first published on March 18, 2019 by Josh
According to studies from both civilian and military medical doctors, and numerous trauma aid stations that operated in Afghanistan, the current tourniquet systems being utilized by the United States Military are inherently ineffective, prone to breakage, and exceedingly difficult to use in stressful or traumatic situations. The CAT, SAMXT, TMT, and SOFTTW systems were all mentioned in the findings, and when looking at some of the statistics of the evidence presented, it could be time for the U.S. Military to start looking for alternative tourniquet systems with a higher success rate, and a lower breakage rate in order to better save lives in combat situations.
According to the 1st Battalion, 6th Marines Battalion Aid Station, between February and May 2010 in Afghanistan, 1st Battalion, 6th Marines reported a 10% breakage rate on their issued CAT tourniquet systems. Their theory about the tourniquets being weakened by the environment in Afghanistan was tested, and the Aid Station reported that 12% of tourniquets used in the test were broken after exposure to the elements in Afghanistan, and an efficacy rate of 57% was also recorded on those that did not break. This means that the CAT tourniquet, when exposed to the environment of Afghanistan, broke 12% of the time, and only actually achieved the needed result to stop blood flow 57% of the time. In that study, it was concluded that CAT tourniquets are next to useless for life saving purposes when exposed to the environment of Afghanistan unless they are left inside of the individual’s first aid kit until such a time that they are needed.
In several other studies conducted with windless style tourniquets, a high failure rate was reported due to the systems being inherently difficult to use. In Israel, a test was conducted with 179 Israeli military recruits without prior medical training. After their standard first aid course, where they learned the Combat Application Tourniquet, they self reported confidence in the use of the CAT Tourniquet. The students were then tested between one week, and two weeks later with the system, and of the 179 users, only 45 of them were able to achieve an effective application of the system. The most common failure point for the students was excess slack in the CAT’s strap, and too few turns of the windlass.
During another similar study at NAVSEA published by J. P. Hill, LT, MC, USN, L. D. Montgomery, Ph.D., K. W. Hopper, HM1, USN, and L. A. Roy, LT, MC, USN, it was stated “Among the problems identified were a difficulty with the Velcro interfering with initial applications, and a difficulty in securing the windlass after the CAT had been applied. Both of these problems were more prevalent with one-handed applications,” and in a similar study titled Effects of Training and Simulated Combat Stress on Leg Tourniquet Application Accuracy, Time, and Effectiveness it was concluded that after 4 days of non-stop training with the CAT tourniquet system, only one-in-four students were able to eliminate the pulse on their patient with the device.
While trauma and field-combat medicine have certainly come a long way since the 1990s, it is imperative that we do not lock ourselves into a bubble that prevents and hinders innovation. If a product that is intended to be used during traumatic and stressful situations is inherently showing itself to be ineffective even a singular percentage of the time, that product needs to be replaced by something better as fast as our minds can innovate something better. The windless tourniquet systems are showing in studies, that even with proper and constant training, they are not getting the job done. With pulse elimination as poor as 25% failure for the CAT and 60% failure for the SOFT-T even in classroom conditions for Navy Corpsman, the need for better systems is clearly apparent.