“Rep. Mo Brooks (R-Ala.) used his belt as a tourniquet to stop the bleeding of a staffer shot early Wednesday during a congressional baseball game practice,” thehill.com reports. “I took of my belt and myself and the other congressman,” Brooks said. “I don’t remember who, applied a tourniquet to try to slow down the bleeding.”

Quite simply, used alone, a belt is not tourniquet. At least not an effective one.

Inside the hospital, and on the battlefield, tourniquets have been used with great effect for a long time. Previous research from tourniquet use in WWII had already shown that there were very few adverse affects or limb loss as the result of the use of a tourniquet, less than two percent, even when applied for as long as six hours.

This is the same thing we see every day during prolonged use of tourniquets in surgical settings. So they are safe. And yet, during the Vietnam war about nine percent of casualties died solely from nothing more than exsanguination from an injury to a limb.

The proper application of tourniquets is credited with saving between 1,500 and 2,000 military personnel during the Iraq and Afghanistan wars. Even so, 24 percent of all battlefield deaths are considered preventable — if the proper techniques of Tactical Combat Casualty Care are followed.

A significant percentage of these deaths are from the improper application of a tourniquet. Research from early in the war in Afghanistan and Iraq showed that 13 percent of all casualties died from an injury that could have been resolved solely from the proper use of a tourniquet.

Back in 2004, the US Army’s Institute for Surgical Research (ISR) in San Antonio, Texas decided to study why so many service members had died from extremity wounds. They used previous research, animal studies, the clinical evaluation of what was going on in the ER (it is part of the Brooke Army Medical Center, a Level I trauma center), as well as cadaver review.

What they found: many people had died of extremity wounds with an ineffective tourniquet in place,  the tragic result of a combination of poor application and poor design.

This began the definitive research on tourniquets and their use. It’s still regularly referred to, tested and updated today. Dr. John Holcomb, a personal friend and a true hero of our nation, was one of the researchers at the ISR for some of this research. He remains one of the pioneers for the development of new tourniquets today.

Dr. Holcomb (above) and other staff looked at many different types of tourniquets and their effectiveness on the battlefield. (It should be noted that previous work had identified pneumatic tourniquets, like the ones used in hospitals and clinics, work extremely well in those settings, but are not suited for extended field care or the battlefield.)

The ISR researchers found that some of the most common tourniquets, straps and belts, don’t work.

It often takes just too much pressure to stop arterial and venous bleeding for simple belts and straps to work. I have certainly experienced this myself as an Army medic and a civilian EMT. For some injuries, such as the lower leg, a belt or strap tourniquet is unlikely to ever produce enough pressure, no matter how hard a human could pull on it.

At the end of the research, two types — and only two types— were shown to be effective at stopping arterial and venous bleeding, could be applied by a non-clinical provider, and were suitable for use in the field.  Those were the ratchet strap and the strap and turnbuckle style.

I’ve seen the ratchet strap used, and I have to say, when it come to simply stopping the bleeding, it is the most effective I’ve seen. I’m referring to the simple ratchet strap like the 4 I keep in the bed of my truck to strap down heavy loads with. With a wide belt, and a great amount of leverage from the ratchet, these can bring incredible force onto a limb, quickly stopping all bleeding.

There are a few drawbacks.

First, the effective ones are fairly large, making them difficult to carry. Second, they hurt like hell. All tourniquets hurt, often more than the initial injury, but these tend to be more than most people can handle. The biggest issue: they do more tissue damage than the other type of effective tourniquet.

The alternative is the strap and turnbuckle style, such as the CAT and the SOFT-T.  This was the one that was proven effective in a battlefield and extended field setting by the ISR, and as the result became the standard type of tourniquet provided to all services.

Don’t take anecdotal stories as evidence of any tourniquet’s success. This is an area that has been well researched using both clinical data and data in the field. The research is clear. The strap and turnbuckle style, like the CAT and SOFT-T work.  Belts don’t.

[ED: Every shooter should keep at least one preferably two CAT or SOFT-T tourniquets in their range bag and have a working knowledge how to use it. Everyone should keep one in their vehicle. And one in the house. Even more than your firearm, it could be the difference between life and death.]

