The Best Tourniquet Is The Tourniquet That Is Right For You.
The Tourniquet is a basic life support tool that is easy to use, effective, and relatively low-cost. There are several options for buyers who want to purchase a tourniquet. These options include length, width, materials, sizes, and types. Some key takeaways to remember when purchasing a tourniquet are the following:
Length: The length of a tourniquet is vital to its effectiveness. When shopping for a tourniquet or tourniquets it is important to know the length of the tourniquet you are purchasing. A length of 36” or 1-meter is a good overall length for a tourniquet that will work on most sizes of people. The military standard length for tourniquets is currently 37.5”. If you have smaller limbs or are a smaller than average person you may want to consider purchasing a smaller size and or smaller length tourniquet that is made to form a smaller circumference.
Width: Width of a tourniquet is probably one of the most important factors of a tourniquet, and is something you must evaluate when purchasing a tourniquet. Limb Occlusion Pressure (LOP) is calculated using the formula:
The wider a tourniquet is the better it is at occluding blood flow. Narrow tourniquets require higher amounts of pressure to stop the bleed. Therefore, up until a point, wider is better when it comes to tourniquets. When it comes to width you must consider the width of the functional part of the tourniquet. This means that for example that a windlass tourniquet that has 1” width webbing threaded through its windlass bar has only a 1” width, and that the 1.5” sleeve it is inside is not the functional width. Furthermore, while wider is better, there is a limited supply of area on the limb so tourniquets that are really wide may exceed the area available above the wound where a tourniquet can be placed. It’s best to a tourniquet that is somewhere between 1.5” and 3” width, with 2” being ideal.
Materials: Materials such as nylon webbing are commonly used in tourniquets because they are strong, lightweight, and rugged. If you intend to carry your tourniquet in tough conditions and environments a nylon-webbing tourniquet will likely serve you better than a elastic band material tourniquet. Almost everyone has had their blood drawn before at a hospital or doctors office. In this setting they used elastic tourniquets to facilitate the blood draw. These tourniquets are only effective for venous blood flow occlusion. Essentially, they stop the return of blood to the heart, thereby increasing pressure below so the technician can draw your blood into the vials needed. They are not lifesaving tourniquets. There are stronger and wider elastic tourniquets that employ this concept and materials though.
Sizes: Most Tourniquets come in a one size fits most configurations. However, some tourniquets do come in variable sizes and widths. If you are a smaller person, and or have smaller limbs, consider looking at tourniquets that offer more than one size.
Types: There are four primary tourniquet types on the market today.
Windlass Tourniquets can take a few forms, with the most common being a windlass bar. These tourniquets are constructed of a webbing sleeve with or without Velcro and other means of forming and keeping a loop such as buckles or rings. Inside the webbing is an internal webbing strip that is threaded through the center of a windlass bar. When twisted it twists the internal webbing strip to reduce its length, thus producing compression that may occlude blood flow in the limb. The bar once tight enough is then locked in place with a variety of different securing mechanism. They typically cost about $5 to manufacture and are retailed with a 600% mark-up somewhere around $29.99 USD.
In addition to the bar type of windlass tourniquet, there are also some that employ an internal windlass mechanism that uses a more user-friendly type of windlass that winds a cable to create compression.
Can Occlude Arterial Blood Flow: Archeologists have found Windlass tourniquets as old as the Roman Empire (753 BCE – 27 BCE). This suggests that this ancient design was popular in the Iron Age (1200 BCE – 586 BCE) and Before the Common Era (BCE) times, more typically known as BC. https://en.wikipedia.org/wiki/List_of_archaeological_periods_(Levant)
Manufacturing Expense: Windlass bar tourniquets are simple and very inexpensive to manufacture. This means they can be made quickly, and for less than $5 USD.
