Lets have a chat about something that gets overlooked all to often in people’s edc line ups…. thankfully, it is a topic that comes up regularly in our Facebook group… this is medical kits, I wish to focus a little on tourniquets first though.

I carry tourniquets everywhere…. EVERYWHERE!!! Even when not at work, there are a couple of reasons for this, the first being because the world seems to be getting worse with all the terrorist attacks and active shooter incidents happening all over the world, and, of course, accidents do happen.
Those that say you should carry one if you’re carrying a firearm, well, yes, you should, but, also, in my opinion, anyone else should carry one. Then there’s the school of thought that you shouldn’t carry one if you don’t know how to use one… now this I do not agree with. If you’re caught up in a situation and someone is in need and a third person, or even the injured party knows how to use a tourniquet and you just happen to have one… let them crack on and do so… or… look at getting yourself some sort of further medical training and get acquainted with a tourniquet, it could save a life one day, even your own.

First off, what is a tourniquet, in short, it is a blood flow restriction tool, typically it is a manufactured device that enables you to add pressure to a limb, or extremity to restrict… not stop the blood flow. There are actual ‘tools’ there are also things that can be used as makeshift tourniquets such as bandages and belts, which I have had the misfortune of having to use. The use of a tourniquet can stem the flow of blood as I have mentioned, but, they can also cause complications, the most common of which is soft tissue damage. As a bit of an extra note, whilst I was at the Emergency services show at the NEC I got speaking to a doctor who has invented an ingenious tool that is a tourniquet of sorts that can be used on heads, which would have so many uses and could be modified for anywhere that would not ordinarily be able to be effectively targeted by a traditional style tourniquet.

The use of a tourniquet, if not used correctly can cause more harm than good. You should only use a tourniquet if you know what you are doing, it is absolutely necessary that you have already tried to stem the flow of blood by applying direct pressure as you would ordinarily do in an emergency first aid type situation. A lot of bleeding can be stopped in this way. Of course, uncontrolled bleeding out can be fatal, but it is preventable. It is only the most severe cuts on arms or legs that will require a tourniquet, they should be applied as soon as possible, when a major artery is severed, a person can bleed to death in less than one minute.

I cannot stress enough that the proper training has the greatest influence on tourniquet effectiveness. If you carry a tourniquet, you should aim to be able to apply one to a leg in less than thirty seconds as well as being able to apply a tourniquet to one of your own arms, again, in less than thirty seconds. As a ‘fun game’ when practicing, put the palm of your ‘injured’ hand against a wall to simulate your arm being trapped. Problems that can be attributed to tourniquet use cover a wide range, these include:

Applying the tourniquet too loosely. This can cause the bleeding to actually get worse, as the return or venous blood is blocked but arterial blood continues to pass by the tourniquet.

Releasing the tourniquet too soon, can cause the injured parties severe bleeding to resume that you have just been trying to stop. Not only can the bleeding result in death, but the returning blood flow can also damage compressed blood vessels, causing long lasting damage.

Leaving the tourniquet on for too long, can cause neurovascular damage and tissue death. Generally, permanent nerve, muscle and blood vessel damage can occur after around two hours.

Placing the tourniquet too far away from the wound, or on the wrong type of wound, like wounds at a joint will cause issues, however there are specialist tourniquets that are available for these types of things, not what we will likely be carrying though.

Fabricating a tourniquet from an inappropriate material. Paracord, for example can cut into the skin, some materials will loosen over time of their own accord. Tourniquets should be 1” to 2” wide. The wider the tourniquet, the more pressure will be required. Commercially available tourniquets such as the Combat Application Tourniquet or CAT, are recommended over one improvised out of found materials, however, if you’re unlucky enough to be in a situation where tourniquets have ran out or are not available, belts, handbag straps etc will have to suffice if there’s no other option and there’s no stopping the bleed. As well as the CAT, there are also another type known as the Special Operations Forces Tactical Tourniquet or SOFTT for short. They also do a specific wide version of this type.

Periodic loosening due to pain or concerns about blood flow to vital organs, which leads to the victim bleeding to death over a longer period of time.

Applying the tourniquet to a victim with low blood pressure this could be someone receiving CPR or in shock, this can lead to increased bleeding if the victim is subsequently resuscitated, as the tourniquet pressure that was effective earlier is now insufficient for the higher re-established blood pressure.

