New! CoTCCC Approved Tourniquets

hey guys my name's Sam and welcome to pragmatics I am super excited for this week's video because the committee for tactical combat casualty care just released new recommendations for tourniquets for the first time since 2004 so in this week's video we're going to be taking a look at all the tourniquets they just recommended and we're also going to take a look at a couple tourniquets that didn't quite make the cut [Music] all right so I want to start this video off on the tourniquets that were just approved and I'm gonna do a brief overview of each one I can't say that I'm going to go in depth of any of these because to be completely honest with you I only really have experience with the cat and the softy wide some of these other tourniquets I just got in the mail played around with them a little bit read the instructions but I am by no means an expert and the use of these are folding or anything like that so you know I'm gonna give you a brief overview but I'm not gonna go super in-depth in them so to give you guys a little bit of background the committee for tactical combat casualty care is a group that's sponsored by the Department of Defense made up of combat medics physicians and a lot of really smart people with a lot of real-world experience in tactical medicine and trauma care they get together and they do regular literature reviews of the trauma care that's out there and studies that have been done and they publish their results in an effort to kind of promote evidence-based medicine in trauma care so they put out pretty much all the recommendations for commercial tourniquet use and before last week they had not done a review of tourniquets since 2004 and we really only had three main tourniquets that were recommended those were the cat tourniquet the soft key wide and then the EMT tourniquet which is a pneumatic tourniquet for today's video I'm only going to be talking about mechanical tourniquets I'm not going to be talking about any of the pneumatic tourniquets that they've recommended just to keep it simple and these are more of what I know if you want to take a look at the data they collected and stay on top of what their recommendations are you can find everything the committee for tactical combat casualty care talks about on a website called deployed medicine they kind of compile all of their data they do quarterly literature reviews that you can read they also have really quick study cards for recommendations in a tourniquet application airway management it's a great resource for you and then they also have a podcast so I'll leave a link to that down below I do want to tell you that I bought all of these with my own money I am not sponsored by any company and I do not have any financial ties to anything here although I would not be opposed to a couple of these sponsoring me alright so kind of starting with the tried and true and some of the older devices that have been approved since that 2004 timeframe the cat tourniquet kind of remains my favorite and I'll kind of tell you a little bit more about that as we go on the video but the cat tourniquet is a really simple tourniquet got a velcro strap here that goes around the loop you tighten it really tight on the limb and then you tighten the windlass put it in these brackets and pull the time strip over it's really simple to use some of the disadvantages with this are that it is hard to get really tight on the limb and that's its biggest failure is you can't if you don't tighten it all the way down you're gonna have trouble tightening the windlass to a point where it actually includes blood flow but all in all the cat tourniquet is one of the most prevalent tourniquets on the market it's what pretty much every soldier is deployed with and then a lot of police officers carry these as well it's what we carry on our ambulances are primary tourniquets so it is what I'm most familiar with and which is one of the reasons I'm gonna continue to use this tourniquet the cat tourniquet is I need to look at my cheat sheet it comes in at $29 retail you can get a discount if you were Police Fire EMS on North American rescues website do not be fooled with these do not buy these on Amazon because they are almost all counterfeit there and they will break when you try to put them on they look really convincing they look really similar just don't buy them straight from the manufacturer that's really the only place that's really safe to buy these so cat tourniquets my favorite now the next one and tried-and-true and what I've been carrying for a while is the softy wide the regular softy is no longer recommended by the committee for tactical combat casualty care so the softy wide is just a little bit thicker and the thickness of a tourniquet is actually really really important because the thicker tourniquet is the lower the occlusion pressures are which means that the less tight this has to be on an extremity to stop the blood flow with that you'll have less patient pain and you'll also have less tissue damage so all of these tourniquets are about an inch and a half a little bit more in some cases in thickness which is really what you should be sticking with if at all possible and for these approved tourniquets they're all about that dimension some of the not approved tourniquets are not so we'll kind of talk about why that's important so the softy wide