CAMP LEATHERNECK, Afghanistan – One hundred percent effectiveness. When it comes to matters of life and death, it’s good to have odds like that on your side.
The newest generation combat action tourniquet can provide that type of reassurance to today’s armed forces when used quickly and efficiently to stop heavy bleeding. Beginning in October 2010, Marines and sailors deploying in support of Operation Enduring Freedom were issued the CAT as part of their individual first aid kits.
Since the tourniquets’ first use in the late 17th century, many advances have been made in the quality and type of materials used to compose them. However, the simple concept for their use and application has remained the same.
“The purpose of the tourniquet is to exert enough compressive force to stop blood flow,” said Capt. Jeff W. Timby, a medical corps officer in the United States Navy.
Timby, a Wallingford, Pa., native, is the II Marine Expeditionary Force (Forward) surgeon and Regional Command Southwest Medical Director, and is also a member of the Tactical Combat Casualty Care organization. His medical experience and knowledge spans the length of his 15-year naval career.
Timby is not only a proponent of the CAT, but also of the advantages of other simple and inexpensive medical gear he says all Marines and sailors should carry in their first aid kits.
“A simple tourniquet, a simple needle, and a simple surgical airway are lifesaving in over 95% of preventable deaths in the battlefield,” Timby stressed.
He cited previous research and reports completed by physician Ron Bellamy during the Vietnam War.
“Bellamy found that the number one cause for preventive death in the battlefield was exsanguination [bleeding to death] from extremity wounds,” Timby said, adding that that fact holds true in today’s Operations Iraqi Freedom and Enduring Freedom.
The second and third preventive causes of death on the battlefield are tension pneumothorax [pressure in the chest] and loss of airway.
Petty Officer 2nd Class Matthew Hicks, a corpsman with II MEF (Fwd.) who has multiple deployments under his belt, highlighted some of the improvements made to the CAT.
“The plastic windlass [what you turn to tighten the tourniquet] is reinforced but smaller, and the tourniquet comes with a time band attached,” Hicks said.
Hicks, a Venice, Fla., native who is currently deployed in support of OEF to Camp Leatherneck, Helmand province, Afghanistan, is a combat veteran who has been trained in the use of multiple tourniquets.His previous deployments include one on the USNS Comfort, a hospital ship out of Baltimore, in support of Hurricane Katrina in 2005; Djibouti, Africa in 2007; and southern Helmand province, Afghanistan, with 2nd Battalion, 8th Marine Regiment in 2009. His extensive medical military training includes a certification to instruct Tactical Combat Casualty Care.
While all the corpsman were issued, or had purchased, the CAT on his previous deployment, the same was not true for the Marines deployed with Hicks’ unit. In fact, he said, this current deployment was the first time that he knew of all deploying Marines receiving the opportunity to switch out their original tourniquets for the newest one to supplement their first aid kits.
In addition to highlighting the positive changes made to the CAT, Hicks touched on the updated training Marines and sailors were receiving with it.
“When I was first taught, the guidance that was put forth was to put a tourniquet two to four inches above the wound,” he began.
He went on to explain that the problem with that was there are two bones in the lower portion of the extremities, which prevent the tourniquet from effectively stopping blood flow.
“Pressing the artery is easier against one bone,” Hicks continued. “Moving the tourniquet up higher to where the artery is more superficial makes it easier to stop the bleeding.”
Like Hicks, Timby emphasized the importance of practicing use of the tourniquet so that the simple tips that save lives are second nature when the time comes to use one on the battlefield.
One example is not to place the tourniquet over a cargo pocket with bulky or rigid items in it, Timby said.
In addition to training and practice, survival depends on planning. Timby suggested that all Marines and sailors in a unit keep their tourniquets in the same place on their gear so that everyone knows where to find them.
Both Timby and Hicks said that storing the tourniquet on the outside of the modular tactical vest or plate carrier vest will reduce the effectiveness and resilience of the CAT.
Due to the environment and terrain, it is best to store the tourniquet in an easily accessible pouch, according to Timby. He explained that the dust could inhibit the effectiveness of the Velcro, lessening the CAT’s compression consistency, and the sun and heat could reduce the strength of the windlass, possibly even causing it to break.
Most important is the recognition of the Marines and sailors who are effectively applying the tourniquets, Timby said.
“The people that make the most difference are the Marines and sailors at the point of injury,” Timby emphasized. “They get [casualties] the care they need. Self, buddy, and corpsman aid are what get casualties to role 2 and 3 [shock trauma platoon and hospital] care. They are the ones saving lives. They are the absolute heroes.”