By Jason Williams and Brian G. Anderson
Tourniquets have become standard equipment for most members of law enforcement and have proven to be an important tool in controlling life-threatening extremity bleeding. There are situations when an officer may be present at the time of a life-threatening extremity injury and is the only one in a position to quickly control the bleeding and save a life. Just as a solid skillset is required during other high-risk activities, the level of skill used in the application of a tourniquet can make a difference in an officer’s or bystander’s survival from severe bleeding.
The tips in this article are based on experience with the military-grade North American Rescue Combat Application Tourniquet (C.A.T.) and the TacMed Solutions SOF Tourniquet, but most of the tips will apply to other tourniquets as well.
Tourniquet basics
There are two items on your uniform that can save your life, your pistol and your tourniquet. In simplest terms, the pistol is used to defend your life and the tourniquet is used to save a life. Both tools require expert skills when operating under stress if they are expected to be effective.
Selecting a tourniquet for use by an individual or an entire department is an important decision that should be based on professional research and evaluation. Fortunately, the research and recommendations are available for anyone charged with making this important decision. The Department of Defense’s (DoD) Joint Trauma System includes groups that are responsible for evaluating equipment that will be used in combat. One of those groups is the Committee on Tactical Combat Casualty Care (CoTCCC) and it is this committee that is responsible for tourniquet recommendations.
Selecting a device/tourniquet that is included in the CoTCCC recommendations provides officers with the confidence that the tourniquet has been evaluated and meets the requirements of the U.S. military for use on the battleground. For details about the tourniquets recommended by the CoTCCC, read “New TCCC guidelines provide officers more tourniquet choices.”
Do your officers have the confidence and training necessary to effectively apply a tourniquet? In this video, you’ll learn about the five important steps of effectively using a tourniquet in critical situations.
Buying tourniquets for the police department
Even though tourniquets are simple devices, manufacturers make improvements that improve their design and effectiveness. Before purchasing equipment it’s a good idea to check the manufacturer’s website for the latest version/generation available.
Before switching from one tourniquet to another, an in-house evaluation is appropriate and can lead to the best choice. Fortunately, tourniquets are inexpensive, making an in-house evaluation a reasonable expense.
Traditionally tourniquets have been black but orange and blue tourniquets are available as well. Blue tourniquets are usually designated as training tourniquets, and their blue color helps keep them separate from in-service tourniquets.
High-visibility orange tourniquets are also available and have advantages over traditional black tourniquets. The orange high visibility tourniquet is more likely to be noticed when multiple victims are being treated on the scene of an active shooter incident or any other incident with multiple victims. Awareness of the tourniquet could have an impact on when the victim is transported off the scene. When multiple victims are arriving at hospitals or trauma centers, the orange tourniquet will stand out and be noticed by hospital staff who are working quickly to treat multiple victims.
Tourniquets are disposable items because of the stress to structural components during use, as well as the likely contamination of the tourniquet with blood and other potentially infectious material. Purchase spares so they are available for replacement.
Finally, shop carefully. Counterfeit tourniquets have been in the marketplace for many years and continue to pose problems for unsuspecting purchasers. The threat to public safety was so significant that it made national news.
To address this problem the Food and Drug Administration (FDA) published a notice warning the public about the counterfeit issue. In the case of the C.A.T., some counterfeits look nearly identical to a real C.A.T. and may be identified as a counterfeit based on the images that show the details of the counterfeits.
In one instance, a counterfeit C.A.T. was constructed and sewn in a manner that would prevent the tourniquet from being tightened. When purchasing tourniquets, it’s best to buy directly from the manufacturer’s authorized distributor or dealer.
On-duty carry of a tourniquet
After selecting a tourniquet for on-duty use, a case or holder should be selected that will accommodate the tourniquet. Tourniquets have gotten larger, so when selecting a holder it’s important to verify that the tourniquet and holder are compatible.
Whichever type of case is used, the tourniquet should be deployable when the officers’ hands are wet from rain, sweat, or blood. During an incident where a tourniquet is being deployed, fine motor skills may be diminished, making ease of deployment a critical factor.