115 Responses to Congressional Baseball Shooting: A Belt Is Not A Tourniquet

  1. I recently took a CERT class (community emergency response team) and tourniquets came up as a topic of discussion. The EMTs teaching the class, all of them, said that belts make excellent improvised tourniquets, that 9 times out of 10 the tourniquets they see on scene are repurposed belts, and that they work almost as well.

    This wasn’t one person saying this, this was at least half a dozen fully employed first responders.

    They also told a somewhat amusing but mostly disturbing story of a cop that attempted to apply a tourniquet to a victim’s neck. No I am not joking.

    • I can’t possibly disagree more, based on my own experience as well as all of the reviewed research out there. I’ve also never heard another paramedic or surgeon say that belts, by themselves, were effective. Please feel free to share my article with any of the first responders you took a course from, and encourage them to contact me for discussion or clarification.

      • I have seen a belt work very well in this application (stopping significant limb bleeding) on two occasions. I’m not going to ignore anecdotes because they show that it can work when done properly. In the best case it was a belt soft enough to tighten by inserting a pen into a loop.

        • “In the best case it was a belt soft enough to tighten by inserting a pen into a loop.”
          So they turned it into a strap and turnbuckle.

        • Yes, this is the only way it would be feasible, to tighten it with another object.

      • I believe you could say that a good tourniquet is far far superior to a belt, but are they really useless? I mean, better than nothing, right?
        I don’t think I would imply that a belt could not stop a bleed, just that it’s not a reliable option.

        • My EDC 1-1/2″ leather Gun belts are way too stiff to substitute for a real tourniquet!

      • Dude, could your God Complex get any bigger? Every doubting EMT person in the country is going to contact you over using a belt as a tourniquet? Seriously?

      • A belt works fine as a tourniquet. As long as you actually use it as a tourniquet and not as a belt (i.e. pulling it tight and using the belt buckle instead of a twisting method.)

        Luckily you don’t need a dedicated tourniquet to save a life. Look around you; there are tourniquets everywhere. Are you wearing a belt? Tourniquet! Have laces on your shoes? Tourniquet! Long sleeve shirt, bicycle inner tube, backpack strap, or a female observer’s brassiere? All tourniquets! You can fashion this lifesaving device out of anything your mind can conceive as a tourniquet.

        http://www.artofmanliness.com/2012/03/21/how-to-save-lives-like-an-army-medic-using-a-tourniquet-to-control-major-bleeding/

        • I’m partial to the “or a female observer’s brassiere”.

          “Excuse me Ma’am, I need you to take your top off. It’s a matter of life and death.”

          Save a life and see some titties. jwm would LOVE this.

      • If If it worked, it was ‘effective’ and that is all that matters. Who cares if it was a belt or a ‘proper’ tourniquet?

    • BS with belts. As using a rubber band to substitute for a condom.

      The EMS mafia still HATES tourniquets. Not invented here is a major part of the problem with the bozos. Add in that the warm fuzzies in the EMS world don’t really like those warlike soldier guys with their guns and bombs and such. As Jon details above the Army has proven the value. Many in the EMS world were trained until minutes ago, and are still buying into, that tourniquet will “kill” the limb. NOT true and in any case a dead body has no need of ANY limbs. Us the tourniquet.

      “Stop the Bleed” is FINALLY getting going. see http://www.bleedingcontrol.org Find a class and acquire a SOFT-T. Concept is that EVERY AED has a Bleeding control kit next to it and every person trained on CPR gets the Stop the Bleed class. The State of Iowa began the “train the trainer classes a week ago. Got my cert done.

      After the Heart Association finally bailed on the program it is now under the American College of Surgeons. They have a very well done canned training program fielded. Instruction is on controlling life threating bleeds using direct pressure, tourniquets and packing of the wound. At http://www.bleedingcontrol.org go to the “find a class” tag. You may not find anything yet as the program is young.

      • I remember as a kid hearing this (the no-go w/ tourniquet for commoners) and thinking it was B.S. The benefits far outweigh the risks/costs. It is only really a problem if the guy looses a limb AND was not going to die. That is a very small subset. Greater is people that would die without it.

