Clinical Indications:

 

• Life threatening extremity hemorrhage that cannot be controlled by other means.
• Serious or life threatening extremity hemorrhage and tactical considerations prevent the use of standard hemorrhage control techniques.

 

Contraindications:

 

• Non-extremity hemorrhage.
• Proximal extremity location where tourniquet application is not practical.

 

Procedure:

 

1. Expose the extremity by removing clothing in proximity to the injury.
2. Place Combat application tourniquet® (CAT®) directly on the skin, 2-3 inches above the wound.
3. Route the self-adhering band around the extremity.
4. For the upper extremity, the band should be passed through the inside buckle, closest to the fabric, and then pull the band tight. If you place it through the outside slit, away from the fabric, you add a small amount of distance between the band and the buckle that could increase the "pinch" feel. The CAT® is delivered in the one-handed configuration with the band through the inside slit, closest to the fabric, and is the recommended storage configuration. For lower extremity, pass the band through the inside slit (side closest to fabric) and then down through the outside slit (to add additional friction).
5. Pull the self-adhering band as tight as possible prior to trying to twist the windlass rod. This will reduce the number of turns needed to stop blood flow.
6. Twist the rod until bright red bleeding stops and no distal pulse is felt on the extremity.
7. Lock the rod in place with the clip and adhere any remaining band over the rod, inside the clip, and fully around the limb. Secure the rod and band with the white Velcro strap on clip.
8. The tourniquet is effectively applied when there is cessation of a distal pulse and bleeding from the injured extremity, indicating total occlusion of arterial blood flow.
9. If hemorrhaging is still not controlled, consider additional tightening of the tourniquet or place a second CAT® side-by-side and proximal to the first and repeat the placement procedure.
10. Tourniquets should NOT be removed or loosened under prehospital care conditions. Doing so contributes to compartment syndrome.
11. Patient should have an identifying mark or tag indicating "TK" and the time of placement. Document application time on the white writeable tab on the CAT® and on your patient care report (PCR). Communicate time at transfer of care.
12. Document the procedure, time, and result (success) on/with the PCR.