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Austere Medicine

Knock-off medical supplies: Is saving your wallet worth risking your life? 

This warning fully understands that many who seek self sufficiency are not made of money and may be on a fixed income. It's always nice to get a deal on something by finding it online for cheaper, but when does the expression "You get what you pay for" come into play? When does quality become priority over price?  bogusCAT Medical Supplies should be that line in the sand. In  CATS eat RATS: Tourniquet Comparison Article we addressed the difference between tried and true and unproven medical interventions, but now we're talking Knock-Offs and copy cats from trying to save a dime by going through unreliable vendors. Some may justify buying a cheaper tourniquet on non-reputable dealers because the differences aren't obvious to the untrained eye. Would you do that on medical supplies, such as heart or cancer meds? I've seen many post pictures of their medical gear and I've caught fakes, knockoffs and at a minimum outdated gear. For instance, China has a terrible problem with infringing upon patents and not caring about which products they make look-alike. While it can often be harmless stuff such as clothing, there is simply no cheap way to go about quality medical supplies. If there is one thing to not be frugal about, I'd recommend it to be what you have to use on the worst day(s) of your life. I've noticed no explanation needed for people to drop hundreds and hundreds of dollars into weapon accessories, just to turn around and relentlessly search Ebay or auction sites for used or knock off medical supplies. While I'm not denying the effectiveness of firearms and self defense, I will rebuttal with frequency of medical emergencies. How many times in your life have you needed to use your firearm in relation to times you've needed medical intervention? Nobody is immune to this, and you can't always trust "How to spot a fake" guides. Some are nearly identical and it is a fact that even the U.S. Military has bought batches of fake CAT tourniquets that have made their way into the battlefield, where they have failed when needed most. They are frequently used by "Military Simulation" (MILSIM) / Airsoft Operators to match their Plate Carriers to what the SOF uses without the cost. Their game is not life or death, but ours is. [caption id="attachment_1229" align="aligncenter" width="620"]The Boston Bombing is a testament to the proof of tourniquets in civilian, especially mass casualty incidents. The Boston Bombing is a testament to the proof of tourniquets in civilian, especially mass casualty incidents.[/caption] You may get lucky when you roll the dice, but I'll stack the odds in my favor and go into a situation with superior training and equipment. Use a reputable dealer to negate the risks associated with subpar products that you, your loved ones and your patients will need in the most common factor of emergencies: Medical Injuries and Illness. References: CAT Knock-Off - http://www.scribd.com/doc/31121665/Combat-Application-Tourniquet-GEN-III-vs-E-CAT

Standards: The tourniquet discussion

[gallery columns="5" type="columns" ids="1612,455,454,512,511"] In the medical world, every lifesaving item you select to go into your aid bag is a critical piece of gear and should be viewed as a NO FAIL item, after all lives are actually at stake. When introducing a new medical product into the market, a professional should have the research and data readily available to back up their claims for said product. The basis of this article is about standards and maybe highlight some of the gimmicks that have been floated around to make a quick buck. Medical standards are critical with tourniquets (TQ) and their effectiveness because of the competitive history between military and civilian trauma models. As a former Special Missions medic who served as a voting member of the Committee on Tactical Combat Casualty Care (CoTCCC), the subject of tourniquets is very near and dear to me. Standards are essential and this article will discuss what the standard isn't and can’t be, what the standard looks like, how standards are achieved, followed by an example of what to look for when making tough decisions with your limited budget.

Full disclosure: We sell the Combat Application Tourniquet (CAT)

What the Standard Isn't When shopping for gear, we often look to industry leaders as they have the credibility and experience to make recommendations for the inexperienced or new. But how is that credibility achieved? It’s the proven history of having done the hard work up front and having the documentation to show for it. If the only selection criteria someone has is how cool or "operator" a guy is there's going to be mistakes, and the medical world is no different. Consumers make the obvious assumption that due diligence has been made by the professionals in question. This isn't always the case, so its important to do some homework. Pulse oximetry is nowhere near the performance standard for a TQ. There are heart patients with no Pulse ox readings in some limbs....no tourniquets!