    • This Vietnam vet disagrees with the author.

      First, it depends on the wound. Most people do not know that the femoral artery retracts up into the groin if severed. That’s a place where a tourniquet won’t fit. It is also one of the reasons application is not directly on the wound but between the wound and the heart. the proper location depends on wound location (ex: above or below the knee).

      A belt, rope, bootlace, and just about anything else is better than nothing, and they do work. To be effective, it often required something under the tourniquet to distribute the pressure. The tourniquet also must be loosened at intervals to allow some blood to reach the limb to avoid gangrene which can kill just as effectively as the initial wound.

      I do agree that lack of proper training is a problem. However, trying to stem the flow of blood is far better than standing around wondering what to do.

      For head wounds, NEVER apply around the neck!

      • I got some of the same training you did early in my career. Unfortunately, it was wrong, and some of it, like losening the tourniquet, likely cost more lives than it saved.

  2. JWT, I’m pretty sure you answered this in a previous article, but I can’t find it. Which of the two tourniquets do you prefer: CAT or SOFT-T?

    • Not sure why that got deleted but I’ll try again. I prefer the SOFT-T because I have broken the bars on some CATs. But I would feel good about CATs from NARP because they are better built, with larger, sturdier bars.

      • Two questions.

        First when you say NARP is that the same as NAR/a typo? I use North American Rescue TQ’s, which I imagine is what you’re talking about and I’ve never seen one of the newer ones break (then again I’ve never applied one IRL to some huge guy either so I’ve never really torture tested a windlass).

        Secondly, when you have seen a failure, what was it and what under what kind of circumstances? I don’t expect the torque value for failure but just a general idea of the person it was being applied to (like regular person vs a fat person vs some one who’s a flat out beast) and which part of the unit actually failed.

        Thanks.

        • North American Rescue Products

          The ones that broke were the ones issued to me. I can’t verify the manufacturer, nor can I verify how they were stored, or if they had been used for practice before. Product failures were between the years of 2007 and 2010. All of the failures were to men with large legs in which the tourniquet was applied to the thigh. All of the injuries were either partial or complete traumatic amputations. In each case, the bar broke prior to bleeding being stopped. I learned that all lower leg extremities, and upper leg extremities on men with large legs, would likely require 2 tourniquets.

      • Be careful of the Chinese copycat cats. They are made of subpar materials and break easily. Just saw a video on it from skinny medic on facebook

    • SOFT-T, because I’ve broken the bar on some of the CATs. I’d feel good carrying CATs from NARP though, as they are better built, with larger and stronger bars than I see sold elsewhere.

  3. Huh? He used what he had at a baseball field. Thank GOD he had that belt. And yes I’ve taken 1st aid and CPR courses many years ago. Be prepared…

    • “Thank GOD he had that belt.”
      I’m glad he did what he could, 10 minutes is a long time to lay there bleeding. But, if (and that’s a really big IF), reports are correct, the gunshot was into his hip, not his leg. I can’t really figure out how you effectively tourniquet penetrating trauma to the hip with just a belt.

      • Scalia had an injury to his hip, the staffer, as you posted, was the one who had the tourniquet applied.

        • Scalia died face down in a hotel in TX. Not long before he was to rule on a SCOTUS case that would have vastly impacted (in the dissent, it was assumed) American Indian Tribal Court’s sovereignty.

          Scalise was targeted and shot in VA because of his appointed committee seats, and because HE WAS TARGETED BY OHOLE with triggering language and comments. OHOLE tied him to the KKK and that was one of the complaints cited by the (D)perp on Assbook.

        • Sorry, similar names to this hillbilly twice removed, but my point was that the majority whip was not the one who had the tourniquet applied, but an assistant to another politician.

      • I dont believe he was talking about Rep Scalese, but another staffer with a different type of wound where his belt was useful.

      • That was my thought too. And compression around a shattered pelvis without knowledge of proper application would likely have killed Scalise.