is very very similar to the cat tourniquet couple big differences is you don't actually take this loop out of the buckle if you want to put it on a leg it has a clip here that you can unclip the loop from and then instead of having velcro it has a friction lock when you tighten it I personally do not care for the friction lock because it makes it a little bit harder to put on your extremity as you pull it the entire tourniquet turns with you so you have to either pin it with your arm pin it with like the wall or the floor whatever is around you and then tighten it so it's just a little bit harder for self-application now I do carry this with me on my everyday carry because this folds down a lot tighter than the cat tourniquet and that's really where this thing shines and I think still holds an advantage over all these other options because it is such a good everyday tourniquet for that size comparison it is a little bit hard you have to make sure you're practicing with whatever you have because when you're applying this it doesn't just sit in a bracket the new gen3 sorry the new gen 4 actually has a bracket put it in and then you put this triangle over the winless so it just takes a little bit of practice it's a great device but just be aware that if you're carrying this you need to be practicing it regularly or you're not going to be able to do it when you know you're in that dire situation when you're bleeding out or shot the softy wide currently comes in at twenty nine ninety three that's off the tactical Medical Solutions webpage I don't know if they offer a discount but that's pretty par for a course for these two tourniquets the new and that is for the new gen for this one is the gen three so they're pretty similar but you know by the newest version if you're going to get something alright moving down the list and I should have talked about this earlier this is the Gen six cap it's not the gen7 Gen six is still approved but they you can't really buy these anymore and they're saying just go to the gen seven as soon as these outlive themselves or you use them the big difference is just the winless the winless is a little bit thicker on the gen7 tourniquet I don't know if you can see that but the gen sevens just a little bit sturdier there so I'd recommend just going with the latest thing that being said if you have the Gen six you don't have to throw it away or not use it it's still acceptable at this point in the same category as the softy wide and the cat tourniquet we have the Sam extremity tourniquet so this is the Sam XD and this is made by the same company that makes the Sam splint which I've talked about earlier on this channel in my splinting video it's a pliable splint that goes in your arm it's a great product they also make a pelvic binder that kind of follows the same principle of this and this tourniquet surprised me because when I got it it feels like a toy it looks like a toy but it actually has really cool functional points to it that I think make this for me what I'm gonna be teaching in my stop the bleed classes because it has some features on it that make it a lot easier for civilians to apply accurately now the sam xt comes in at 37 95 so it is a little bit more expensive and really on its surface and it's usage is very similar to the cat tourniquet it's got a velcro strap down here you apply it around the limb and you pull this off and tighten now the big difference with this is is as you tighten this around the extremity you'll notice that there's these holes on the strap once you get it to a tightness that's acceptable for this tourniquet so it's not too loose remember I was talking about how in the cat tourniquet if you don't tighten it all the way down the windlass isn't going to be effective well this will tell you exactly when you've reached that and it will click and it will lock this strap into place with two little prongs that pop out velcro it down and then you turn the windlass just like you would with the cat tourniquet put the time strap over it right the time and you're done now that feature with the tightness is amazing you know it's a lot easier to teach a civilian or somebody that has no medical training how to tight until you hear a click then it is kind of a subjective like oh just make sure it's tight that doesn't work as well so I really like this for that that being said I don't think I'm going to be carrying these simply because this piece that clicks is just a little bit thicker than the cat tourniquet it's one more piece and to potentially fail there's no data on it failing or anything like that but you know this is I'm just a little bit worried about the potential for this and it's just one more thing I don't really want to worry about you know people in the medical field if you have a lot of experience you don't necessarily need that because you can kind of gauge how tight to bring this tourniquet there is one other winless style tourniquet that I did not have time to get shipped here and that is the TMT the tactical mechanical tourniquet it is very similar to the cat tourniquet it just has a little bit of a different bracket for the windlass to slide into and then it's also not velcro it has one of the friction locks for the strap itself so when I get that in I will make sure we have a video on it or something like that the TMT comes in at 2995 so almost identical to the cat