
• The ratcheting tourniquets - the M2 and the XT8 - were more easily applied to a 3rd party. Self aid with either was more problematic than the CAT or SAM-XT. However, they are a bit more "fool-proof" in that, the strap doesn't have to be nearly painfully tight to begin tightening them. 

Some point out issues with CAT and SAM-XT tourniquets. Here they are, along with this author's commentary on each:

CAT - Some places have seen CAT TQs fail a lot. Of course, the primary reasons for CAT TQ failure are as follows:

• "El-cheapo" knock-off tourniquet. These are available on Amazon for as low as $7. Get a real CAT from North American Rescue via Rescue Essentials or another trustworthy source. The knock offs have a windlass that can be bent easily with the hands. It cannot possibly twist tight enough to occlude the pulse. 
• Failure to tighten the strap at the beginning of application. The author has an anecdote here: always advocating people make triple-sure that the strap is tight, including the phrase "if you don't get it tight enough, you cannot possibly spin the windlass enough to make up for it." At a recent medical class, the author overheard a dad telling his son that he would just have to spin the windlass more, since the son had not gotten the strap tight. This was only five minutes after the cautionary statement! Naturally, the author stopped them and corrected this error. 

The only known knock against the SAM-XT is that the strap can fold over on itself. That is possible, but with just a wee bit of training, a person is not likely to do that. 

It would seem to this author that every tourniquet has a level of skill required to make it work. Might as well pick a good model, and make sure to spend an extra few minutes learning how to properly use it. 

And a very few places say that the CAT and the SAM-XT do not work on very small people (infants). This might be true, but the first aid responder can use direct pressure on such a small person to stop the bleeding. Perhaps even using an Israeli bandage and extra-tight pressure to make a makeshift TQ. 

What do you recommend? (at a minimum)

1. A good TQ - CAT (Gen 7) or SAM-XT.
2. Compressed gauze for wound packing or pressure. Or both. Alternately, an Olaes bandage is an Israeli bandage, gauze for wound packing, and more.