  4. “Wrong” would have been watching the individual bleed out. The paraphrase Gunny Highway “improvise, adapt and overcome”. I am not arguing with your medical advice, just your condemnation of an untrained civilian, who chose to do something rather than wait for someone better equipped and trained to arrive. I don’t think the gun shot victim is really complaining that “a belt is not tourniquet”. I suspect that many of those present and their staff will get real aid bags and training so that they are ready for future events.

    • The entire first paragraph and “wrong” sentence were added by RF in editing. I believe his point was not that the first responder did anything wrong, but that a belt is not a tourniquet.

      • I almost stopped reading at that point, or rather almost didn’t click the facebook link, due to the asinine implication that they should have done nothing rather than the wrong thing. I’m glad I clicked though, this is the most interesting and useful content I’ve seen on TTAG in years. I honestly had no idea that a belt was insufficient. When I was a school child in the 90’s, they told us tourniquets were the old way and no longer used due to tissue damage. I only recently learned that was apparently a load of BS. I may not go out and purchase these tourniquets tomorrow (even though I know I should, and should get some real training), but at least now I know if something did happen and no one more qualified than myself was around, to go for my ratchet straps instead of a belt (I have some endless ones that would be perfect, the ones with hooks are near useless for making a circle).

  5. So if you don’t have a proper tourniquet you just let them bleed out? Actually, a mis-applied tourniquet can make things worse. Also, I’m not sure how to apply a tourniquet to a hip, since tourniquets are for wounds on limbs. Pressure is best. However, whatever was done seems to have helped, so …

  6. On my first deployment to Iraq we were given a first aid kit from the Israeli Army. The first thing that comes out of the little velcro pouch when you open it is an Israeli tourniquet. These in my opinion are some of the best tourniquets on the market so good in fact that we in the United States have duplicated them and you can get them from us manufacturers now. It’s what most SWAT teams a big cities use in their immediate medical kit. Basically it looks like a regular tourniquet but acts as a tourniquet and a pressure dressing at the same time. And is very easy and efficient to use you can put one on if you’ve been instructed correctly in about 5 Seconds. And I’ve had to apply one before to a fellow that lost his foot and it completely stopped the bleeding within four seconds and I’m guessing that it stopped the bleeding immediately just the gravity was pulling the residual blood left in his arteries and in his veins and capillaries out the wound. If you guys want a really good tourniquet they still call them Israeli tourniquets you can get them anywhere on the internet. Very very good piece of Kit to carry with you if you carry a handgun for self-defense. This kit also included a couple pressure dressings with gauze cling rap. And a tube of petroleum-based jelly sterilized such as like Vaseline. I also added three Tampax tampons. You can actually use a tampon in a bullet hole wound two clog the wound and exorbitant. It even comes with an applicator to inserted into the hole so it stays sterile. Another very good piece of Kit to have.

  7. A twisted-up cotton T-Shirt (adult sized) [wet-it if necessary to slightly increase the strength (allows it to twist to smaller diameter)] makes a great impromptu tourniquet ‘loop’ for a turnbuckle-style tourniquet. A BELT in this instance can very adequately perform the function to tighten it and it can be used to secure it to the same extremity. This requires some strength, or some adrenaline push to get done. But is more likely to be on-hand.

    MARK THE BODY ON THE FOREHEAD THAT YOU HAVE APPLIED ONE AND WHEN.

    Scalise was shot transversely across his pelvis, and applying pressure to this area may have been able to use a T-shirt gauze brace if you cut the neck and shoulders and did it ‘girdle’ style, and cinched from the back.

    Yes, good OP, very needed info. Like they said in Iraq, if you need a tourniquet, where’s yours? I’d give you mine, but as soon as I do, I’ll need it for me [no good deed goes unpunished].

    Be a gentlemen, always wear a T-shirt belt and socks. That’s a good mini-kit for evil (D) encounters (if you fail to interdict their evil sh_t at-range).

  8. How about a belt and a large stick or rod used to keep twisting and twisting which can really tighten it up. That’s what I was told to do when nothing else was available.

    • Yes, to both you and Joe R. above, a flexible belt, with a stick or very sturdy object, and some way to lock it down, can be a very effective tourniquet. Note: flexible belt, very sturdy object. I have used a T shirt as a tourniquet, but I have also had a T shit tear apart while it was being tightened.

