CAT or SOFT-W tourniquets

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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CAT or SOFT-W tourniquets

Post by taipan821 » Wed Sep 07, 2016 2:12 am

Hello all

currently looking into turning my trauma bag into more of a response kit.

I'm trying to keep it similar to the response kits used at work, of which work uses the CAT and SOFt-W tourniquets

which one is better?
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Re: CAT or SOFT-W tourniquets

Post by Dabster » Wed Sep 07, 2016 11:03 am

I have never heard of the SOFt-W but a bit of Googling indicates it is built of sterner stuff than the CAT but works about the same. I am intrigued.
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Re: CAT or SOFT-W tourniquets

Post by norcalprep » Wed Sep 07, 2016 4:02 pm

As I understand it, any of the top-tier stuff is all good, just depends on your training. You really can't go wrong.

Personal preference: my wife and I pack the SOFTT-W for the wide strap feature (the -W indicates the wide version). Supposedly the wider the strap the more comfortable it would be. Putting on a TQ is going to be very very painful, no matter what, but can you imagine how painful a very thin tourniquet, like the RATS, would be? It's like pinching off your limb.

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Re: CAT or SOFT-W tourniquets

Post by JayceSlayn » Wed Sep 07, 2016 10:42 pm

I have the SOFTT-W in my kits. I think both will get the job done, but the wider strap theory (i.e. less potential for collateral trauma at the tourniquet site) sounds like a good idea to me.
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Re: CAT or SOFT-W tourniquets

Post by ManInBlack316 » Wed Sep 07, 2016 11:21 pm

That's like ARvsAK bro :ohdear:

I prefer the CAT because it's what I used in training and therefore have my hours behind and will be more proficient using that than a SOFTT-W, but that's my own personal situation. I like the CAT because I can put it on one handed, I don't know much about the SOFTT-W and haven't yet held one in my hands. The trick to using a CAT on something like a leg injury is not to try to lift up on the buckle to keep the Velcro from sticking to itself, but instead try grasping the windlass in one hand and pulling the strap with the other, I find this helps me it snag free.
Just to throw a monkey wrench into the equation, there is also the SWAT-T, but I feel that it's better as a pressure bandage that also can be a TQ, maybe to also add more TQs in bags where you might have just two because of the cost of the CAT and SOFTT-W.

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Re: CAT or SOFT-W tourniquets

Post by IANMCDEVITT » Sun Sep 11, 2016 4:08 am

Use whatever you are comfortable AND have trained with......if it's a CAT , use the CAT if it's your "work" TQ. Don't project that a product sucks until you've bought one, tried it in training, and found it doesn't work for you. I use the RATS, there are other units here, deployed, that use it often.....NO, you won't read that on the internet. Basically because those units that use it? Are too busy saving our asses to play on a forum. There is no quicker, more assuredly effective tournaquet that will stop that bleeding so that you may either continue the fight, or self extricate, then the RATS. The SOF-T wide is great. I'd take it over a CAT. One of the reasons is that there are literally hundreds of thousands of Chinese copies all over the world of the CAT and when you are overseas, you often see only the copies. I've also RECENTLY SEEN them get caught up in inexperienced soldiers clothes on application or get twisted, and haven't been put on effectively. I've also seen them attempt to apply to an upper arm injury, and many of the soldiers carry their phones in a uniform pocket at the bicep, therefore the TQ is not applied effectively........figure you have ONE CHANCE TO COME OUT OF THE FIGHT ALIVE.......there's the RATS.

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Re: CAT or SOFT-W tourniquets

Post by IANMCDEVITT » Sun Sep 11, 2016 4:26 am

OK, sorry, terrible connection. So.....the criticism is that the thinness of the RATS is to painful?......alright, my question to you is have you ever seen the seconds after someone has either a partial or complete amputation ? Different people react different ways. I've seen people continue to shoot back, I've seen people drop their weapon and grasp the injured limb, I've seen people mad, start swearing, and fight back harder, I've seen people look in shock at the injury.......what I'm saying is, the REASON YOUR PUTTING ON THE FRIGGIN TOURNIQUET is because your still under real threat ad basically WHO GIVES A SHIT IF ITS PAINFUL..........Your correct, the wider the tourniquet, the more "comfortable" it MAY be.......In real life? I need something on that's going to work, so I can get back on my weapon, see the other injured, or pick that dude up and RUN.

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Re: CAT or SOFT-W tourniquets

Post by taipan821 » Sun Sep 11, 2016 5:00 am

IANMCDEVITT, while you have a good point I might need to explain something.