and the softy wide now the last category of tourniquet and one of the new styles that was approved by the committee for tactical combat casualty care are these ratchet tourniquets now these ratchet tourniquets are very similar to like a snowboard binding if you're into snowboarding this tourniquet here is the ratcheting medical tourniquet this tourniquet is super simple to use it has a friction lock here for the strap you put it around the extremity it's got instructions right here you pull that tight around the extremity and then you grab this tab here to keep the tourniquet from turning and you ratchet it down until you have cessation of blood flow it works really well for a buddy application if you're putting this on your own arm though you actually have to bite this strap right here to keep it from turning and that's what they recommend in their instructions I found that to be kind of difficult it's not saying you can't do it it's not saying this is a bad device but it will take lots of practice there there's a theme here you have to practice on whatever you're carrying so with this one I don't think I'm going to be carrying this either you know it doesn't it might be a little bit thinner than a flat folded softy wide but you have this buckle here that sticks up pretty far and then you can bend that over and put that in a pouch like this I'm a little bit nervous about perpetually bending this hard plastic here if it would develop wear I have nothing to support that opinion so you know if I haven't seen like a manufacturing recommendation for it but that is a possibility for storage if you are looking to make it a little bit smaller pretty neat device the ratcheting medical tourniquet the RMT comes in at 36 dollars a piece which you know we're kind of seeing a theme everything's gonna be a little bit below $40 with some being a little bit cheaper a little bit more expensive the big advantage I see of this tourniquet is that when you're pushing this up some people might not have the dexterity maybe you have arthritis in your hands or just don't have the muscle strength to turn the windlass on like a cat or a soft key wide because that does require a lot of pressure with these ones you've got a really good mechanical advantage with this ratchet and it's going to be a lot easier for you to do in my opinion to release this it's really easy to just pull that one it's really tight this actually takes a lot of force to get that undone alright the last two tourniquets on the recommended list are the TX three and the TX 2 now these are made by the same parent company even though they're marketed different this one's marketed from Rev med X and I'm not entirely sure about what some of the relationships between these companies are I will do some research get back to you on that but this is very similar to this down to the instructions on it so this is the TX 3 so it's a three inch strap here and that's pretty cool because that means that you're gonna have much lower occlusion pressures for this tourniquet because it is so wide obviously you lose a little bit of compactness with this you can fold it over just like the other one but once again I'm a little bit worried about this hard plastic and having that bend or snap the TX three works almost identical to the ratcheting medical tourniquet it has the same instructions in everything you put this around the extremity you hang on to this loop and you tighten down until it's tight on the arm or leg if you're self applying this to your arm then you bite this and you tighten it down and then you ratchet it until you have the cessation of blood flow now while you do have really thick bands here that pressure isn't going to be quite as well distributed up here because your tension point is really right on this section so you're gonna have lower occlusion pressures here it's gonna be a little less painful but I've noticed on both of these you do get a little bit of pinching when you put that on because this does bunch up this fabric so just be aware of that you know obviously patient comfort isn't our primary concern when we're dealing with massive hemorrhage but especially for long term care if maybe you're not right next to a hospital or you don't have the ability to get them to a hospital right away just be aware that these might cause some pain there and you might want to just try to avoid that pinching by lifting up a little bit as you apply it this one does have a younger brother it's the tx2 which is almost identical to the ratcheting medical tourniquet it's just a two-inch strap down so it's just a little bit smaller both are approved both work great you know if you can carry it I'd carry the thicker strap because that's going to be a little bit more comfortable for your patients the TX 3 is the most expensive and this comes at almost $40 so just you're paying for a little bit more fabric and you're paying for the ratcheting mechanism on this one so these are all the tourniquets that were recommended by the committee for tactical combat casualty care they have not released the specific data on their literature review they have not released that paper yet or published it that should be coming in the next week or two and when it does it will show up on that deployed medicines website what you should be looking for there is they should be giving you complete criteria of what studies they