Identifying and choosing the best tourniquet for you can be a difficult task. Everyone has their favorites, and many resellers hold a biased or antiquated opinion because they are merely regurgitating what someone taught them, which was taught to them by someone who learned in a similar method. Furthermore, some resellers, companies, and committees have conflicts of interest such as financial that don’t have your best interest in mind so buyer beware if you are choosing a tourniquet solely based on its use or recommendation of so and so committee. Knowing the Do’s and Don’ts of Tourniquet selection is vital in helping you pick the best tourniquet for you.
Knowing yourself is the first step in the process of tourniquet selection. Ask yourself who you are, what you want from the tourniquet, and what, when, where, how, why are you possibly going to use the device. For Example:
- To identify if a tourniquet is single-use take a look at the label. If it is single-use there should be a medical device symbols with the number 2 inside a circle with a line through the center. This symbol indicates that the device is single-use, and is common with many windlass bar type tourniquets. You may find this on ratcheting tourniquets, but it is meant to indicate that if used in a real life situation to control bleeding it should be discarded afterwards.
2. Do I want least expensive?
Do I want highest quality?
- The least expensive tourniquet is not always the go-to tourniquet. Low prices are not common with high quality tourniquets. The typical price for a tourniquet typically runs between $30 and $40 USD. Tourniquets priced below the average may not be up to the quality standards you need in a tourniquet. Essentially, you get what you pay for, when you purchase the least expensive tourniquet.
3. Will I use this tourniquet only on land?
Is it possible I will use this tourniquet on land, water, or in the air?
- The environment you find yourself in could compromise your tourniquet effectiveness. For example, some military divers have found that applying a windlass bar tourniquet to a swimmer in distress is next to impossible. Therefore, choosing the right type of tourniquet whether a wrap, windlass, or ratcheting tourniquet is paramount for marine environments. Specific, marine-grade tourniquets may be the best option for maritime or rugged outdoor users.
4. What kind of quality management system does the tourniquet manufacturer use?
- Quality counts when it comes to the production of tourniquets. All Tourniquet manufacturers are required to have at a minimum ISO 9001 certification. In the USA, manufacturers must be ISO 9001, and have an FDA compliant quality management system (QMS) per 21 CFR 820. ISO 9001 uses a continuous improvement approach. Furthermore, in order to sell internationally it is preferred but not mandated by some countries that ISO 13485 be implemented, with some countries requiring ISO 13485 in order to sell at all. The aforementioned QMS is designed to ensure consistent production and traceability of all parts / components so that any issues can be corrected quickly. Typically, manufacturers who have ISO 13485 certification also have ISO 9001. Other quality standards such as RoHS2 or REACH compliance are also indicative of good manufacturing practices because they ensure specific harmful chemicals or processes are not used in tourniquet production.
5. Does the tourniquet manufacturer provide objective evidence of tourniquet efficacy to its customers online or its website?
- Doppler ultrasound studies / images are a great tool for validating that a tourniquet is effective. Other tools such as CHI Systems HapMed Tourniquet Trainer are also great tools for tourniquet testing. At a minimum a manufacturer should provide a Doppler ultrasound report on its homepage. Color images, and signed reports from a medical doctor and certified vein technician indicate that the test was conducted by an independent 3rd party with no conflict of interest in the results. Beware tourniquet manufacturers that only have Audio Doppler videos that they conducted in-house. Consider the source of the information and the personnel who conducted the test, as they are just as important as the test.
6. Can the Tourniquet be used 1-handed?
- If a limb tourniquet cannot be used with only one hand that should be a clue that you should look elsewhere. Limb tourniquets must be able to be applied one-handed, because you never know if you will have the use of both hands / arms. Wrap tourniquets typically require two hands to apply. While a wrap tourniquet may have a low price, that price comes at the cost of being able to rapidly apply the tourniquet single-handed. Relying on others for assistance or wishful thinking puts you the tourniquet user at a deficit. When selecting a tourniquet, the last thing you want is a tourniquet that doesn’t incorporate 1-hand application or self-application into its design.
7. How well does the tourniquet hold up to everyday elements such as sun, sand, dirt, UV rays, impact, or hot and cold temperatures?
- Quality always counts. Tourniquet material selection is crucial for longevity, and ruggedness. There are lightweight materials with great strength that are easily used. Nylon webbing is typically used in non-pneumatic tourniquets. Nylon webbing is strong, UV resistant, and holds up well to most elements. Thread is another consideration, especially for maritime use. Nylon thread while strong initially, loses its strength over time when exposed to UV rays, and marine environments. Therefore, tourniquet thread should be marine-grade if the device may be exposed to water or coastal areas. If Velcro is used is it the typical 2-part hook and loop Velcro or is it the Omni-tape all in one Velcro. Omni-tape sounds great in theory that is, until you are out in the surf or water, and realize that it lacks the holding power needed to stay connected. If you are going to use a tourniquet in or around the water you should select a marine-grade tourniquet.
8. Does the tourniquet manufacturer have any reviews on social-media?
- Reviews online and on social media are another tool for your tourniquet selection. While subjective, they do carry some weight. Legitimate reviews cannot always be identified, but more often than not, you can identify illegitimate reviews with simple inference. Sweeping generalizations, and hyperbole may be red flags that a review is illegitimate. Furthermore, investigate the social media profile of the user. If the profile has little to no information, friends, etc., its possible it's a fake profile.
9. Are there any testimonials on the tourniquet manufacturers website?
- Testimonials may also be a great tool for tourniquet selection. Look at the manufacturers website for any testimonials on their homepage or other pages online. This may be indicative of a good product if well-known people have endorsed a tourniquet. However, be careful that any endorsements seen are not bought and paid for by the company. The latter is difficult to ascertain though.
