Here's a stateside civilian example of why it may be wise to have a good tourniquet and the training to use it. Note the blood on the sidewalk; early reports say "I saw people's legs blown off".

Double Explosion at Boston Marathon

I have used a tourniquet a number of times in non-combat situations. Once was for a gun shot wound, one was for a suicide attempt and the remainder were for injuries of non-violent causations.

Tourniquets one of those things that when you need one, you really need one! As many have mentions CAT and SOF-T tourniquets are the standard for commercial tourniquets. You can't go wrong with either one, the only makor difference is the SOF-T has a metal windlass and the CAT's is plastic. That being said, I don't carry either of those.

My favorite tourniquet is the McMillian Tourniquet. Having used a all of the tourniquets mentioned in this post on a real patient (except the SOF-T, which I have used in training) the McMillian Tourniquet is as easy to use as the others and is much more durable than the others.

Now, the tourniquet I carry the most offen is the TK-4L, it is a pretty simple elastic design but it actually works. I have heard and read a lot of complaints about the TK-4 and the TK-4L but very few of those who don't like them have actually used them or tested them in a realistic tests. I would rather have a CAT or a McMillian, but you can't beat the TK-4L for size and price. These are cheap and compact enough to keep in just about any kit.

An article about tourniquets and the Boston Maraton Bombing...



"Without Tourniquets, Many Wouldn't Have Survived" Firehouse.com

Same here. I have CATs and SOFTT-Wides in my dedicated kits but the TK4 is hard to beat for ultra compactness. I have some trouble applying a SWAT-T with one hand, and I suspect it would be tougher with blood on everything. I find the TK4 to be easier to apply one handed.

Thank you, for a most informative and enlightening post. One has to wonder, in view of the massive casualties in Waco and Boston, if at some point it wasn't necessary to resort to improvised Ts?

Several acconts in the media referred to people in Boston using belts and other items to improvise tourniquets. From the New York Times article "Doctors Saved Lives, if Not Legs, in Boston":


The organizers of the Boston Marathon deserve great credit for being prepared. On some other forums it has been noted that because of the huge number of racers and spectators involved they always treat this event as a Mass Casualty Incident in their pre-race preparations, with a large medical presence standing by. While the preparations were in expectation of heat exhaustion, heat stroke, dehydration, etc, they quickly transitioned to handling trauma. They also had a robust ICS structure in place to run the event. All that paid off when the unexpected occured.

The reason I asked the question is that,even in the rather small scale events in which I have been involved, I have seen all the dedicated first aid items exhausted, making improvisation the order of the day. Improv can often be a necessary strategy.

It is nice to have the right materials, but you should always know how to make do with what you have at hand. That goes for first aid or survival.

I read reports that the neck lanyards holding ID credentials were used by several first responders

As was noted in the article I posted upthread, most of the tourniquets used in Boston were, at least initially, improvised. One of the reasons I think that classes such as WFR are so valuable is that they stress improv and thinking outside the box.
And that is exactly why pre-planning and big training exercises are so usefull, and why it paid off big time in Boston. One key part of pre-planning for MCI is to develop (and practice) a system of triage and dispatch, so that the injured are spread out over a number of hospitals, to reduce the odds that any one ER becomes overwhelmed. From Emergency Planning, Speed Saved Lives After the Boston Marathon Attack:

One of my favorite quotes: "Plans are worthless.....but planning is essential" - General Dwight Eisenhower
You can never know exactly what is going to happen, so things will never go exactly as you planned. But it is usually much easier to modify an existing plan to fit new circustances, than to create a plan totally on the fly under extreme stress.