Only Locks On One End: To lock the windlass bar in place you must turn the bar 180 degrees to lock it in to its secured position. This means you may exceed the required compression needed for occlusion, and more importantly you cannot make precise adjustments to maintain occlusion pressure, which studies have shown decreases with time with windlass bar mechanisms.
Twisted Webbing: A contributor to the loss of occlusion pressure over time is that the internal webbing strip is twisted. This means that as the webbing reaches its maximum force load it also reaches maximum length, which may allow movement of the twisted webbing, contributing to the loss of occlusion pressure over time.
Unnatural Twisting Application Movement: Once the webbing is secured tightly around the limb in the correct position the user must twist the windlass bar with one-hand. While it is possible to use 1 or 2 hands, the movement can be a bit odd for the unfamiliar and will become increasingly difficult as forces increase.
Windlass Bar Breaks: It has been known for quite some time that the amount of force required to twist a bar has been known to break the windlass bar resulting in a catastrophic failure of the device. When you consider that if your tourniquets are supplied by a government organization it is highly likely that the lowest bidder, who makes their tourniquet with the least expensive materials available, supplied your tourniquet.
Elastic Band Tourniquets can take a few forms, with the most common being something that resembles an exercise band. These tourniquets are constructed from a single piece of elastic band material. They are stretched by the user around a limb, and wrapped several times until they stop the bleed.
Can Occlude Arterial Blood Flow: Elastic tourniquets generally have a very wide configuration, which allows it to provide compression at lower levels than non-pneumatic tourniquets.
Wide: Elastic tourniquets are wide so the predicted limb occlusion pressures are generally lower and almost always in the safe range.
Easy To Use: Elastic tourniquets are easy to use because the method of employment is simple.
Material Type and Strength: Since an elastic tourniquet is a single piece of elastic material any damage to the material may render the device ineffective. A simple tear, cut, or accidental snag could be disastrous.
Width: Wider is generally better when it comes to tourniquets up until a point. Since these devices are meant for limbs, there is a limited amount of space for the application of a tourniquet above the wound. Therefore, an elastic tourniquet could be too wide for proper application.
1-Hand Application: The nature of application of an elastic tourniquet may preclude the user from using only 1-hand to apply the tourniquet. A tourniquet that is not easy to apply one-handed has a significant gap in its usability.
Pneumatic Tourniquets can take a few forms, with the most common being something that resembles a blood pressure cuff. These tourniquets are constructed of a sleeve with Velcro. Inside the sleeve is a manually inflatable compartment that can be inflated by hand, or a machine automatically inflates another form. Manually inflated pneumatic tourniquets generally consist of a bulb that is squeezed to increase pressure inside the tubing until occlusion pressure is reached. The automatically inflated pneumatic tourniquets are connected to a machine that inflates and provides measurements of pressure automatically. Pneumatic tourniquets are generally only seen in hospitals, but there is one version that is currently approved by the CoTCCC.
Can Occlude Arterial Blood Flow: Pneumatic tourniquets generally have a very wide configuration, which allows it to provide compression at lower levels than non-pneumatic tourniquets.
Wide: Pneumatic tourniquets are wide so the predicted limb occlusion pressures are generally lower and almost always in the safe range.
Common, Easy To Use: Pneumatic tourniquets are commonly used in hospitals for orthopedic surgery. If you have had limb surgery under general anesthesia you’ve had a pneumatic tourniquet used on you during the procedure.
If punctured rendered ineffective: The inner tubing within the sleeve of a pneumatic tourniquet if punctured is rendered ineffective. Essentially, the materials are not as rugged to wear and tear.
Application Time: A pneumatic tourniquet may take longer to apply depending on the environment the injury happens, size of the user, size of the person rendering aid, how many times the bulb needs to be pumped, etc.
May Be Difficult To Apply High On Limb: A pneumatic tourniquet may be difficult to apply high up on a limb due to its size. Injuries sustained near junctional areas, but still on a limb may not allow the full width of the device to be applied above the wound.
