Always Better. | July 26th 2021
In the last blog post we dispelled some tourniquet myths. This week I wanted to cover some basic terms and concepts that are important when discussing tourniquets. You need to be clear on these for later when we start training on how to use them.
The first thing you will hear when discussing tourniquets, or many other pre-hospital medical devices, are the terms “TCCC” (pronounced “T triple C”) and “CoTCCC” (“Cot-See” is how that is pronounced). TCCC is Tactical Combat Casualty Care. TCCC started as a research program by Naval Special Warfare in the mid 1990’s to determine soldier causes of death in combat. It eventually grew into a training and medical treatment program partially adopted by some SOCOM units individually but was first wholesale adopted by the 75th Ranger Regiment in the late 90’s. The TCCC program was so successful for the Rangers, including an unparalleled record of 0 preventable battlefield deaths for several years during the height of the GWOT, that TCCC was officially adopted by SOCOM and eventually all US Military components and numerous aligned foreign militaries in the early 2000’s. CoTCCC is the Committee on Tactical Combat Casualty Care and is a group of some of the best minds in military and civilian medicine that meet several times a year to update and improve the TCCC program. For years CoTCCC stayed well away from endorsing any products at all but continually received requests from end users on what equipment was the best. Eventually they began “approving” medical devices. A CoTCCC Approval is mandatory for any medical device that seeks to be adopted by the US Military. So why the history lesson? Because one of the first things discussed during any tourniquet conversation is whether the tourniquet is TCCC Approved or CoTCCC Approved. After all, the single largest concept to come out of the TCCC Program was the scientific and practical data that dispelled the very myths discussed in the last blog post.
There are currently NINE CoTCCC Approved tourniquets but two of them represent over 90% of the military and civilian markets. Those two tourniquets are the CAT and the SOFTT-Wide. BFG sells both tourniquets individually and as components in our medical kits.
The CAT (Combat Application Tourniquet) is by far the most widely used and recognized tourniquet worldwide. So much so that the term “CAT tourniquet” is often incorrectly used to identify other manufacturers products much like Kleenex and Coke brands have become common terms for tissues and soft drinks. The CAT is distributed (not manufactured!) by North American Rescue (NAR) in South Carolina. It is a common misconception that they are the manufacturers because they are and always have been the exclusive distributors. In fact, the CAT was designed by individuals who were associated with NAR but who kept the companies separate for business reasons. Wise since NAR has since become a publicly traded entity and still must purchase its primary product from another company. The CAT is sold by BFG individually under Part Number P-MED-TQ-01-BK.
Note the BK designation. That is because there is also a P-MED-TQ-01-BL which is a training tourniquet that we also sell.
Which brings up an important point. Tourniquets are a ONE TIME USE MEDICAL DEVICE. You should never train or practice with your primary tourniquet. Repeated use can weaken the materials and cause a device failure when an attempt is made to tighten the tourniquet in a real world situation. This can lead to the death of the patient. Anytime you speak to someone who states they have used their tourniquet for practice, they should be advised to mark that tourniquet as a training device and immediately purchase a new one. Anyone purchasing a black CAT should be advised to also purchase a blue one for practice use.
A common complaint you will hear regarding the CAT is that the plastic tightening bar (that stick looking part is actually called a Windlass and is what is twisted to tighten the tourniquet) will bend or break. This is absolutely false and is likely the result of people who have purchased counterfeit tourniquets off of the internet made from substandard materials. I have personally tried unsuccessfully to break a CAT windlass by wrapping it around a flagpole at Fort Polk and turning a group of Army medics loose on it. It survived.
Notice that I mentioned counterfeit tourniquets? Just as with some BFG products, unscrupulous individuals market fake tourniquets that are so well counterfeited that it is almost impossible to discern them from the real ones in appearance. Only by looking at the quality of materials can they be discovered as fake. I have personally been present at large agencies to conduct training when I had to inform them that their municipally purchased tourniquets were fakes and needed to be replaced. Just as with many products, end users and agencies should be cautioned to only buy from the manufacturer or authorized distributors. NEVER from an unknown internet source or a site such as Ebay.
The SOFTT-W (Special Operations Forces Tactical Tourniquet – Wide) is the invention of a former Delta Force Medic Operator who started Tactical Medical Solutions. The SOFTT-W is the second most popular tourniquet worldwide and is preferred by many for three primary reasons. As mentioned above, some greatly mistrust the composite plastic windlass of the CAT and the SOFTT-W was designed with an all metal windlass for this reason. Secondly, the SOFTT-W uses friction buckles much like BFG slings to hold tension as opposed to the Velcro used in the CAT. Lastly, the SOFTT-W folds much flatter than the CAT and is preferred by users for whom space is at a premium or who wish to conceal their medical gear.
The SOFTT-W is sold by BFG under Part Number P-MED-TQ-03-BK.
BFG also sells the SWAT-T (Stretch Wrap And Tuck – Tourniquet). The SWAT-T was designed by a US Air Force PJ who later became a physician. Although this device is marketed as and can function as a tourniquet, we sell it as a Pressure Device to aid in the application of hemostatics and for other medical uses. The SWAT-T will absolutely function as a tourniquet but is very difficult to apply one handed or on oneself. For that reason, the CoTCCC will not give the SWAT-T an Approval as they established one-handed application as a requirement for any tourniquet. That being said, the SWAT-T will work as a tourniquet in situations in which others won’t work such as on the limbs of small children and on animals with odd shaped limbs (K-9’s especially). The SWAT-T is affordable, compact, lightweight and can perform multiple tasks (including being used as a large sling shot to launch eggs and golf balls, ask me how I know). For that reason, you will often see the SWAT-T in the medic bags and IFAK’s of very experienced medical providers. You will often hear the SWAT-T referred to as “that big rubber band thing.” BFG sells the SWAT-T under Part Number P-MED-TQ-04-BK.
I hope this BFG MED blog post brings you up to speed on some tourniquet related terms and concepts that will be of use as we move forward in future posts with when, why and how to apply a tourniquet. BFG MED blog – On the cutting edge of care.
The patented C-A-T® is a true one-handed tourniquet proven to be 100% effective by the U.S. Army’s Institute of Surgical Research. Tests proved that the C-A-T® completely occluded blood flow of an extremity in the event of a traumatic wound with significant hemorrhage.
Pronounced Soft T Wide, the Special Operations Tactical Tourniquet Wide is a CoTCCC approved tourniquet preferred by many users due to its strong construction, metal windlass and ability to fold flatter and smaller than the CAT.
The SWAT T is being utilized in BFG med kits as a PRESSURE DEVICE and not as a primary tourniquet. While it can be utilized as a tourniquet, we recommend the CAT or SOFTT-W as a primary tourniquet for their ability to be self applied.
Adequate training should be completed from a licensed professional before performing any first aid discussed in this article. This is not medical advice.