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Marketing IS NOT data. "Cool guy Johnny" used "product XYZ" is NOT data. It validates their experience but offers no quantifiable performance metric. Just because an operator designs and uses it doesn't mean it works, or will work for you. Where is the data collection, the peer reviewed studies, and the study comparisons? Simply put, “Tacticool” is not a standard. Often times, operators are only using a particular device, because this research was ALREADY conducted... When introducing a new device, just saying a Green Beret, Ranger or Navy SEAL used it isn't enough, nor should it be because the lives of our family friends and peers are on the line. The fact is, a good medic can make bad gear work in a pinch. But that level of anecdotal evidence shouldn't be confused with a product that will perform at the lowest common denominator. What the Standard Looks Like Larry Vickers of Vickers (Corrected from Viking) Tactical routinely presents, in an educational format, the quality of his content and validates what he teaches and why his product concepts work. He provides quantifiable data and demonstrations that support his methodology. Although his tactical experience is relevant, Mr. Vickers has created an virtual encyclopedia of content and data for his approach to tactical shooting and product development. He puts in the work and validates it without relying on “Tacticool” for credibility. He is “Tacticool” because he IS credible. [caption id="attachment_1618" align="alignleft" width="150"]C.A.G. using Ultrasound with a CAT TQ C.A.G. using Ultrasound with a CAT TQ[/caption] For a tourniquet, the accepted standard for performance is a Doppler study and in some cases, the ultrasound. It’s the only way we can ensure that the device has achieved total arterial occlusion, also known as stopping the blood flow. This test needs to be performed on a human thigh, due to the large amounts of tissue and pressure required to achieve end state. Basically, we need to see if a tourniquet on the upper thigh is strong enough to cut off blood flow all the way down in the foot. Arms are, generally speaking, easy to do and shouldn't be the comparative standard for use in the field. A tourniquet must work on both the legs and arms if it’s going to make it into an aid bag. There are a few other variables we also need to consider such as TQ width, ease of application and design but none of those mean anything if at the end of the day the TQ doesn't stop a major femoral bleed.

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There is no question that a skilled provider can create an improvised TQ that meets all of these criteria and will perform when the moment of truth has arrived, but the conventional homemade TQ doesn't offer the market a PREDICTABLE standard in which to train, compare, plan and gather data. Manufactured TQs provide standardization and the ability to teach down to the lowest common denominator so that critical life savings skills can be decentralized into the hands of untrained providers.
Dr. Zeitlow reviewed the prehospital use of tourniquets (CAT Tourniquets used on 73 patients with 98% success) and Combat Gauze (used on 52 patients with a 95% success rate) in the Trauma Service at the Mayo Clinic. He added that "improvised tourniquets were uniformly unsuccessful." Dr. Zeitlow also noted that the Mayo protocol calls for Combat Gauze to be used only after failure of standard gauze. There are 2 CAT tourniquets and 2 Combat Gauzes on each prehospital vehicle or aircraft. -CoTCCC minutes 2014-
When building up to human studies you often see a lot of testing done with non-human models, for example live tissue and even mannequin or cadaver tests. Again, still not the gold standard even though it seems they are validating the product. This is important to understand because there has been a release of various test data comparing the Rapid Application Tourniquet System (RATs) TQ against the CAT TQ on a mannequin. While the findings are indeed in favor of the RATs, this data in no way undermines the value and performance of the CAT nor does it provide gold standard test results for the performance of the RATs. The CoTCCCs Role in Todays Accepted Standards It needs to be said that few groups of people have done more to save the lives of American Service members than the CoTCCC. They have a well-documented, battle proven track record of medical excellence. The CoTCCC are directly responsible for the current level of professional respect the military and special operations currently enjoys in the medical community nationwide, better yet, GLOBALLY. In the last few days I've read a lot of attacks on the CoTCCC in favor of fads, and it reflects poorly on the veteran community as a whole.

tccclogoMost active duty service members aren't aware of the CoTCCC because they have only been exposed to the intellectual product that they have been provided, loosely called TCCC. For active duty service members TCCC and CoTCCC are indistinguishable because it’s only in the civilian market where there is a new difference in the meaning. I’m not going to get into who did what and for what trademark, just know that if you have to play "six degrees of separation" to substantiate your TCCC claim, it’s misleading. My personal synopsis of the labeling issue is that the product was marketed and released before it was fully tested. In most cases that's ok because sales feedback is critical, but not in the medical world. A medical device will be in court and on trial the first time it fails. This has a huge potential to damage the credibility of the military medical model. It’s not a popularity contest, it is life and death so standards must be achieved and then maintained.