Ratcheting Tourniquets can take a few forms, with the most common being a ratchet and ladder strap combination. These tourniquets are typically constructed of webbing without Velcro with one or two buckles or rings at one end. To use, you thread the free end of webbing through the 1 or 2 rings, and pull tight. If only 1 ring, it is likely that the tourniquet has Velcro because only 1 ring won’t keep the strap tight. The ratcheting tourniquets with 2 rings have the webbing weaved through them so that the 2 rings clamp down onto the webbing to secure the tourniquet in place. When the lever of the ratchet is lifted the ratcheting buckle teeth engage with the ladder strap teeth, adding more compression with each subsequent engagement until occlusion is reached. They typically cost more to manufacture because they require more precision and higher quality functionality. Ratcheting Tourniquets retail somewhere around $29.99 - $70.00 USD.
In addition to the ratchet and ladder strap style tourniquet, there are also ratcheting tourniquets that use a drum type of ratchet that is typically seen on cargo straps. This type of tourniquet was field tested by the U.S. Army Rangers in the early 2000’s. The rangers did not adopt the tourniquet, because there were reported issues with skin and clothing getting caught in the ratchet. However, the drum ratchet tourniquet is still sold in a few places for $36.66 USD.
Can Occlude Arterial Blood Flow: Ratchet Tourniquet efficacy has been proven by Doppler ultrasound and field-testing to fully occlude arterial blood flow.
Higher Quality Parts: The ratcheting buckle used with this style of tourniquet comes with higher manufacturing costs. While the device seems simple it is a extensively designed component, and takes excellent engineering skills to identify all of the correct inputs to process and create a fully functioning ratchet. The angle of the tooth engagement, thickness, ratio to ladder strap teeth, material properties, and the like require extensive design and testing time.
Self-Locking: Once engaged, the user has to apply a considerable amount of force to release the compression. This means it is unlikely that a bump or other force will release pressure. Once a ratchet tourniquet is on, its not coming off unless you want it off.
Precision Compression: The ratchet in conjunction with the ladder strap is a precision self-locking mechanism. This gives the tourniquet applier the means to make micro adjustments in compression. Furthermore, it allows the tourniquet compression to stay within the safe ranges of 300 – 500 mmHg. In comparison, windlass bar tourniquets can only be secured by doing a half turn (180 Degrees) of the bar, which may exceed the required pressure gradient.
Gross Motor Friendly: Ratcheting tourniquets utilize a simple method of operation. It is easy to simple lift the ratchet lever up & down.
Faster Application: Time is everything when it comes to bleeding. The faster you apply a tourniquet the more blood kept in the injured persons body, and the better their chance of survival. Because the ratchet is so easy and fast to use, the total TQ application is much faster than other types of tourniquets.
More Expensive: Ratcheting Medical Tourniquets are more expensive to purchase due to the higher production costs, and quality requirements. However, the price tag is typically only a few dollars as most ratchet tourniquets cost $30 something USD to purchase.
Repetitive Training Use: Ratchet tourniquets can typically be used for training without compromising its components. Regardless, applying force to any type of material will have a net effect over time. Users should be cognizant, that repetitive training use and maximum ratchet force application may cause some components to wear prematurely. This applies to all types of tourniquets even windlass, which are one time use.
Mechanical: Mechanical parts may have a higher incidence of malfunction, because there are more moving parts. If the manufacturer did not engineer to withstand elements like UV rays, salt water, or the like you will see rust and corrosion very quickly. It’s important that the ratchet springs, rivets, and base be made from a corrosion resistant stainless steel 304 or better. Using any other type of material, even if powder coated will lead to corrosion, rust, and malfunction once you have one scratch.
Material Bunching: Because the ratchet is riveted in place on the tourniquet to allow it to move along the length of the ladder strap the material below has to move along with the ratchet. This may bunch up the material.
The best tourniquet is the tourniquet that is right for you.