10. Who if any has endorsed this company / tourniquet?
- Endorsements from organizations are also something to consider. Many government entities won’t endorse products without a thorough review. That being said, beware committees or the like that may have financial conflicts of interest tied to their endorsements.
11. Are the tourniquets offered in configurations that align with my use?
- Where do you plan to use this tourniquet? Back packing, hiking, swimming, parachuting, law enforcement, military, boating, surfing, diving, etc., all present unique and different requirements from a tourniquet. Traditional tourniquets are not designed for saltwater use; therefore, you need an amphibious type tourniquet for specific maritime professional and water sport applications.
12. Can I carry the tourniquet in more than one configuration?
- How you carry your tourniquet can be just as crucial as the type of tourniquet you select. Generally, you want to carry your tourniquet in a neutral place where you can reach it with both arms. However, it is not always possible to carry a tourniquet this way. Selecting a tourniquet that has the versatility of being carried in several configurations provides you the user with increased functionality that can be tailored to your liking. In recent years, wearable technology has emerged in many industries and products. Tourniquets are no different. There are tourniquets that can be worn on your limbs such as ankle, or wrist, in addition to the traditional belt or torso carry configurations. When it comes to carry functionality, the more options you have the better because you may want to carry your tourniquet with you to a concert, or other social gathering, so having your TQ on your ankle would be more ideal and comfortable.
13. Does everyday carry of the tourniquet require the purchase of additional equipment?
- Traditional tourniquets require the user to purchase a holster, or pouch in order to carry the tourniquet on your gear. This means that your low-cost tourniquet is not really low-cost, and you’ve just been upsold. Tourniquet pouches normally cost just as much if not more than the tourniquet, therefore, by the time you are done purchasing your tourniquet you’ve paid more than double the initial tourniquet price. Not to mention, a TQ pouch takes up valuable real estate on your kit or equipment.
14. Are the instructions on the tourniquet?
- Instructions for Use (IFU) should be a must have for your tourniquet you decide to purchase. While you may know how to use your tourniquet, you may be the injured person, and the bystander who applies the tourniquet to you may not be trained. Instructions on the tourniquet provide the best chance of success of laypeople to correctly apply the tourniquet in an emergency. Of course, having trained personnel around is ideal, but emergency situations don’t afford us this luxury always. Tourniquets with instructions printed on the device are superior to those lacking instructions for use. Select a tourniquet with instructions over those without.
15. Is there a place to record the time of tourniquet application?
- A place to record the time of tourniquet application is a must have. This area allows you to use a sharpie marker or similar writing utensil or even blood to record the time the TQ was applied. Said time lets medical professionals know how long the tourniquet has been in place so they know how much time they have before the risk of complications may rise.
16. What mechanical advantage does the tourniquet use?
- The mechanical advantage used by a tourniquet directly relates to its efficacy. Windlass, Ratchets, and Wrap style tourniquets are all effective methods of limb compression to control bleeding. Selection really comes down to the user, and what they feel works best for them.
17. Does the mechanical advantage used lock and hold the compression needed, or is it known to lose compression over time?
- Some tourniquets may lose compression over time after applied. This has been noted in windlass bar tourniquets, and thus may require additional pressure to maintain occlusion.
18. Is the tourniquet application a gross motor skill?
- When under duress the human body activates its fight or flight response. This means that your senses are heightened, and you may be affected adversely with tunnel vision or loss of fine motor skills. A Tourniquets design must incorporate and be friendly to gross motor skill operation. Wrapping tourniquets offer a gross motor skill application, however, they are not able to be used 1 handed. Windlass bar type tourniquets can be used one-handed, but the twisting of the rod is an unnatural motion that can be compromised under duress, and is extremely difficult to impossible in the water.
19. Is it possible that the key tourniquet components could break?
- Windlass bars are prone to deformation under heavy amounts of force, and have been known to break while in-use. Ratcheting tourniquets are designed so that the ladder strap teeth will deform prior to the ratchet teeth so that if 1 tooth breaks the whole device is still operational and can continue to function.
20. If the military or similar organization uses the tourniquet, do they use a lowest bidder approach in their procurement process?
- The military uses a request for proposal system of equipment procurement. This procurement process typically selects the lowest bidder over the highest quality. If you’ve been in the military or around service members you’ve probably heard them speak of this fact. Military grade sounds great, until you realize that everything the military uses is made by the lowest bidder. Therefore, just because the military uses something doesn’t mean it’s the best. When selecting a tourniquet remember this information. The military has billions on dollars to spend on gear so it can by the least expensive equipment that is disposable. Conversely, you are likely not a billionaire, so you might want to look for the highest quality that comes at an affordable price other than something endorsed by a military committee or organization.
21. Wider is better when it comes to tourniquets:
- Limb Occlusion Pressure (LOP) is calculated with the following formula (limb circumference / TQ width) * 16.67 + 67 = LOP
The width of your tourniquet plays a huge role in its effectiveness. Traditional windlass bar combat tourniquets use a 1” (2.54 cm) webbing system sewn into a 1.5” (3.81 cm) sleeve with Velcro. This narrow width means it requires twice the pressure of a 2” (5.08 cm) wide tourniquet to reach occlusion. Furthermore, said higher amounts of pressure are more likely to cause complications due to tourniquet application. Choose a wider tourniquet that can be used 1-handed.
(Measure the width of the functional portion of the TQ, not the sleeve that may house said functional webbing of a non-pneumatic tourniquet).