BULLSEYE: Combat Application Tourniquet CAT

By David Jones

Wear an $800 vest, carry a $900 AED, and have a $25 C.A.T.® ready to go!

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It wasn’t very long ago that we were taught to use a tourniquet only as a last resort in order to stop blood loss from an extremity wound. The fear was that the tourniquet would cause irreparable damage to the limb. New evidence from recent military operations in Iraq and Afghanistan, as well as civilian bloodless extremity surgeries, has proven otherwise. The new theory is that it can take longer than two hours before a tourniquet can cause damage beyond repair. The vast majority of people in the United States can be transported to medical facilities within two hours but can bleed to death from a severed arterial in just a few minutes. Extremity blood loss is the number one cause of “most preventable death” that can be addressed at the self-aid level.

Law enforcement officers, like their military counterparts, operate in a higher risk environment than most civilian occupations. One of these elevated risk factors is exposure to gunfire. Today, most departments recognize this threat and issue body armor to minimize the risk to their officer’s torso area. An area often neglected is an officer’s extremities (arms and legs). The blood lost from a bullet wound to the chest is the same blood lost from a severed femoral artery. Dead is dead!
As police trainers and firearms instructors, we know that a greater than average number of officers are hit in the extremities. This is in part due to target fixation by the suspect focusing on the officer’s weapon (shooting where you look) as well as hitting portions of the officer that are exposed from behind cover. This was demonstrated during the infamous 1986 Miami shootout when three of the eight FBI agents involved were each struck in the arm. This is why agencies train for weak hand shooting now.

While direct pressure is usually the first method applied to stop bleeding, it is not effective in the middle of a gun battle. An officer needs his hands free to operate his weapons platform (to avoid getting shot again). The officer may be pinned down behind cover for some time as medical assistance will not respond until the scene is secure. A self-applied tourniquet will keep vital blood pumping to his/her brain and prevent him/her from losing consciousness (a bad thing in a gun fight).

The practice of front-line law enforcement officers employing tourniquets has been gaining significant traction in recent years. It has been endorsed by the American College of Surgeons and the FBI after a joint study following the Newtown School shooting. It has also been endorsed by the Federal Emergency Management Agency (FEMA) and the National Tactical Officers Association (NTOA). One of the most significant endorsements for front-line police officers to carry tourniquets was from Boston Police Commissioner Ed Davis at the 2013 International Association of the Chiefs of Police (IACP) conference. Chief Davis said, “The use of tourniquets is extremely important in our business. We have equipped all Boston Police officers with them.” This was immediately after the Boston Marathon Bombing, which resulted in the amputated legs of several victims.

The tourniquet of choice for many law enforcement agencies is the Combat Application Tourniquet® (C.A.T.®). The C.A.T.® is a small, lightweight, one-handed tourniquet that completely occludes arterial blood flow in an extremity. This is the standard tourniquet issued to individual U.S. military personnel. Just as with any other pieces of duty gear, the C.A.T.® must be readily accessible by the officer with either hand without looking. When the officer needs it, he really needs it! Many officers carry the C.A.T.® in a pants cargo pocket while others keep one attached to their body armor inside their uniform shirts. Many tactical officers like to keep one on their turn-out gear. Some officers are now wearing them directly on their duty belt in a kydex or nylon pouch, such as the ones offered by 1110gear.com. Having a tourniquet on every officer’s person is essential, especially while on foot patrol or conducting traffic stops. Having one in the trunk of your vehicle while you are pinned down by hostile fire inside a school or shopping mall is a bad idea.

Since 2006, all U.S. military personnel who have deployed to hostile locations have been trained on the use of the C.A.T.® Since many law enforcement officers also serve in the National Guard and military Reserves and a high number of veterans transition into police work, the use of the tourniquet is becoming significantly more common. As the tourniquet would likely be employed during firearms related activities, training should be incorporated to get officers thinking about how and when they would apply it. Common thinking would place it along the lines of the tactical reload (lull in shooting and have a solid piece of cover). Another scenario would place it in the active shooter realm where an officer is down (wounded) and protocol dictates that additional officers proceed to the active shooter, leaving the downed officer behind. The tourniquet would allow the downed officer the ability to render aid to himself.

Officers should practice placing the tourniquet on both the upper and lower extremity. This is why it is essential that a single-hand application tourniquet such as the C.A.T.® be used. It is surprising how quickly a tourniquet can be applied with minimal practice if carried in a dedicated location. This method has been attributed to saving thousands of U.S. soldiers’ lives during the wars in Iraq and Afghanistan. In addition to preventing loss of life to blood loss, it also allows the officer to ‘stay in the fight’ and potentially win the battle (stopping the bad guy from harming others).
In today’s post 9/11 world where active shootings and terrorist bombings are a real threat and the myths of tourniquets causing limb damage have been disproven, many departments and individual officers are starting to carry them. An officer wears an $800 vest that needs to be replaced every five years and carries a $900 AED in his patrol car. Having a $25 C.A.T.® on his person (that does not have an expiration date) just makes sense. As law enforcement trainers, it is our responsibility to ensure the officers know how to use the tools available to “Shoot, Move, Communicate and Survive.” Just as we incorporate the ballistic vest into firearms training (transition from the Weaver stance to the modified Isosceles to project the vest toward the enemy), we should incorporate the tourniquet into tactical training.

Tourniquets save lives! Let’s make sure the officers who carry them know how to use them when seconds count. PM

David Jones is a retired Special Agent with the Department of Defense and is currently serving as the Emergency Manager/Police Officer at the University of Wisconsin – Green Bay Police Department. He can be reached at djones1560@gmail.com.

Captions:

  1. The C.A.T. ® can be carried on your duty belt, attached to your outer vest cover, clipped to your rifle’s sling, etc.
  2. Tourniquets are designed for single-hand operation by the wounded officer himself.
  3. Officers may be pinned down and must rely on their own ability to stem the flow of blood from an extremity.
  4. Tourniquets may save victims’ lives in active shooter situations when immediate medical attention is not available due to an unsecured scene.
  5. Applying a C.A.T.® yourself allows a cover officer to stay in the fight.

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