Now, we have had a quick look at things not to do with a tourniquet, but if a tourniquet is in fact necessary, principles to remember when applying a tourniquet include:

The tourniquet must completely stop arterial blood flow, by arterial, we mean the blood that is moving away from the heart

Larger limbs require maintaining more pressure.

As tourniquet width increases, required pressure increases it is worth remembering that the material will also tend to bend in the middle, moving pressure towards the center and away from the edges.

Place a tourniquet approximately two inches from the wound if possible. Repositioning of the tourniquet may be necessary if the initial location proves to be ineffective.

Make sure the tourniquet is applied upstream. By this we mean between the wound and the heart.

Where possible, ensue that the tourniquet is in direct contact with the skin. This is to reduce chances of the clothing causing the tourniquet to slip.

Record the time of application This is for the emergency services, doctors and what not. You can write it on the limb itself or in close proximity, some tourniquets, like the CAT, have a space for this on the tourniquet itself.

If the attendance of the ambulance, transport or whatever is significantly delayed, **cooling the limb **with ice/cold packs or exposing it to a cold environment may help reduce tissue damage.

Many of you reading this will want to be ready to rescue folks in need. As I have already said, I usually carry the CAT tourniquet on my person, in my car, and in my EDC bag, some people will possibly feel that carrying the CAT on their person find the to be too bulky. This is where specific carrying options come in to play. I generally carry the CAT in an ankle rig, it is out of the way, not interfering with the pocket real estate for other edc goodies but is still easily accessible. I carry it this at at work and when able to do so when not in work…. just not with shorts. I also regularly carry a SOFTT wide, thisncan sit in a pocket on cargo shorts nicely.

There are two or three main types of tourniquet on the market, the CAT the SOFT T – wide and the RAT’s tourniquets.

The CAT Tourniquet is basically a large adjusting strap and uses Velcro to secure it and stop it from loosening. It uses a smooth plastic windlass to tighten down the tourniquet. The CAT has a red tanned adjusting strap to make finding it easier. I like the fact that they have a place to write the time of application built in to the design. The CAT has two hooks that the windlass can hook into with a Velcro cover to stop it from slipping out. The only drawback I can see is that you may have difficulty with completely stopping lower limb bleeds.

The SOFT T Wide is often thought to be superior to the CAT tourniquet. The wide version solves the problems associated with the SOFT T and I’d being too narrow. The adjusting strap on the SOFTT wide uses a friction buckle system to secure it and stop it from loosening. The SOFTT wide uses a quality, gripped metal windlass to tighten down the tourniquet as well as having a metal latch on the adjusting strap to make looping it around a trapped limb easier. The SOFTT wide has a triangular latch that locks onto a groove in either end of the windlass.
The SOFT T – Wide tourniquet has become a standard item with ambulance staff as it has a sturdier design and an easy to use buckle clasp system for looping the strap around a trapped limb. The SOFT T – Wide is not the same as the SOFT T. The Wide’s design is more comfortable, intuitive, compact, and streamlined than the regular SOFT T.

The RATS Tourniquet.

Historically, most, if not all, tourniquets used in the field use a windlass mechanism, where a bar is twisted until the tourniquet is tight.
However, now, with the RATs tourniquet, you are gifted with have a no-bulk solution for Everyday Carry, elasticated models, like the RATS tourniquet, have been gaining popularity as a cheap and effective alternative to windlass models like the SOFT T and CAT tourniquets.
The RATS uses its elastic strength to stop the blood flow There are a lot of reasons to recommend the RATS; it’s cheap, it stops bleeding wonderfully, it doesn’t loosen after it has been applied, and applying it is faster than windlass tourniquets.
This isn’t new technology though; surgeons have been using elastic tourniquets for years. The problem is that elastic tourniquets can create too muchpressure, causing painful and permanent neurovascular damage.
Pressure created by elastic tourniquets increases by a multiple of the length stretched during each wrap of the elastic, so depending on how far the elastic is stretched, the pressure can vary substantially. This makes it tricky for the user to apply enough pressure to stop the bleeding but not enough to cause damage. However, and this is a big however, it’s a tourniquet, it fits in your pocket, it is small, it can still save someone’s life… and at the end of the day, I would rather have nerve damage than be dead… soooo… The RATs tourniquet does have plenty of real-world saves, it works on children, the elderly, and even on dogs (unlike some other tourniquet options), and it costs considerably less at less than £20 as a pose to the £30-40 for a genuine gen 7 CAT or SOFTT.

So, I know we have touched upon it slightly, but who actually needs a tourniquet?

