As we’ve previously stated before the best tourniquet is the tourniquet that is right for you. If you feel more comfortable with a particular type, or brand of tourniquet, that is the best tourniquet for you, just ensure you periodically review new innovations, and thoroughly test all types of tourniquets. Currently, there are four primary types of tourniquets on the market. Depending on whom you talk to about tourniquets, you will get a wide array of opinions and recommendations. Always consider the source of the information, identify any conflicts of interest, and take the knowledge gained from that interaction and apply whatever percentage works best for you. In addition, take into consideration that it is very possible that social media accounts that look like actual people, may in fact be marketing teams or company representatives posing as external independent people. So do your research. For the purpose of this article we will only discuss the ratcheting tourniquet type. The other types will be written about in follow-on articles.
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. If you think the Pro’s outweigh the Con’s give a ratcheting tourniquet a try.