The Combat Application Tourniquet (CAT) from North American Rescue is easily the most ubiquitous tourniquet in the North American landscape. They’re affordable, proven, and available widely. Most everyone knows how to use one in theory, and many in practice. However, we can all improve. With that in mind, here are a few tips for easier application to help stop the bleed quicker and better.
Staging your tourniquet properly can help shave off precious seconds. First and foremost, take your tourniquet out of the plastic. All medical supplies come in some sort of packaging, and some of it is there for sterility. We obviously vacate less for sterility and more for accessibility. Don’t let the plastic get in your way when you need life saving measures.
Next, give yourself more room to work with. When you pull a CAT out of the packaging, you’ll find that a few inches of the fabric will be latched to itself. As seen in the picture below, if you put the red tip of the tourniquet fabric through the buckle only far enough that it can attach to itself on the other side, you’ll give yourself a much larger loop to work with. When applying a tourniquet one handed (such as to your other arm) you’ll find it is much easier to work with.
Some will say this is overkill. Possibly, but I’d rather have the room to work with.
My experience with trauma injuries is that there are no clean wounds. Amputations are not inflicted by samurai with katanas cutting clean bologna slices out of folks. Exploded welding tanks and car crashes over 70 mph tend to rip limbs apart. If you want to slip a tourniquet over a limb without having to feed the end through the buckle, it will often be over a messy injury. It would be a favor to yourself to have as much space to work with as possible.
Pull the fabric tight and turn the windlass. Applying the CAT isn’t very intensive in terms of steps and requirements, but there are a couple of tricks that can make their application easier and more effective.
Use leverage to your advantage. Blood is slippery and if you’re using a tourniquet, you’ll probably get it on your hands. The CAT can spin in a frustrating circle if you are pulling on it one direction without pulling on it in another. The best method I’ve discovered is to use the windlass as your anchor to pull the fabric right.
Put the windlass between your middle and ring fingers. You can then wrap your palm around the windlass for a sure grip and a solid point for which to grab and pull the rest of the tourniquet tight. The tighter you are able to apply a CAT before turning the windlass, the more effective each turn of that windlass will be.
Tourniquets applied loosely before turning the windlass can often take eight, nine, or even twelve full rotations before becoming effective. If you apply a tourniquet with no slack the needed turns on a windlass can become half of what they would have been otherwise. I’ve seen arms lose circulation after only two spins of the windlass on a well applied tourniquet. Likewise I’ve seen a femoral bleed controlled in as little as three full turns.
Lastly, utilize the flat plastic plate that the clip and windlass are attached to. The fabric synches tight around the entire circumference of the limb equally, but the plate applies a flat pressure. As a result, the plate actually applies a bit more force than anywhere else on the tourniquet fabric.
This is the underside of the tourniquet that is placed on the limb. For best results, place this plate on the groin side of a leg, or the armpit side of an arm. The brachial artery runs roughly along the bottom of your bicep on the inside of your arm. The femoral artery stems roughly from either side of your groin and travels inwards towards where you can touch your knees together.
Putting the plate on the artery directly will ensure that the most pressure is reaching the most critical area.
I will part with a couple final tips on tourniquets to address questions I often get asked.
First, don’t just buy one tourniquet, you’ll need a spare to practice. The windlass is attached to a fabric that runs along the inside of the velcro portion, sort of like a stiff inner belt to a battle belt. This material is meant for one-time use, as it does stretch and wear on the nylon fabric it is made of. You will absolutely NOT want to rely on a tourniquet that has previously been wrenched on for practice. The material will not be guaranteed to work twice.
NAR offers CATs in many colors. Blue tourniquets are designated for training. Please only use them for training. The color is to let everyone know not to use that tourniquet for real life. They are identical to regular CATs. However, the color is there to let folks know that it has already been used. A real-use CAT is not reusable.
Next, for those on a budget; please do not worry about CAT holsters and pouches. I have some and have used them on my kits. They’re nice, but absolutely not a requirement. My absolute favorite tourniquet pouch is a pocket. It requires very little fine-motor-skills to get to (as opposed to dealing with clasps and buttons) and has been what every US Army Soldier has used their calf pockets for since the dawn of calf pockets.
Remember, if you put a CAT in a pocket, nothing else goes in that pocket. A tourniquet commands its own space and will not tolerate sharing. Fumbling past your earbuds and chewing gum to get to your CAT is a great way to add time to a time sensitive situation.
Finally, practice. Time yourself for best results. A great beginning target time is 60 seconds from pocket/pouch to applied effectively. Your goal should be to reduce that time to 30 seconds to consider yourself proficient. The fastest I’ve ever done it is 8 seconds, and the fastest I’ve seen it done is just under 5. Granted, that was in a training environment. But know that there’s always room to get just a bit quicker. It might just save someone’s life.