It has been shown that tourniquets save lives in the military and law enforcement, but one of the largest problems in adapting tourniquets to civilian use is complacency.
In average civilian life, you (hopefully) will not need a tourniquet often. In fact, the majority of us will go our entire lives without needing one. If you do need a tourniquet, however, you’re going to need it fast.
In a first aid kit, a tourniquet tends to start out on top and gradually work its way down towards the bottom of the pack as other items get used and placed back on top of it.
Military personnel and police officers tend to carry tourniquets on their person when on duty for quick and easy access. If the tourniquet is at the bottom of your pack, it isn’t really going to do you much good in a real emergency. As I say, mine is generally carried in my ankle rig or it will sit on my duty belt.
If you have a dangerous job, this is a good reason to carry a tourniquet in everyday civilian life. When working around heavy machinery crushing injuries are a distinct possibility. In this case, it will provide a quick fix to a potentially deadly problem. If you work in a major city or near to a tourist attraction that may be of interest to terrorists… it isn’t nice to think about, I get that… but think about it.
There’s no real need to have it on you 100% of the time if you’re only around heavy equipment during certain times of the day etc.
Even though tourniquets are underused in civilian life, there is evidence supporting their efficacy.

How to Use a Tourniquet, now this isn’t a proper substantial lesson, you will not receive a certificate after reading this post, it is just a guide, as I have said numerous times throughout this post, get some training if it is what you want to do.

To use the Soft T Wide tourniquet:

  1. If at all possible put pressure on or as near as you can to the wound in order to slow the bleeding.
  2. Unhook the clasp and thread it around the injured arm or leg making sure the strap isn’t twisted.
  3. The tourniquet should be placed high and tight regardless of where the injury is. This means put it on the arm close to the shoulder and on the leg close to the hip as tight as you can wind it. This is because internal injury may extend farther up the limb than is visible from the outside.
  4. Hook the metal latch together and pull out the slack in the line, so that the tourniquet fits snugly on the limb. You can use your chin to help hold it in place.
  5. Turn the windlass until the bleeding has stopped, and hook either end of the windlass into the triangular latch to secure it.
  6. Write down the time of application. A tourniquet should not be left on for more than 2 hours to prevent permanent nerve damage.


Handy hints and tips to remember:

The tourniquet should be the first thing you see when you open your first aid kit. If your first aid kit has pockets or the ability to attach Molle pouches etc. on the outside, you may even want to put it there instead. The idea is that you want to be able to grab it as fast and as easily as possible.
When you pack your tourniquet of choice, you should also preset the adjusting strap so that the loop is long enough to go around your thigh.
When in doubt, APPLY IT. You can take it off any time within the next 2 hours without damaging your patient.
If your tourniquet doesn’t have a place to write the time of application, take some masking tape/medical tape and wrap it around the end of the adjustment strap ready for use.
It is ok if you have to use two tourniquets if one doesn’t stop the bleeding.
A tourniquet can be used in conjunction with quick clotting bandages, israeli bandages, or other hemostatic agents.
A tourniquet will not feel comfortable. On an uninjured arm proper application will cause some bruising.
Try to remove heavy coats, jumpers and trousers. Antourniquet can be applied over clothing, but bunched or folded cloth makes it more difficult to stop blood flow.
For quick deployment, you can carry your tourniquet using a specially designed tourniquet holder. Not just my ankle or belt carry options, there may be others that suit your specific needs.

So, in summary:

After you have received proper training, of course…

•           Make sure you tourniquet is easily accessible.
•           If you buy a tourniquet ensure it is genuine, practice applying it on arms and legs in less than thirty seconds.
•           A tourniquet should be placed high and tight, close to the body.
•           When used in anger, out in the field, use  the tourniquet in conjunction with Quikclot bandages or Israeli/pressure bandages for best results.
•           Don’t leave a tourniquet on for more than 2 hours.

One comment

  1. Rats in my pocket all the time, cats in the Primary Care Bag and cats in the Major Trauma bag so they’re never far away. The problem is that HCPs tend to carry in a grab bag but to be fair it’s never going to be the attending crew who needs one of these. It’s the bystander. By the time any attending crew arrives it’s likely to be futile if a TQ was required. So it’s up to the general public to heed this call and those likely to find themselves in need of one themselves to carry. Few good ones out there but the rats fits in with the EDC. I just don’t choose to show it anymore as it often attracts the wrong kind of comments. Cracking post. Saw it a week or so ago and never got round to finishing. Reminded by Ben’s post tonight.

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