The RATs TQ displays the big red label associated with TCCC. This is misleading but I don't entirely put the blame on the RATs team, rather the company that markets the label. I know what it takes to get a medical device up and running and, thanks to regulation, it’s nearly impossible. The temptation to cut corners is too great to put the blame entirely on the makers of the RATs. Competing in a market dominated by the FDA is a challenge to all medicine and not just veteran owned companies.

Combat Gauze at shop CAG!

Whether it works or not is irrelevant to the fact that professional credibility has been entirely undermined by this marketing tactic. Moving forward, how are we to accept the validity of any research done in support of the RATs? A veteran owned business is not removed from the challenges of competing in a free market, and that means creating content and products that withstand scrutiny and criticism, beyond the standards of a civilian company. The established civilian market doesn't want to compete with us, they want us to falter. We have the experience to back up our ideas so veterans don't have to dabble in conjecture. There is an entire community of civilians looking to undercut the military medical model, especially in trauma, and its gimmicks like this that will feed their machine. Credibility is king. I want to be clear, I'm not shooting down the efficacy of the RATs TQ, but I see nothing that demonstrates proven performance. At first glance it appears to be a glorified rehash of the old surgical tubing and it looks like a lot of other designs that have come and gone in the last few years. I’d like to see the testing, I'd like to see results. If it turns out to be the next big thing then great, good for them. At the end of the day I wish them luck, but it looks like the cart is ahead of the horse. What Should You Be Looking For? That depends on what kind of market you're in. The war has been going on for 15 years, so it’s not that there isn't room for innovation but there isn't any need to take chances either. The data is out there to substantiate the extra dollars on a limited personal budget. The question is how bad do you want to save $15?  As I've mentioned from the onset of this article, we sell the CAT tourniquet and for good reason. I have personally used them so I'm happy to endorse them, but the CAT has a long standing, well documented history of saving lives. As recently as last year, the Mayo clinic is reporting upwards of a 98% success rate for properly applied CAT TQs in a pre hospital setting. Ill accept that standard for my family.

Combat Application Tourniquet at shop CAG

It is one of the industry dominating products because the data is out there to validate the few extra dollars it costs to buy one. Take a look and see, then ask yourself, does your tourniquet have any real results behind it? The CAT does and we've provided it below. Conclusion Medicine is an established industry with proven practices and standards that have been set for years because they have the proof that this approach works. Few markets have the same level of scrutiny as the medical and medical malpractice industry. Even Special Operations follows and acknowledges this fact, and it’s this approach to research and development that has established the SOF community as a credible research and development institution. We have to be careful as a community not to overlook quality standards in favor of the cool factor. Our company, Crisis Application Group Inc. (CAG) won’t be testing the RATS TQ. At the end of the day it’s the responsibility of the manufacturer to prove the validity of their product, not the job of competitors to disprove it. Our initial impression of the RATs TQ is so what, show me the data. We won’t be going down the "rabbit hole" of will it work or why it works, or doesn't. That's not to say it won't, it’s just that we aren't buying into the “Tacticool” marketing. Maybe one day the RATs will be ready for the big leagues, but so far it’s not and there's a lot of work ahead of them. CAG will stick to proven methodology, technology, and personal experiences. [caption id="attachment_981" align="aligncenter" width="300"]Firearms, Tactical & Defense Training Firearms, Tactical & Defense Training[/caption] Open source data: Combat Application Tourniquet cotccc-meeting-minutes-1402-final 030. CAT_Single-Routing_ 024. Final_tourniquet_working_group_minutes_march_2010 Chpt 8-Pg 91 023.1 TK CALL AAR_Jul-09 rebuttal to Johnson 026. The Military Emergency Tourniquet Program's lessons Learned with Devices and Designs - 2011 027. Tourniquets - 2011 029. Re-Evaluating the Field Tourniquet for the Canadian Forces 032. Israeli NSW Feedback_to _the_Field_(FT2F) #11 FT2F #12 - TQ Use in OEF OIF and OND - 16Jul12 022. Battle Casualty Survival with Emergency Tourniquet Use to Stop Bleeding - 2009 General TQ studies (Good reading) 009. Surgical Tourniquet Technology Adapted for Military and Prehospital Use - 2004 010. Labortory Evaluation of Battlefield Tourniquets in Human Volunteers - 2005