Australian Ambulance service, not combat service (sorry for any confusion). I've never seen a RATS or a SWAT-T and I've only used a MAT once in training so I am eliminating those choices. I also am concern about aggravating/secondary injuries at the tourniquet site due to proximity to hospital. But regardless of this you have made 2 good points for the SOF-T.

1. You have experience with traumatic injuries that require early intervention using a tourniquet and you recommend the SOF-T and the RATS over other products

2. The CAT is copied, which then pulls into question the build quality of a random CAT tourniquet, the SOF-TW I played with was all metal where as my CAT is plastic

Thanks for the info, and if you have any other suggestions I'm happy to hear them
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Re: CAT or SOFT-W tourniquets

Post by IANMCDEVITT » Sun Sep 11, 2016 6:10 am

Yes. Thanks for explaining. I think there's a common understanding. See, the REASON, tourniquets have come back into "vogue" is due to the research from BATTLEFIELD MEDICINE.....and it seems mAny civilian services have taken their use and efficacy OUT OF THE CONTEXT of TCCC......so you made a point to tell me the Ausy Ambulance deals with no Battlefield Medicine. Is the threat level high where you are? Are you on a SWAT Team ? PSD ?.......if it's civilian pre-hospital EMS, why use a tourniquet? Why risk any nerve injury when you are safe and have the resources to use the proper steps, NOT UNDER FIRE to stop bleeding....I don't understand ? And what do you mean by you don't want to exacerbate any injury ? Distal to the tourniquet placement ? Proximal to its placement ? Fill me in.... I want to learn also. By the way, that MAT sucks. Throw them out. They are Chinese made and suck.....ok, teach me man.

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Re: CAT or SOFT-W tourniquets

Post by taipan821 » Sun Sep 11, 2016 6:35 am

IANMCDEVITT wrote:Yes. Thanks for explaining. I think there's a common understanding. See, the REASON, tourniquets have come back into "vogue" is due to the research from BATTLEFIELD MEDICINE.....and it seems mAny civilian services have taken their use and efficacy OUT OF THE CONTEXT of TCCC......so you made a point to tell me the Ausy Ambulance deals with no Battlefield Medicine. Is the threat level high where you are? Are you on a SWAT Team ? PSD ?.......if it's civilian pre-hospital EMS, why use a tourniquet? Why risk any nerve injury when you are safe and have the resources to use the proper steps, NOT UNDER FIRE to stop bleeding....I don't understand ? And what do you mean by you don't want to exacerbate any injury ? Distal to the tourniquet placement ? Proximal to its placement ? Fill me in.... I want to learn also. By the way, that MAT sucks. Throw them out. They are Chinese made and suck.....ok, teach me man.
Ok, let me try. Yes, tourniquets are back in vogue due to battlefield medicine, as is battle dressings (Emergency Bandage). For my state ambulance service (there are 6 Ambulance services in Australia) tourniquets are for uncontrollable haemorrhage due to amputation, that's all they are to be used for. Australian laws (especially gun laws) are more restrictive, so we do not have mass shootings, we do not have semiauto weapons, we do not have concealed carry, open carry etc so gun-related injuries are extremely few and far between. The ambulance service does not play an active support role with the Police Special units, we will stage at a safe distance and wait for them to make the area safe before entering. Our response times also vary depending on the distance from station. Time from injury to Major Trauma Center can take as little as 30 mins (10 min response, 10 mins loading, 10mins transport) to several hours (3 hours to scene, 1 hour stabilising, 3 hour drive back to hospital), that's just prehospital care in Australia. If the limb can be saved we want to minimise damage to stump, and we may (especially with road vehicle crashes) have to place the tourniquet over another, less critical injury, you just don't know.

And I agree with your views on the MAT, it takes to long to apply and the strap just causes further injury to placement site.

Hope that helps
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Re: CAT or SOFT-W tourniquets

Post by IANMCDEVITT » Sun Sep 11, 2016 8:03 am

Thanks for the info. That's actually one of the rare places I've never worked or visited....is there any way you can just use your steps to control bleeding along with hemostatics to control the bleeding instead of immediately jumping to a TQ ?......See, if you have a conscious patient, in a safe area, there is an extremely large percentage of the time that bleeds can be controlled with just your normal steps.....direct pressure, pressure dressing, initial pressure point, elevation, hemostatics, wound packing.......See, I use the TQ because I have too. Either someone is trying to kill me, my patients, or both of us, or I have multiple patients with Multisystem trauma. Either way, with your extended transport time (3 hours possibly), the tourniquet must be reduced. You'd be doing yourself a favor to use your steps.....but, like I say, I 've never been there. If you care too, go to war tems. On Facebook, you can see why I have to use the TQ's.

