Pvt. Shane Jones, left, 79th Basic Combat Training Brigade, practices applying the CAT Tourniquet to the wrist of Pvt. Daniel Evans during medical portion of Initial Entry Training, Fort Sill, OK, May 2006.
The Combat Application Tourniquet (CAT) is a small and lightweight tourniquet that completely occludes arterial blood flow in an extremity. The CAT is self-contained, and does not require a separate stick to tighten the tourniquet since the CAT uses a windlass to tighten its strap. The windlass can be locked in place once the bleeding has been stopped. The CAT can also be applied with one hand if necessary.
The CAT is a component of the Improved First Aid Kit (IFAK) and some group first aid packs. Because every individual Soldier is carrying a CAT, troops have ready access to the capability to provide Self-Aid/Buddy-Aid (SABA) to control and stop severe hemorrhage from a limb, the leading preventable cause of death on the battlefield or in natural disasters. When trained to use the CAT, soldiers are advised to remove it from its plastic package and keep it clean in the IFAK pouch, ready for instant use in an emergency.
The Combat Application Tourniquet (CAT) was named one of the Army’s 10 Greatest Inventions for 2005. Prior to the CAT, tourniquets that were available through the military’s supply system included a cravat-and-stick tourniquet that Soldiers were taught how to use in basic training, and the ineffective strap-and-buckle tourniquet that dated back to the American Civil War. A third tourniquet, called the one-handed tourniquet, was also available but, while it worked on arms, it did not work well on legs. In 2004 testing by the U.S. Army Institute of Surgical Research, the CAT performed at least as well as the best of other tourniquets and had the advantage of a shorter learning curve. As a result, both the Army and Marine Corps have adopted the CAT, assigned NSN 6515-01-521-7976.
Reports from field use in Iraq indicate a problem with the plastic windless rod of the CAT. Training is being modified to teach users to grasp the CAT in a way that will relieve stress on that part until an improved CAT becomes available.
Change in Tourniquet Doctrine
The adoption of the Combat Application Tourniquet (CAT) comes with a re-examination of the doctrine of the battlefield use of tourniquets. They had been discouraged since World War II when many soldiers suffered amputations due to tourniquets that were on for too long due to poor transportation and overloaded field hospital doctors. However, Army researchers found that the tourniquet is extremely effective in controlling otherwise fatal bleeding. Studies of Army experience found that seven to ten percent of battlefield deaths in Vietnam and Somalia were caused by profusely bleeding arm or leg wounds, and if a tourniquet had been used, the servicemember would most likely have survived.
The realization of the potential of the tourniquet, properly used, to save lives led to the revised doctrine: every servicemember should have a Combat Application Tourniquet (CAT) and be taught to use it. Reports from Iraq in 2005-2006 indicated that tourniquets became much more common than ever before. It became abnormal to see a severe extremity injury without a functional tourniquet in place when the casualty arrived at an Army Combat Support Hospital.
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