Austere management of Lower Back Pain (LBP)


Austere management of Lower Back Pain:

    Lower Back Pain can be difficult to treat, even with the luxuries of modern medicine. In an austere environment, proper diagnosis and treatment can prevent further injury and start the slow process back to recovery so you can get one of your fellow Emergency Action Members back on their feet. This is a quick little introduction that barely scrapes the surface, and is not to be taken as gospel. Acute Lower Back Pain (LBP) has many causes, one of the most common is from improper form while lifting an object. I see it in day to day life from Deadlifting when form gets sloppy as higher weight is attempted while the athlete is tired.  It does not need to be heavy weight at all as I've also had patients pick up a very light object  at the wrong angle and were in a great deal of pain. This is why good form is important.
     Back Pain, unfortunately, is not always an easy fix and definitely not a quick fix. Some have more chronic issues from herniations, disc degeneration, spondylosis/sponylolisthesis, and more that are much more difficult to fix. Others are caused over time from weak hip flexors, abductors or other muscular imbalances. It can even be caused from lots of high impact, especially if you have the wrong footwear or a Bug Out Bag on your back. These can all take us out of the fight, if at least for awhile.
  Before I get into treatments, I'm going to address the patient. With musculoskeletal issues, there is no magic pill that makes it go away and there is a lot of responsibility on the patients part. In my experience, I see many patients who do one of two things:
A.)   Fight through it and exacerbate the injury.
B.)   Baby it too much and it gets locked up and tight.
  Pushing through the pain because of your ego does not give it a chance to heal and babying it does not build it back up to help it heal properly. The correct answer is a happy medium, or as I like to call "Active Rest." This means resting at first, but not taking it too easy. Walking around if tolerated, stretching and foam rolling. This will help the healing process along. From there, progressively move in the right direction. It does not stop there, as there are many things you can do for a Lower Back Injury.

Treatment options to consider:

  • How to warm up and apply a heat compress in your situation.  (Heating up a towel)
  • Which medications, if any, to stockpile.  ( Muscle relaxers or pain management )
  • Herbal Remedies that work for you or patient. ( Some are a hit and a miss. )
  • Stretching, Foam Rolling, Massage ( work to regain full Range of Motion )
  • Physical Exercises to rebuild and strengthen core and supporting structures
It won't be easy, it won't be overnight, and you may not get back to perfect, but I guarantee you that failure to take care of yourself will only make it worse. Once an injury happens the first time, the second time can be twice as easy. I would recommend for anyone with LBP, as well as the Medic of an Emergency Action Group or other [caption id="attachment_1442" align="alignright" width="235"]( Just a few examples of some of the back exercises a physical therapist or other medical provider may show you) ( Just a few examples of some of the back exercises )[/caption] prepper group to have multiple reference books/guides/pamphlets. This includes finding out what pre-existing conditions/injuries you have in your group.If you prep food and water to prepare for eating or drinking, you should prepare your body for the rigorous labor of a survival situation or even the daily life of self sufficiency. Before an Austere situation, Physical Therapy can do much more for an injury than self care. Physical therapy regiments done consistently and properly can hopefully alleviate pain and have you moving in the right direction, but at a minimum prevent your LBP from getting worse. One of the books I recommend is the Treat Your Own Back book by "Robin Mackenzie." It doesn't end there, You'll want other books for the myriad of other musculoskeletal problems you may encounter, or that already exist in your circle. Finally, if you can remember one thing from this article ( Print it out and share it), Here's a couple red flags during a collapse to immediately seek higher medical care:
  1.  The patient complains of "saddle paresthesia" or numbness/tingling where a saddle would touch their legs if they were on a horse. (Makes it easy to remember)
  2. The Patient complains they have lost bowel/bladder control. This can be inability to hold it in and extend to unable to void bowels or bladder as well.