Cases that have covers that are held in place with plastic buckles may become difficult to operate, making elastic or hook and loop covers a better choice. The elastic covers have a pull tab, but if that becomes too difficult to open, the entire elastic cover can be grabbed in one hand and pulled out of the way. Gear attachment options include simple belt loops and Modular Lightweight Load-carrying Equipment (MOLLE) system. Rigid tourniquet cases are available with and without flexible tops.
Cases have been developed that mount on the front of pistol holsters, freeing up space on the duty belt or vest. Ankle cases are also available. Before committing to a department-wide purchase, the case should be checked for compatibility with the tourniquet and attaching options for duty belts and tactical vests.
Officer uniforms have become loaded with a lot of gear and it may be difficult to find space for the tourniquet case or holder. Before committing to a position for the tourniquet and holder, it is important to determine if the tourniquet can be reached and deployed with either of the officer’s hands. Attaching the tourniquet holder too far to one side may make it impossible to reach with the hand on the other side of the body.
Prepare for tourniquet application success
Here are five tips for successful tourniquet application.
1. Remove the plastic wrapper. The plastic wrapper that protects a factory fresh tourniquet may keep the tourniquet clean during shipping, but it needs to be removed before placing it in service. A life-threatening incident is no time to try to remove the plastic wrapper, especially when fine motor skills are compromised, and hands are slippery from blood or sweat.
2. Powder those gloves. Latex and nitrile gloves can be difficult to don with hands that are slightly damp. A little bit of powder can be applied to the inside of each glove ahead of time and before stowing it in the glove holder. A travel-size container of powder can be kept in a personal gear bag, making it available after gloves are used and new gloves need to be prepped. Skipping the powder in the gloves can lead to torn gloves that are thrown aside when they are needed most. If given a choice of gloves, the heavy-duty 7 mil or 9 mil gloves are thicker and more durable than lighter-weight versions.
3. Just like a cowboy’s lasso. Before a tourniquet is placed in its holder, it should be set up for quick application to a limb. For example, using the C.A.T., the strap should be threaded through the buckle to form a loop with a tail. The loop should be large enough to slip over uniform footwear and up onto a thigh while the tail should be long enough to easily grasp and pull when it’s time to tighten.
4. Efficient vs. neat. When a C.A.T. tourniquet is applied, the windlass (stick) is tightened and is inserted into the windlass clip. The windlass retention strap is then stretched across the windlass clip opening to hold the windlass in place. Delays in application can occur if the officer routinely carries the tourniquet with the windlass retention strap stretched across the windlass clip opening. In this configuration, after tightening the windlass to stop the bleeding, the officer will have to hold the windlass under tension while trying to grasp the windlass clip strap to remove it from the opening. A better configuration is to keep the windlass clip strap on one side of the clip. It’s not as neat looking but it’s more efficient when efficiency counts.
5. Order of use. When setting up a personal trauma bag or individual first aid kit (IFAK), arrange the contents in the order in which the items in the kit will be needed. When the bag is opened the first item needed should be seen first, followed by the second, etc. For instance, gloves first, tourniquet second followed by hemostatic dressings/bandages, etc.
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About the authors
Jason Williams is a 20-year veteran of the Aventura Police Department in Miami-Dade County, Florida. Jason has been a member of the multi-agency SWAT team for 16 years, as well as a team leader for the past 12 years. He is currently certified in several instructor areas including Active Shooter Response, less lethal, ballistic shield, mechanical/ballistic breacher and several more. Jason served as a K-9 handler for 12 years working two dual-purpose canines. His experience as a SWAT team leader/member and K-9 handler has pushed him to become a better tactician and to share his expertise.
Brian G. Anderson is a retired battalion chief and paramedic from Miami-Dade (Fla.) Fire Rescue. Prior to retirement, he focused on fire-rescue active shooter procedure development and inter-agency active shooter exercises. He is an instructor at Palm Beach State College and is also a volunteer instructor with Trauma Training Group, Inc., an organization that provides no-cost Stop the Bleed training in South Florida. He has delivered bleeding control training to private, public and charter school personnel and members of city and county law enforcement agencies.