      • Wait a minute. I thought a belt was not a tourniquet. Now certain belts are tourniquets. And t-shirts. I’m so confused. For many of us, we would best understand: “A belt is not a very good substitute for a real tourniquet. But in a pinch, do the best you can with what you got till the well equipped, trained folks arrive”. But that’s too fucking simple for “war heroes”.

        • I posted that a belt could be used as a PART of an IMPROMPTU tourniquet.

          If you or someone you’re working on needed one, I wouldn’t be holding you back, I’d be trying to help.

          I wouldn’t have you take off a bad tourniquet unless and until we both had a “better” one already started in the same place.

          You want a quick-fast answer? Do what you can with what you got. Just reading about it here has expanded your brain motor’s creativity on useful options.

          Pick your own damn heroes. Mine’ll be you, ok?

    • Even the metal clipped ‘zip-ties / tie-wraps / what have you’ will not hold up to the twisting, and the metal clipped type will not hold up to just being ‘cinched’ in the normal way they are typically employed.

      Any port in a storm though. Maybe a few applied in-tandem might stem the bleeding somewhat?. They can be used to retain over-dressing once the bleeding has been cut-off. Shoe laces can work the same way.

      They are good for splinting, if an arterial bleed is accompanied by a compound fracture. The big ones are good if one leg has to be splinted to the other (in absence of any other suitable material / or weight limit for litter-carry or helo extract).

  9. I usually wear Galco gun belt. I don’t think there is any chance i could twist it enough to be a tourniquet even with a lever.

    I don’t normally carry a tourniquet on my person and my vehicle may be too far away.

    EDC posts may start looking like a patrol load-out.

  10. No love for RATS?

    They claim this:

    “Proven to be effective in occluding blood flow in both upper & lower extremities by the U.S. Army’s Institute of Surgical Research.’

    • I have seen the claim but not the research paper. The last research I’ve seen was from 2011, which cited only the ratchet and strap and turnbuckle style as being effective. The RATS may be effective, but I haven’t seen the clinical data to back that up. If you can find it and post it here I would very much appreciate it.

      • still searching…

        Found some terms I never want to experience first-hand: Combat Ready Clamp (CRoC), Abdominal Aortic Junction Tourniquet (AAJT)

      • Put their wallet or something under the ratchet or you will be getting punched in the head until they lose consciousness.

    • Don’t take my word on this over JWT but, here’s the basic problem that I have with the RATS TQ: the maker isn’t honest IMO.

      The guys over at ITS Tactical busted them on this. The RATS TQ was being sold with the lable “TCCC Approved”. This wasn’t a lie but it was intentionally misleading.

      What they did was set up a COMPANY with the acronym TCCC. That company “approved” the RATS system. OK, so far so good. BUT it’s plainly obvious that by putting “TCCC Approved” on the device they were trying to get consumers to think that the Committee on Tactical Combat Casualty Care (CoTCCC) approved the device, which was not and so far as I know, still is not true.

      Following that I don’t necessarily trust anything the RATS folks have to say but that’s just me.

  11. I get it, but most people will never have any need for a tourniquet. Normal people are not going to walk around with one. You might as well wear a helmet around as that would be more effective at preventing injury.

    You know what people do walk around with (not just in their cars)? Belts. And they sure as hell CAN work. When it comes to traumatic bleeding, what you have right now is what you need to work with. Teaching people how to use belts as effectively as possible is a useful goal. And while it may be difficult to get enough pressure by simply tightening a belt alone, if you have a good pen or some sort of tube you can loop it into the belt and create a makeshift turnbuckle tourniquet. Much better than two people at a scene looking at each other and not doing anything.

    So yeah, the evidence shows that dedicated tourniquets are better. That’s why cops are carrying them now and I agree that any medical kit beyond band-aids should have one (range bags, etc). But belts can do a lot if you know how to use em.

    • I agree that most people won’t carry them around on their person but I think that’s kinda like arguing most people won’t hoof around all day with a fire extinguisher.

      Two each in a range bag, in your car and maybe in your desk at the office if you feel the need would give you a lot of enhanced capability in the places you’d be most likely to need them.

