“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.]