End note: I would like to ask you to comment with which methods of treatment, especially natural remedies have you used to manage yours or others? (There is no right or wrong answer, as different strokes works for different folks. )


" Ready - Sure -Secure "

Every Day Carry (EDC) Tourniquets: What you may need if you have to draw your firearm

"Medical and trauma emergencies are the most likely crisis that you and your family will face in any emergency. If we look at the all the recent catastrophes faced by our great nation one thing stands out as the most experienced event; TRAUMA. It doesn't matter if it’s a chainsaw accident, tornado or a gunshot wound. Life happens and you need to have the right gear. "
  A firearm is the first object that comes to mind when an EDC or "Every Day Carry" list is mentioned. While I've seen card sized items and flashlights commonly added to most EDC's since then, there's a vital piece missing. We can agree that our EDC, especially our firearm, is to get through an emergency and protect ourselves and others...  But what if that does not go as planned? [caption id="attachment_1229" align="alignleft" width="300"]Tourniquets came in useful for civilians during the Boston Bombing Boston Bombing: A testament of the effectiveness of tourniquets outside of the battlefield, as well.[/caption]   In a situation where firearms or other weapons involved, the optimal end result is that the threat is taken down, good guy escapes unharmed. Unfortunately, you and I both know that with the nature of ballistics and a high adrenaline moment of stress, that this may not be the case.   Even if you have to remove your weapon from the holster, you or your loved one may be harmed in the process eliminating the threat, or you may even have shot a bystander in the process. Unless a paramedic is thirty feet away, that person may very well bleed out long before medical attention arrives. That's where your EDC Tourniquet comes along.

Green Beret medics on CAG NET discussing austere medicine!

  Extremity (Arm or Leg) bleeding is the number one preventable cause of death on the battlefield, which means this situation is not to be taken lightly. A tourniquet applied properly may save a life in this instance. It's better to use one,  than hesitate and risk exsanguination or "bleeding out." The days of "Don't put it on or you'll lose that limb" are over, studies show that it will take 4-6 hours before permanent damage even begins.  Whether 911 is coming in 15 minutes or you are in an austere situation where help may be delayed or you may have to self-transport, none of that matters if they don't make it through these next few minutes. The decision is clear: Acting now or bleed out on the spot.   That's why I recommend a tourniquet being added to your EDC. Even if you don't carry a firearm daily, Medical injuries are far more likely in an emergency or austere environment than having to draw a firearm. That is why we're going to go over how to use a tourniquet and how to store them. We've already established types of tourniquets so you may make an educated purchase in another guide: Crisis Application Group: C.A.T's eat R.A.T's: Tourniquet Comparisons (CLICK HERE) [caption id="attachment_1231" align="aligncenter" width="300"]Self Aid is a critical skill Self Aid is a critical skill[/caption]   If you can visualize a hole leaking water from a watering hose as the arterial bleeding and the faucet the hose is attached to as the victim's heart, you can know "Why" you're doing it:  the application of the tourniquet is basically you going farther up the hose (artery) to stop water (blood) from coming out. You may waste precious seconds with bandages and direct pressure hoping that fixes the wound. While those methods may be used to slow bleeding, you are going for arterial occlusion meaning the bright red bleeding stops.  "Twist, Twist, Twist the Windlass till the bright red bleeding stops." "Where do I put this thing?"   The CAT and SOFT-T only seem bulky but with a little folding you can make it's silhouette smaller. Personally, I carry at CAT tourniquet on me everywhere I go, and have at least 2 more in the car at all times. That's not even mentioning my medical supplies.

Combat Application Tourniquet (CAT) $28.99!

A1   I recommend putting it on your belt, however this is not gospel and your imagination is the limit; You can use pockets, ankle holsters or truly conceal it under a shirt by looping it like a bandolier. With the belt method, you can loop the tourniquet through the belt as shown, using the velcro to your advantage.

  If you're worried about a tourniquet attracting attention on a belt, you can pull a shirt or jacket over it, just as with a pistol but with less chance and worry of imprinting. If you can't get it stable enough, try using thick rubber bands to tie it into the belt. If you still can't get it working or need a more durable container for extended wear and abuse, there are a variety of tourniquet holders that are commercially available that are smooth and keep it in good condition.




