The subject of tourniquets is one that's frequently debated, and for good reason — a tourniquet is a critical life-saving device. If a tourniquet fails to properly occlude blood flow, there's a high likelihood an injured individual may bleed to death before ever making it to a hospital. There is no shortage of evidence for the value of tourniquets, whether they're being used in a combat setting or a civilian pre-hospital setting.

However, not all tourniquets are created equal. A poorly-designed or carelessly-produced tourniquet may be difficult to apply, inconsistent in its results, or may simply break under tension — these are obviously unacceptable outcomes when seconds count and lives are at stake. The Committee on Tactical Combat Casualty Care (CoTCCC), a division of the Department of Defense's Joint Trauma System (JTS), conducts extensive research and testing on various tourniquets to determine their effectiveness for combat situations. The CoTCCC then publishes a list of recommended products based on this selection process.

Until recently, the CoTCCC recommended three tourniquets for combat use: the North American Rescue C-A-T, the Tactical Medical Solutions SOFTT-W, and the Delfi Medical Innovations EMT. The EMT uses a pneumatic inflation system, while the C-A-T and SOFTT-W use the more popular windlass design.

North American Rescue IFAK with C-A-T Gen 7, hemostatic gauze, and other trauma care supplies.

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On May 6th, 2019, CoTCCC released a new Recommended Devices & Adjuncts document that substantially expands this list of tourniquets recommended for combat use. The CoTCCC now recommends the following TQs in the non-pneumatic limb tourniquet category:

• Combat Application Tourniquet (C-A-T) Gen 7 and Gen 6
• Ratcheting Medical Tourniquet -Tactical (RMT-T)
• SAM Extremity Tourniquet (SAM-XT)
• SOF Tactical Tourniquet – Wide (SOFTT-W)
• Tactical Mechanical Tourniquet (TMT)
• TX2” Tourniquet (TX2) and TX3” Tourniquet (TX3)

As for the pneumatic limb tourniquet category, the Delfi EMT is still recommended as well as the Tactical Pneumatic Tourniquet 2” (TPT2). Junctional tourniquet recommendations include the Combat Ready Clamp (CRoC), SAM Junctional Tourniquet (SAM-JT), and Junctional Emergency Treatment Tool (JETT). However, these categories are typically used for more specialized applications.

Keep in mind that all CoTCCC recommendations relate to combat use by trained military personnel, so their relevance to civilians with limited training may vary. The Committee for Tactical Emergency Casualty Care (C-TECC) offers a set of TCCC-based guidelines that are geared towards the civilian market — go to C-TECC.org to learn more.

For more information and a complete list of the newly-recommended tourniquets, read the CoTCCC Recommended Devices & Adjuncts (as of 5/6/19). You can also download the list in PDF form.

Written by Patrick McCarthy