included in this literature view and what they excluded and why so that should give all the information for what their criteria for these tourniquets is so I'm kind of awaiting those you know I trust this committee because they're not a special interest group they really have no stake in any of these tourniquets or brands so these are just they're kind of unbiased opinions they've had really good recommendations in the past so let's talk about a couple tourniquets that are not recommended and I have two categories of these tourniquets I have one that I will still carry even though it's not recommended and then I have two that I will probably throw in the trash and I feel a little bit bad because I even spent money on them just for this video so the one tourniquet that you guys have seen me kind of talk about on this channel repeatedly is the swat teeth this is the stretch wrap and tuck tourniquet this is an elastic tourniquet that basically goes around the arm and you stretch it out every loop and it will include blood flow flow it is not recommended by T Triple C for a couple reasons one this is really hard for self-application especially if it's bloody you have any kind of moisture on this it slipped out of your hand you need to practice with this a ton second it's going to take a little bit longer than all these other options to apply to the limb so that's a big problem if you're bleeding out because every second that's delayed is a second that your patient's not going to do as well so if this has all these disadvantages why do I carry it well just because it's not co T Triple C approved it is still evidence-based and it has a lot of studies on it that show it is very effective at occluding blood flow it's also multi-purpose so you can use this as a pressure bandage along with a couple other uses as like slings and things like that so I carry this as more of an last zort EDC item it's thick so it has really really low occlusion pressures and it's very comfortable for patients which is a big deal in some instances it's also very compact and cheap so I can keep this in my pocket and it works pretty well no this is not your best option if you can carry one of these other recommended tourniquets please do so but if you're going to carry something for EDC I think this is your go-to choice as long as you practice with it a lot a couple other advantages for this is that this will fit any size patient down to very very small children it is also recommended right now for k9 te si si this is their recommendation for a canine tourniquet it does work pretty well for that so one really quick point about pediatric application of tourniquets they've had a bunch of studies that have come out that show that cat tourniquets and softkey wides will be able to fit a majority of pediatric patients in elementary school now there are some exceptions to that and in those cases you can use the SWAT T because this will fit any sized patient now I will tell you that children that are that small or that young have really low mean arterial pressures which simply means they've got low blood pressures in general and they're going to require less occlusion pressure to actually stop that bleeding so generally speaking a pressure bandage wrapped tight around a kid's arm is going to be enough to stop that bleeding but you can use this as a tourniquet option and this is pretty quick to apply in those instances so if you are worried about a very small child I would recommend this tourniquet as what you carry for that now the last two tourniquets I want to talk about today and probably what's gonna get me the most dislikes on this video are the rats tourniquet and the stat tourniquet okay so the rats tourniquet came out a number of years back it's been around for a while and it was developed by a Special Forces dude that saw some issues with the cat and wanted tourniquet that worked and the principle here is that you'd put this around a limb you'd put this through and then you'd wrap it multiple times and the multiple wraps would give you that width that we were talking about with the tourniquets this turning has a bunch of issues and I would never recommend anybody carry this I feel bad that I even spent money to get this tourniquet to review because it is such a thin band it has been associated with really really high occlusion pressures and a lot of soft tissue damage so this is really actually harming your patients much more than these other tourniquets are second they've had one comparison study with this between the cat and soft key wide and you know a lot of people point to that study is like a positive for this because in the conclusion it's like well all three tourniquets can stop bleeding pretty effectively but if you really go and look at the numbers this has much longer application times it takes much longer for cessation of bleeding to occur with this tourniquet and it has that a lot more pain factor to it because it is such high pressures anecdotally this comes off with patient movement you drag a patient you're moving them it comes out of this they have a Gentoo that's supposed to be a little better but it really has not been demonstrated to work any better it really doesn't have any real advantages maybe it folds a little bit tighter than say the SWAT team but if you're gonna choose an election elastic tourniquet stay away from this it's just not a