CAT's eat RAT's: Tourniquet Comparisons

We have come a long way in trauma medicine since the days of "Use a tourniquet only as a last resort." We now know it can be on for hours before it even begin to damage the patient, and now tourniquets are often times your first intervention in tactical medicine

A Guide to avoid gimmicks in the world of Tactical and Austere Medicine:

Tourniquet+poster   We have come a long way in trauma medicine since the days of "Use a tourniquet only as a last resort." We now know it can be on for hours before it even begin to damage the patient, and now tourniquets are often times your first intervention in tactical medicine. It's now a rush to create the latest greatest equipment, especially tourniquets, to save lives both on the battlefield and here back home as referenced in their success in the Boston Bombing. Most often times these new medical innovations are not created by a scientist in some dark lab but the warriors who return from the battlefield and realize what we need. I applaud those who innovate in order to save lives and experienced Tactical Medics can make their own decisions about the newest medical interventions. Unfortunately, some products

come out seeming to be best thing since sliced bread and we here at Crisis Application Group are here to help you make an educated decision in what you choose to purchase because this purchase may be used to save somebody's life.  Every tourniquet has its Pro's and Con's that can and should be mitigated by rigorous training. When the human factor is eliminated as best it can through rigorous training, THEN we can talk about proper equipment.  It doesn't matter if you have the best tourniquet in the market if you can't use it properly.



R.A.T. Tourniquet:

CATSeatRATS   Cutting right to the chase: I'm not sold on the R.A.T. Tourniquet just yet. (Pictured:) it has "TCCC" approved on it, which is not the military's official "CoTCCC" which Crisis Application Group's CEO was formerly a member of. That could be misleading to many folks that think it has been approved for battlefield use. The RAT tourniquet is a flat bungee that works through wrapping the cord around the extremity to stop bleeding. While you could improvise many items to slow the bleeding, I expect total arterial occlusion from a commercial product. I have yet to see Doppler prove that it occluded arterial blood flow, studies on live tissue, or real CoTCCC approval. The RAT tourniquet page has video documenting it stopping the pulse through the use of a Pulse Oximeter, but that is not where the bar is set. I see the temptation with the lower cost and size, but in medicine you can't take the "idea" over proven effectiveness. In the game of saving a life, you may have to spend the extra dollar.

CAG Tier 1 Med Packs! Complete modular systems $99!

  There is also the argument about proper width, which is directly correlated to soft tissue damage and more importantly arterial occlusion. It states and is 1.5" when properly applied, which I will give them the benefit of the doubt. However, with items used in a high stress environment, you'll want a redundant product that is less likely to be messed up. For instance, if there is too much spacing between the wraps, or overlapping too much could require the Operator to re-do the intervention, releasing the tourniquets pressure. In addition, Some haFlatBungeeTourniquetve argued about the length of RAT tourniquet on a thigh, but after seeing a video demonstrates it's use on a 26" thigh properly, I have no complaints there.

  A large portion of the reviews say it's fast enough than taking an already 'looped' CAT from the foot of the patient and jostling it all the way up. I teach my TCCC students the option for a CAT to instead be applied through the friction adapter at the correct height of the limb. This requires less movement and going around the limb than the multiple loops of the RAT.   A tourniquet isn't just about putting one on, but keeping it on. I would like to see how it would hold up in casualty drags and carries, where rocks, debris and gear can cause a tourniquet to possible become loose and therefore less effective.   If we received one in the mail, we'd surely test it out further. Until then, we'll wait till we see more concrete proof.

SWAT-T Tourniquet:

[caption id="attachment_454" align="alignleft" width="372"]SWAT Tourniquet SWAT Tourniquet[/caption]

   This is the SWAT-Tourniquet. It's name is also how to use it: "Stretch, Wrap and Tuck." . It's an elastic wrap, I've used one in practice when I came across it. It was very strenuous to get working and after application to the legs and I put it on aggressive and tight. In addition, when finished wrapping, you have to find a place to tuck the tail into or it will unwrap itself, which was one of the largest issues I had. I would mention the pain, but that has no room in saving a life because "The Operator feels no pain (when doing medical interventions.)"  I would not recommend this product that is not CoTCCC approved and many units do not allow it. I wouldn't even use it as a pressure dressing to avoid compartment syndrome, and an ACE wrap is easier to see blood leaking through if your intervention fails.