      Realistically the place most of us are most likely to see an injury that requires such a device is a car accident. After that, in terms of likelihood, at a range due to an ND or something. So, in those cases having them kinda close at hand is like having a fire extinguisher strategically placed on the wall.

      That’s just MHO on the situation.

  12. When I taught Red Cross First Aid, tourniquets were always discussed. We never said belts are not tourniquets, just that they are poor ones. But we also taught that if that’s what you have handy, apply it fast, after which you can take the time to either improvise a better one or find a “real” one — because it’s better to at least slow the bleeding down NOW than to let it flow for even half a minute while waiting for something better.

    That said, it’s crazy what can be used for a tourniquet. The wildest instance I know of was a kid who didn’t hesitate to go to his only option: his Speedo, which when looped around his friend’s leg and hauled on hard did the trick.

    • Not to mention if you use a belt most belts today are made in like taiwan-china places like that and most of the buckles will just break because they use pop metal in them so when you start to really put pressure on when you need it the most the belt ends up giving up. If that’s all you have then use what you have available but tourniquets are cheap and so are those emergency field kits that contain these type of items to dress a severe wound or a compound fracture. Use what you brung but prepare for the worst and hope for the best is my way of thought. And don’t forget to carry a permanent black Sharpie to write on the tourniquet but mostly on the patient the time and date the tourniquet was applied so that when the surgical team gets the patient into the ER and on the operating table they know exactly how long that tourniquet is been on and they can address clots with blood thinners and stuff like that once they have the wound stitched up.

  13. No the Israeli tourniquet if you do a Google search it’ll show you what I’m talking about I’ve even used a US military style tourniquet before in combat and they work equally as well. The difference is you’ve got two pieces of material separate of one another in the Israeli tourniquet and the ability to put a upside down bottle cap in the patch between it and use it as a pressure dressing as well or collapse the to lanyards and twist and lock as a tourniquet it works really well I know that might be a little hard to follow sorry about the run on. And Israeli tourniquets are used for large battle wounds not small little dressings.

      • Yeah I got a little confused there he Israeli tourniquet can be used as a tourniquet and I did use an Israeli tourniquet to stop blood loss when a friend of ours lost his foot overseas. It’s been now almost 18 years since I was overseas and I mistakenly messed up and thought the Israeli had the lanyards on it where the u.s. model has the lanyards on it and the Israeli uses a clip that causes pressure directly over a bullet wound and you basically hook the bandage into the clip on top and bottom and then pull back against the clip and wrap it around the wound but if you get it tight enough it will cut off blood flow from that area to the lower extremity. I’m not good with my vision that’s why sometimes there’s no punctuation I’m legally blind from an IED attack. But if you search for videos on how to use an Israeli bandage they will show you exactly what I’m talking about. You can also use an upside down bottle cap on top of gauze directly over a bullet wound to create even more pressure on that exact spot that helps immensely as well. There’s a couple of good things that’s important to say about the Israeli tourniquet it also comes and special wrapping that is sterile on the inside that you can use to dress a chest wound or a lower abdominal wound but especially a chest wound because usually when you get a hole in your chest air start sucking back into your chest preventing your diaphragm from exhausting the air out of your chest cavity causing you to suffocate. Just a bonus I carry one of each and my emergency field kit

      • JWT; Do you have an opinion on the rubber surgical tube/stick type tourniquets found in some first aid kits? I ask because I ended up with a bunch of them and seeded them throughout my various pieces of kit. I realize now these are suboptimal, but do they offer enough of an advantage over a twisted bandage, belt or rifle sling to bother keeping them in my loadout?

        I’d like to put one of your preferred type in my basic LBE and one in my truck, but like bleedstop, bandages and a few other essencials, I like having lots of mini kits stuffed in other kits so odds are I’ll have something to work with even if suboptimal.

        • I’ve seen surgical tubing, wrapped a couple of times and a pair of forceps used as a turnbuckle work great.

  14. Those of you criticizing him for his correct assessment that belts are not tourniquets, and mentioning that a belt CAN be used may be making the mistake of thinking of a belt PLUS a tight roll of cloth CAN block off blood-flow. Yes, it’s very true that in a pinch you can use a belt to make a tourniquet. But the belt alone will never work.