good device it does not have the data back it up the business has done some pretty shady practices in marketing this you'll notice that some of these have like a t Triple C approved rats tourniquets bought their own organization called us T Triple C and they approved their own tourniquet so that they could say it was T Triple C approved and basically mislead the public in that way they've also purchased some domains that bring you right to their website just some practices that I think are ethically wrong and this tourniquet just is not a good option for you I would remove these from your kits altogether all right the last tourniquet we're talking about is the stat tourniquet and I got a bunch of questions on these a couple months back I'm gonna tell you right up front I need to be a little bit careful what I say about these guys because I have heard through the grapevine some well-known medical youtubers that stat has been threatening lawsuits to anybody leaving them bad reviews now granted I don't think they have any traction there because what I'm telling you is what I've seen in my opinion of these and then facts I'm not just slandering them or giving any false information so for one these are completely unstudied the company has not released them for Doppler trials or any kind of medical proving this was literally a concept that was come out with and they put it into use and they really don't have much data to back it up the company has been unable to supply any data either and that information comes from crisis med which is a they've got an Instagram channel and they did a study on these they got 25 of them and I think something like 22 failed and they do not occlude arterial blood flow to the legs very well at all I would stay away from these at all costs they have no mechanical advantage so it's really hard to get them really tight they have a timer for an hour on them but an hour doesn't mean anything you know we've heard the golden hour but really there is no huge physiologic change that happens from 55 minutes to an hour and five minutes so the golden hour is kind of false so this really has no use so I want to clarify the golden hour comment really quick because I know somebody's gonna get upset basically in trauma care the faster you get them to definitive care the faster you get them to an O R and a trauma surgeon the better the patient's going to do so you want to keep that time as short as possible but an hour there is nothing special there [Applause] never carry these III would never carry these you know they just do not work as they're advertised I've had my own failures I've tried them out on me and it's really hard to get the right pressure on your leg you need to put a lot of force into it they're exceedingly painful they're pretty thin you know even the thinnest tourniquet here there's still a lot thinner than the ratcheting medical tourniquet so just just be really cautious with these and make sure you do your research I would always recommend going with Co T Triple C approved tourniquets you know there's a lot of gimmicks out there there's a lot of innovation too but you should not be the one to trial these there needs to be data there needs to be things to support its use you don't want to be trialing this on somebody the first time and being the first case review where you put it on somebody and they bled out go with proven devices and I think that is something that's very hard for people to do especially with all the ingenious marketing out there I mean you see a video with with this and I was sold when I first saw it because they have such good marketing campaigns same with rats so make sure you do your research make sure there's data to support them guys if you have any questions about anything I covered today please leave him in the comments down below I am super excited about all of these and really any of these are good options except those so any of these are good options make sure that you are getting something that works for you whether that's you know you're looking more for price whether you're looking for a feature that one of these has you know these are all good options for you and you're not wrong to go with any of them just make sure like I've been preaching the whole time that you are practicing with all of these devices because that is super important you're in a stressful situation you've been shot your buddy's been shot you are not going to be thinking clearly so you need to have that muscle memory that allows you to apply this even though you're in that heightened state guys if you have any questions please leave them in the comments down below on this video I really enjoy your feedback I'm super excited to be getting out of this area in the next month and actually having a studio to filmin that's going to be much better for production value in general but I'm really looking forward to the future of this channel and I will see you guys next week [Music]

Channel: PrepMedic

Views: 85,863

Rating: 4.951807 out of 5

Keywords: SWAT-T, RMT, Ratcheting Medical Tourniquet, CAT, Combat application tourniquet, SOFT-T, SOFTTW, SOFT-T Wide, Tactical Medical Solutions, TX2, TX3, Paramedic, Stop the bleed, CoTCCC, TCCC, Tactical Combat Casualty Care, TMT, Tactical Mechanical Tourniquet., Skinny Medic, EMS, Ambulance

Id: M16tp4tOR_w

Length: 27min 32sec (1652 seconds)

Published: Sat May 11 2019