Committee of TCCC (CoTCCC) Approved Tourniquets:

  The two tourniquets widely used in the the Special Operations community as well as experience in the staff here at C.A.G.,  but even more importantly have approval from the Committee on TCCC (CoTCCC) and Fort Sam Houston's Institute of Surgical Research are the Combat Application Tourniquet, version 3 -or- CAT3 and Special Operations Forces Tactical Tourniquet -or- SOFT-T/SOF-T. CATTrauma CAT-T   The CAT3 has been ol' faithful for quite some time. It does get a lot of hate, though, and as someone who has taught all different groups of people TCCC, I can see where it frustrates newcomers. Just like many other good pieces of equipment, a tourniquet is not a learn-once and done. The CAT3 needs some practice to get down smoothly, especially with the friction adapter. C.A.G. has a video you can watch to learn how to do it right and practice in order to stay under the goal time of 30 seconds.

** A CAT3 once used for training or any other purpose should not be used in trauma.

[youtube https://www.youtube.com/watch?v=BAF5LIxzOPo&w=420&h=315]

SOFT-T:   Special Operations Forces - Tourniquet is another tourniquet we recommend, but just as with the CAT, it will take practice to get it right. If you foresee you or others in your group having a hassle with the tightness of the screw or remembering it, the newest generation SOFT-T has a buckle that makes life easier. SOFT-TSOFT-TW (Wide version with Buckle instead of screw.) LEFT: SOFT-T RIGHT: Newer SOFT-TW Wide with Buckle in place of the screw.




Improvised Tourniquets: token1

  Improvised Tourniquets are as their name implies, using what you have available in an attempt to create a tourniquet effect. They are good to know how to make and have prepared for an austere or mass casualty incident where you do not have one, or do not have enough tourniquets. However, they do not work as well as commercially designed tourniquets, so prepare a few in case you run out and tuck it away in your intellectual equity toolbox. Our very own Crisis Application Group's Jay Paisley demonstrates just how simple it can be.

[youtube https://www.youtube.com/watch?v=0Q_ClfyM0Ls]

  What I hope you take away from this article is to be skeptical of new inventions proclaiming to be the next big thing, especially in the business of saving lives. I could go over every possible tourniquet on the market and write a book but I'm sure you got the point. When you come across one you're unsure about, do some research or even feel free to ask us about it. Inspect your tourniquets as you receive them, as some have cheap after-market knock offs made of cheaper, flimsy products or even an older generation of what's currently best. I also recommend you take your tourniquets out of the packaging and prepare them properly as fumbling around with that can cost a few extra seconds when the goal is preserving "fresh clean blood."

CAG Class: Intro to Austere Field Medicine, Conyers, GA!

  Once more, I applaud those out there creating these products to save lives on the battlefield, Law Enforcement Officers and even Civilians back home. I would love for a product that is smaller, faster and lighter than what we currently use, but more importantly I want one that can save more lives. It would be a safe bet to stand back and monitor a product you're interested in while it receives further testing and real world application to work out the kinks. Even the beloved Combat Gauze had criticism when it first came out and replaced Celox and Chitogauze awhile back, then in the new TCCC updates Celox/Chito are back in the game as alternate uses because they work intrinsic of the clotting cascade and may perform better for someone with poor clotting factors. It goes to show you that what you knew about medicine 6 months ago may not be correct, and what you knew a decade ago might not work as well as what is out today.   For now I recommend you stick with what you know and keep training. No matter which tourniquet you or your community purchase, buy at least two; One for training, one to keep when you need it. Mark/spray paint the training TQ to keep it separate and train on it often to stay fresh and keep your time under 30 seconds. The equipment doesn't live up to its full potential without proper, consistent training.   If you have any question on medical products, feel free to ask the medical subject matter experts here at Crisis Application Group about it. We have Special Operations, Special Forces, former CoTCCC members and other Medical Professionals that can give you a professional opinion. Trust the reviews of those who have used tourniquets on real life trauma casualties. [caption id="attachment_2" align="aligncenter" width="300"]Med training with Crisis Application Group Med training with Crisis Application Group[/caption]   Don't take our word for it, Check out these References and come to your own conclusion, or Google "TCCC" or "CoTCCC tourniquets" : JSOM TCCC References: https://www.jsomonline.org/TCCC.html TCCC PDF from U.S. Army Institute of Surgical Research updates, as of 02 June 2014: http://www.usaisr.amedd.army.mil/pdfs/TCCC_Guidelines_140602.pdf