    This specific case wasn’t a tourniquet, it was a makeshift pressure bandage which while not stopping the bleeding, might have kept him from bleeding out by SLOWING the bleeding.

  15. Two in my range bag, two in my motorcycle cargo pants, I am pretty rarely without one handy.

    I have the NAR product but I am looking forward to purchasing a couple of the SOFT T as well.

    As always JWT thanks for your service and real world knowledge

  16. How can I contact you to discuss the practical application of improvised tourniquets? While a belt and windlass may not be a great tourniquet it will certainly work. Proper placement of the tourniquet and tightening the windlass are more important than arguing about if a belt will work.

  17. Huh. I like to think that I am pretty well informed on many matters and especially first-aide. I just learned otherwise with respect to first-aide!

    I had no idea that you really need the right device to effectively reduce blood loss to extremities. Never stop learning!

    Thanks Mr. Taylor!

  18. Maybe it was before your time, but belts were recommended in first aid manuals to be used as makeshift tourniquets. The recommended technique was, surprise, not to employ them as one would a belt, but to use some object, like a stick, to wind them tight. Here is may be important to note that belts are not the ideal solution, but if they are all one has, then one should try. Shoelaces were also mentioned.

  19. The situation at the shooting “could have” been improved with a fully stock trama ambulance. However, they didn’t have one. As I was once yelled at “Make a decision soldier. Right, wrong but make a decision!” A person is bleeding out. What do you have that can be used?
    Given, Monday mornng you should go over the event and decide what improvements can be made. (Note to self, add tourniquet to aid bag.) my son took action when someone fell and cut their head open. His complaint? “Everyone else stood around and watched.” Dowhat you can with what you have.

  20. “Quite simply, used alone, a belt is not tourniquet. At least not an effective one.”

    Yes, much better to do nothing at all and watch a man bleed out.

    • Alternatively, if you are aware that a belt alone will not be effective, you could use something that is.

      • Pray tell, point out a better solution from the materials available to them at that time and place.

        • I believe JWT is correct, the Rep that came to Scalise’s aid would have likely shat himself if the belt broke, or if he wasted a lot of time attempting to use it when he might’ve been feet away from better options. Bad if the belt didn’t work (caveat emptor) and it left Scalise bleeding out, and the assisting Rep. stunned to inactivity.

        • Off the top of my head, a T Shirt or two and a bat would work great. But if you could provide me with a list of everything there maybe I could give you more options.

      • I find there are two kinds of peoplen in a crisis, those who planned to ‘figure it out’ when something happens, and those who are successful. Sounds like you’re getting blow back from a lot of people who prefer to improvise over plan for major calamities. Not what one would expect from a bunch of people who have made the leap to going armed, but nonetheless…

        Also, some of the objections to the idea that a belt makes a poor tourniquet seem intentionally obtuse.
        For anything, there are good, better and best scenarios, certainly in dire circumstances try whatever may work, but realize that a higher order of equipment, training or circumstance will tend to improve outcomes.

  21. In an emergency, the average civilian will not have a proper tourniquet, however, most people do wear belts. Given that this shooting qualifies as an emergency, this article is as useful as TEATS ON A BOAR! I honestly do not understand why Jon Wayne Taylor felt it necessary to write this article. Even in battlefield situations, medics are not always around and many a soldier has used a GI issued belt as a tourniquet! What does he think the average person carries on his or her person everyday?

    • What’s your point? Sorry, this comes across as defending ignorance and laziness.

      The “average person” doesn’t read TTAG and won’t have a gun either. Does that mean all the articles on the effectiveness of a gun are “teats on a boat” stupid?

      The point of an article like this is that your average TTAG reader DOES carry a gun. As such, we’re a subset of the population with a higher percentage chance of encountering a situation where a TQ might be needed. Since that’s the case it makes sense for us to have some knowledge of best practices, pitfalls and what to expect. Armed with that knowledge we can prepare for a bad situation that hopefully never happens.

