What’s the best tourniquet

• Beau Doboszenski, Owner/Lead Instructor

• Originally published April 19th, 2018

As I mentioned in a previous newsletter, there are a number of items I carry with me all the time and one of those items is a tourniquet. Tourniquets have been used by soldiers on the battlefield since the conquest of Alexander the Great in the fourth century BC, and they are making a major comeback as a prominent tool for the defender's Every Day Carry (EDC). The lack of a tourniquet even changed the course of American history during the Civil War. 

In this newsletter we'll review a few different types of tourniquets and how they work. These instructions are not comprehensive, so be sure to follow the guidelines for the specific type of tourniquet you buy, and get in plenty of practice.

From the Macedonians to the Romans to the Philippine islands (where warriors would pre-set tourniquets on their limbs before engaging with the enemy) to the modern battlefield and even in the pockets of defenders, this simple tool has saved countless lives.

How it works is very simple: using a strap and often a mechanical device called a "windlass," the tourniquet can be placed on a limb to stop the flow of blood from a wound lower down on the limb.

A blood loss of about half a gallon, or about 30-40% of the body's total blood, can place a human into hypovolemic shock and can lead to cardiac arrest and death. The tourniquet, quite simply, cuts off the exit route of blood from the body.

Tourniquets have come a long way from the strap and stick you can see above and now there are three major types: velcro and windlass, strap and hook, and elastic.

The first, and probably the most common, is the velcro and windlass type, represented below by a C.A.T. brand of tourniquet. This tourniquet has an internal and external strap, a buckle, a windlass, and a locking mechanism. To use, simply slide the loop high and tight on the wounded limb. Pull the strap through the buckle as far and tight as possible. Use the velcro to secure it in place. Then turn the windlass until the blood flow to that limb has stopped. Turning the windlass will actually tighten the inner strap of the tourniquet without affecting the velcro portion. The windlass can be secured in the locking mechanism to keep it in place.

This type of tourniquet has been in use by the military and law enforcement for decades. It is simple, straightforward to use, and inexpensive. 

The downside to this type of tourniquet is that they're not easy to carry with you. They are pretty big and bulky and the large windlass is not flexible and can't be folded or made smaller.

The next type of tourniquet is the strap and hook, and it is represented below by the R.A.T.S. brand of tourniquet. This device has an elastic strap with a locking mechanism.

One side of the strap is permanently connected to the locking mechanism, then the rest of the strap loops through another opening of the locking mechanism creating a small loop bridged by the locking mechanism. To apply, lay the loop and locking mechanism high on the wounded limb, wrap the strap once around, then feed it through the loop. Pull tight and begin wrapping the wounded limb opposite until circulation is stopped. Finally, place the end of the strap through one of the lips of the locking mechanism to hold the strap in place.

The positive of this style of tourniquet is that it is fast to apply as there are few moving parts. It is also fairly easy to carry this tourniquet with you everywhere, as only the locking mechanism is inflexible.

The downside is that this style isn't quite as intuitive as the other types of tourniquets.

The last style of tourniquet is the elastic like the SWAT-T brand shown below. These tourniquets are just a gigantic rubber band. They're applied very simply: throw the band high across the effected limb, and start wrapping. When it's applied tightly, tuck the end of the band into one of the wraps to lock it in place.

The positive with this style is they're very easy to apply, and as the whole tourniquet is flexible, very easy to carry in any pocket. Also, with a knife or scissors, this tourniquet can become 2 or 3 tourniquets with a couple of cuts for quick use in a mass casualty scenario.

This tourniquet can also be used as part of a pressure dressing, rather than as a tourniquet, by simply using the band over a gauze or cloth dressing and then wrapping it loosely.

The downside of this tourniquet is that it is much harder to apply this one to yourself if you have one arm that is damaged.

So what's the right one? The right tourniquet is the one that you'll carry with you, that you're willing to use, and that you know how to use correctly. There are thousands of lives saved per year because of the simple application of a tourniquet. Having one with you gives you the ability to add to that live-saving number.