New tourniquet named one of Army's 10 greatest inventions
By Karen Fleming-Michael
June 22, 2006
WASHINGTON (Army News Service, June 22, 2006) – A tourniquet tested by Army researchers and recommended as the best to give to every deployed Soldier in Iraq and Afghanistan was honored June 21 as one of the Army’s 10 Greatest Inventions for 2005.
The Combat Application Tourniquet was tested along with eight other tourniquets in 2004 at the U.S. Army Institute of Surgical Research in San Antonio, Texas. The evaluation was prompted because many deploying Soldiers and units were purchasing tourniquets off the Internet, but the tourniquets’ effectiveness had not been determined. Once testing was complete, the institute’s researchers recommended the Combat Application Tourniquet be pushed to deployed troops to stop otherwise lethal blood loss.
“If USAISR (U.S. Army Institute of Surgical Research) hadn’t done the work, there still wouldn’t have been an effective tourniquet out there,” said Dr. Tom Walters of the institute that studies how to save the lives of Soldiers who are wounded in combat.
Up until that point, he added, the 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 strap-and-buckle tourniquet that dated back to the American Civil War. The latter “had always been known to be ineffective,” Walters said.
“The ISR’s efforts resulted in removing this tourniquet from the inventory and a removal of its national stock number.” A third tourniquet, called the one-handed tourniquet, was also available but, while it worked on arms, it didn’t work well on legs.
In the “tourniquet-off” held at the institute during the summer of 2004, 18 volunteers helped evaluate the nine tourniquets’ ability to cut off blood flow. When the results were in, the CAT, as well as two other tourniquets, came out on top. The CAT had a smaller learning curve than the others, so researchers recommended it for the Army. The Marine Corps has adopted it as well.
“Soldiers carry them on their body at all times when outside the wire,” said Col. John Holcomb, commander of the Institute for Surgical Research, who has been deployed eight times as a trauma surgeon in Iraq.
Getting a tourniquet to the troops was only part of the work the Institute of Surgical Research accomplished. The team also changed doctrine. During World War II, tourniquets were frequently used, but fell out of favor with doctors who were treating evacuated patients, said Walters, a muscle physiologist.
“By the time they saw Soldiers with tourniquets, the tourniquets had been on for a long time” and usually led to the limb being amputated, he said. “They (the doctors) had a real bias against them” and didn’t recommend them.
However, when Walters and Maj. Bob Mabry, the battalion surgeon for the 1st Special Forces Group, conducted a search of historical documents they found that tourniquets had gotten a bad rap not because they didn’t work, but because tourniquets lacked a champion.
“What typically happened is that every time there was a call for a change in doctrine (for increased tourniquet use), it would be at the end of a war. There would be a long lag until the next war, and everything would be forgotten. Then it would start all over again,” Walters said. “It was just an unending cycle, it seemed.”
Two studies helped to improve attitudes about tourniquets when both came to the same conclusion: Seven to 10 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 lived.
“This realization resulted in a real shift in people’s attitudes, so they decided tourniquets weren’t a bad thing at all and, in fact, everyone should have one and be taught to use it,” Walters said.
The lightweight CAT uses a windlass to tighten its strap and can be locked in place once the bleeding has been stopped. It can also be applied with one hand, though that capability hasn’t often been needed during current operations, Walters said.
“Based on all the information that I’ve been getting from the theater, the original scenario where someone is wounded in a firefight or urban warfare situation and they apply it to themselves just hasn’t been the way it’s been working out,” Walters said. “The vast majority of the wounds have been IEDs (improvised explosive devices) and usually a tourniquet has been put on by somebody else that didn’t get as injured.”
Not only did the institute recommend the CAT, it ended up sending one of its Soldiers, Sgt. 1st Class Dom Greydanus, to teach Special Operations forces how to use it. The institute also helped write tourniquet doctrine for the next common task manual.
“I just figured we would test them, give a recommendation and then we’d be done,” Walters said. “I didn’t anticipate that we’d be so much involved in the doctrinal changes and education. I’m usually dealing with laboratory rats, so this is why this isn’t anything I would have expected to be doing.”
Hundreds of thousands of the tourniquets have gone with Soldiers to the U.S. Central Command’s area of responsibility. Based on reports Walters receives from institute personnel who are deployed to Iraq, tourniquets are much more common than ever before.
“Tourniquets are being used on almost every extremity injury, and they are saving lives,” said Holcomb, who was recently deployed as a surgeon at the 10th Combat Support Hospital in Iraq. “Tourniquets were rarely seen early in the war, and now it’s abnormal to see a severe extremity injury without a functional tourniquet in place. There is no pre-hospital device deployed in this war that has saved more lives than tourniquets.”
The ceremony honoring the Army’s 10 Greatest Inventions was held in Crystal City, Va. Accepting honors for the CAT were Mark Esposito, inventor of the CAT, and Bill Howell, the principal assistant for acquisition, U.S. Army Medical Research and Materiel Command, the headquarters for the U.S. Army Institute of Surgical Research. All the inventions were showcased for Army leaders at the event.
The winning team for the CAT include:
• Dr. David G. Baer, U.S. Army Institute of Surgical Research;
• Col. John B. Holcomb, USAISR;
• Dr. Thomas J. Walters, USAISR;
• William H. Howell, U.S. Army Medical Research and Materiel Command;
• Dr. Joseph C. Wenke, USAISR;
• Sgt. 1st Class Dominique J. Greydanus, USAISR;
• Donald L. Parsons, U.S. Army Medical Department Center and School;
• Master Sgt. Ted C. Westmoreland II, HQ, U.S. Special Operations Command; and
• Mark Esposito, Phil Durango, LLC.
(Editor’s note: Karen Fleming-Michael writes for the U.S. Army Medical Research and Materiel Command Public Affairs Office.)
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