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Re: CAT or SOFT-W tourniquets

Post by SteelWolf » Sun Sep 11, 2016 12:46 pm

CAT vs SOFT-W. A long standing debate. Both are combat proven, both have pro's and con's.

CAT: Lighter, less expensive, easy to apply one handed, even under extreme stress, to yourself. The Gen 7 has a single routing buckle, and the windlass is VERY beefy. If I had to apply a TQ to myself, it would be a CAT. That's what I sell and stock in my IFAKs on our webstore. We carry them on all of our Ambulances and Fire Apparatus at work.

SOTF-W: More expensive, somewhat (slightly) heavier. Often very difficult to self apply one handed. A wider band equates to theoretically better performance. But an extra 1/2 won't make that much of a difference. More steps are involved in securing the TQ. None of these are BAD, this is also a very proven and effective TQ, but this TQ does require a bit more practice to get proficient.

As for proper hemorrhage control? Follow your local protocols. As for my agency? If the bleed is immediately life threatening, and is amenable to a TQ, use a TQ. Every time. If it is not amenable to a TQ, (Junctional / Truncal, etc), use wound packing with or without hemostatic agent, and junctional pressure (either grab an extra fire fighter or use a pre made device such as the JETT, etc). We fairly routinely use TQs at my agency, especially on shootings / stabbings and industrial accidents. Also, in many response areas, I am the only Paramedic on the call, so if we can slap a TQ on and let me do other things, it works well for us. I recently had a guy lop most of his left hand off while cutting wood. We had a 20 minute response, the volunteer FD applied a TQ before we arrived, once on scene, I was free to provide other care, such as resuscitation, monitoring and pain management, instead of dealing with direct pressure, etc, for a 95 minute transport to the Level 1. (No helicopter due to weather so... good times that was).

As for Nerve Damage, this is a very unlikely outcome. And, at the end of the day, Life over Limb. I would rather have a slight Neuropathy than be dead.
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Re: CAT or SOFT-W tourniquets

Post by norcalprep » Sun Sep 11, 2016 1:33 pm

IANMCDEVITT wrote:Use whatever you are comfortable AND have trained with......if it's a CAT , use the CAT if it's your "work" TQ. Don't project that a product sucks until you've bought one, tried it in training, and found it doesn't work for you. I use the RATS, there are other units here, deployed, that use it often.....NO, you won't read that on the internet. Basically because those units that use it? Are too busy saving our asses to play on a forum. There is no quicker, more assuredly effective tournaquet that will stop that bleeding so that you may either continue the fight, or self extricate, then the RATS. The SOF-T wide is great. I'd take it over a CAT. One of the reasons is that there are literally hundreds of thousands of Chinese copies all over the world of the CAT and when you are overseas, you often see only the copies. I've also RECENTLY SEEN them get caught up in inexperienced soldiers clothes on application or get twisted, and haven't been put on effectively. I've also seen them attempt to apply to an upper arm injury, and many of the soldiers carry their phones in a uniform pocket at the bicep, therefore the TQ is not applied effectively........figure you have ONE CHANCE TO COME OUT OF THE FIGHT ALIVE.......there's the RATS.
IANMCDEVITT wrote:OK, sorry, terrible connection. So.....the criticism is that the thinness of the RATS is to painful?......alright, my question to you is have you ever seen the seconds after someone has either a partial or complete amputation ? Different people react different ways. I've seen people continue to shoot back, I've seen people drop their weapon and grasp the injured limb, I've seen people mad, start swearing, and fight back harder, I've seen people look in shock at the injury.......what I'm saying is, the REASON YOUR PUTTING ON THE FRIGGIN TOURNIQUET is because your still under real threat ad basically WHO GIVES A SHIT IF ITS PAINFUL..........Your correct, the wider the tourniquet, the more "comfortable" it MAY be.......In real life? I need something on that's going to work, so I can get back on my weapon, see the other injured, or pick that dude up and RUN.
You're right. I made an assumption, and I am sorry I did so.

In my defense, I didn't question its effectiveness or project that it sucks; I said that "Putting on a TQ is going to be very very painful, no matter what" and then go on and assume that RATS would be even more painful. I was trying to find an opposite end of the spectrum between wide and thin, and used the RATS as the example of thin. I didn't mean to denigrate the RATS and imply that it sucks or is less effective in its role as a TQ.