      It’s no different than pointing out that a JHP is a better choice of round than an FMJ. It’s meaningless to the “average person” who doesn’t carry but it’s useful to those who do, that is the readership here.

      Your average person does exactly fuck all to better themselves in a personal or societal context. Articles like this are for the select few that choose to better themselves so that they can better care for themselves and others. If that’s not you… well, skip the article.

  22. Could you follow up with an article showing us how to make effective better-than-nothings with belts and stuff when real tourniquets aren’t around?

  23. Not to be rude dude, but they were under fire, without a proper IFAK. I don’t know about you but adapt improvise and overcome. In the perfect world, yes I would go with a proper tourniquet all day long, but dude, cut them some slack.

  24. Use what you got! guess I’ll error on the side of possibly helping or watching a Bleed out! Ive seen cloth issue Dungaree belts used and worked at least till the Helo ride, wrap loosely around area using a Scabbard as a stick twist tight, wrong maybe but the dude lived. Gee what do you use when medics run out of tourniquets, didn’t know IFAK’s had Tourniquets in them

  25. BS. A belt can be used as a tourniquet, not the best choice, but if it’s what you got. Some belts are not as good at it as others. Clothing can be used as well. It’s not hi tech.

  26. If the staffer keeps his leg it is probably because the belt did NOT work as a tourniquet but rather an immobilizer and reminder not to move it too much. Nobody mentioned releasing the pressure to allow periodic blood flow which is a necessary evil.

    There are a number of scenarios in which the belt would have been better used to hold direct pressure on the wound. But I wasn’t there and neither were you. The staffer hasn’t died as of this point and maybe they’ll keep their leg so that is what I am hoping for regardless of the exact technique, tourniquet or otherwise. I’ll wait a while and see what the medical professionals say.

    • “Nobody mentioned releasing the pressure to allow periodic blood flow which is a necessary evil.”

      No, it is not. This is a disproven practice. Do not do this.

  27. It’s true. A belt is not tourniquet. At least not a good one. But sometimes you gotta go with what you got. Better a belt than letting the blood continue to flow out.

  28. My EMT liscense expired a couple years ago and I’ve been kind of out of the loop since then, but this is the first I’ve heard of the ratchet strap tourniquet, great piece of knowledge. The whole tourniquet sop change reminds me of the CPR to CCC switch. What good do the rescue breaths do if you can’t pump the fresh oxygen to the brain because the pressure loss during the time the heart wasn’t being pumped? It takes a long time and a lot of pumping to bring that pressure back up, and it never does if you interrupt it every 10 pumps for two more breaths. We had amazing results switching to CCC. Kinda got off the rails there, anyways, great article JWT, it is spot on.

  29. Stop the bleeding! Pressure on the hole in any way you can but a thumb and the ball of the hand work well, depending on the size of the hole and where exactly it is. And don’t forget to relieve the pressure every 10 minutes or so to allow the limb some blood.

  30. I’m a paramedic that has been working 911 EMS for almost 7 years now. I have seen very few bleeds(including arterial) that could not be stopped with just pressure dressings. But if you are/were an EMT in the field you should know if you don’t have the proper equipment on hand you improvise. A belt is the best most have on hand, and while probably not optimal is most likely sufficient if properly cinched down and secured. I have had to use a triangle bandage twisted down in the past, while not optimal it stopped the arterial bleed until I could access better equipment. 99% of the population is not going to EDC an IFAK, handgun, spare mag, plate carrier,…

    • “I have had to use a triangle bandage twisted down in the past”
      Which works far better than just a belt, as the research has shown.

      • I’m assured it does. It stopped the bleeding on a lacerated radial artery for one of my patients. But my point is in the field you sometimes have to improvise, and while it may not be optimal it’s better than the alternative of nothing.

  31. Goddamn we gotta bunch of doctors here now and almost all of you have slapped a tourniquet on and saved a life. Yeah right……. most of you fools ain’t even seen a tourniquet much less put one on in the real world.

    Improvised medical devices will seldom work as well as the real legit item will but, you must do your best. With what you have at the moment. I am glad as hell I have not gotten hurt around most of you jackasses. I would hate for you to break the normal protocol you follow when saving a life.

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