In a combat situation, I certainly agree that the medical decision to apply it should not be swayed by whether or not it's painful. However, when not in a combat situation, I would argue that the painfulness of one product relative to the painfulness of another product can be a valid point of consideration when making an administrative decision of which TQ to stock and acquire training.

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Re: CAT or SOFT-W tourniquets

Post by taipan821 » Sun Sep 11, 2016 5:13 pm

IANMCDEVITT wrote:Thanks for the info. That's actually one of the rare places I've never worked or visited....is there any way you can just use your steps to control bleeding along with hemostatics to control the bleeding instead of immediately jumping to a TQ ?

Either way, with your extended transport time (3 hours possibly), the tourniquet must be reduced.
forget haemostatics, they aren't cleared for use in Australia yet (hasn't passed regulation process)

Here's some links for you, taken from the Queensland Ambulance Service Clinical Practice Procedures and Clinical Practice Guidelines

https://ambulance.qld.gov.au/docs/clini ... et_CAT.pdf QAS CPP for the CAT
https://ambulance.qld.gov.au/docs/clini ... OFTT_W.pdf QAS CPP for the SOFT-W
https://ambulance.qld.gov.au/docs/clini ... ontrol.pdf QAS CPM for haemorrhage control

In a nutshell TQs are to be applied when there is an uncontrolled haemorrhage that can not be controlled by other means (direct and indirect pressure) or when there is a lack of resources (single officer, multiple casualties etc) when the TQ is applied time and date is noted, the TQ is not taken off until the patient has arrived at a suitable trauma center
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Re: CAT or SOFT-W tourniquets

Post by KnifeStyle » Sun Sep 11, 2016 6:17 pm

In a TCCC course recently the instructors has us run both these tourniquets for the stated reasons, he initially was a SOFT guy but has switched to CATs for self-application speed because even as a seasoned medic he was having snags self-applying and getting the shackles locked. The SOFT still works fantastically if you're applying it to another, both tourniquets are the only two that have been approved for TCCC use. Currently I'm price hunting and buying orange CATs, but if I were given a SOFT-W I'd still throw it in a kit.
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Re: CAT or SOFT-W tourniquets

Post by IANMCDEVITT » Sun Sep 11, 2016 10:33 pm

Aaaaaa, to each his own. We don't need any approval from committee's, thank God. I take the advice of the folks that are currently working in the AO on what has worked for them and then base my treatment off that and what's available before I rotate in. Taipan, grab a RATS and see how it works. Remember, TCCC and Battlefield Medicine is based on Self-aid first and after very little practice, that RATS goes on in about 5 seconds, then your back in the fight.

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Re: CAT or SOFT-W tourniquets

Post by JIM » Sat Sep 17, 2016 11:58 am

IANMCDEVITT wrote:Aaaaaa, to each his own. We don't need any approval from committee's, thank God. I take the advice of the folks that are currently working in the AO on what has worked for them and then base my treatment off that and what's available before I rotate in. Taipan, grab a RATS and see how it works. Remember, TCCC and Battlefield Medicine is based on Self-aid first and after very little practice, that RATS goes on in about 5 seconds, then your back in the fight.
Hi Ian, I tried various tq's cat, all soft versions, swat,mat,rats but the RATS didn't seem to me to have a positive closure.

Any issues with these getting loose when dragging a casualty to safety?
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Re: CAT or SOFT-W tourniquets

Post by IANMCDEVITT » Sat Sep 17, 2016 12:43 pm

Good question. Nope. I have not.....and we the ease and speed of use as a TRUE one handed TQ, I have been teaching Tier 1 dudes to use them and carry them. As always, we recheck placement and tightness with every patient movement. I've even timed my regular soldiers because they have CATs, CAT application time ranged from 17-25 seconds. The RATS is like 5 seconds and feels like you could snap off a fire hydrant with it.

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Re: CAT or SOFT-W tourniquets

Post by jdev » Tue Sep 20, 2016 6:15 pm

IANMCDEVITT wrote:Good question. Nope. I have not.....and we the ease and speed of use as a TRUE one handed TQ, I have been teaching Tier 1 dudes to use them and carry them. As always, we recheck placement and tightness with every patient movement. I've even timed my regular soldiers because they have CATs, CAT application time ranged from 17-25 seconds. The RATS is like 5 seconds and feels like you could snap off a fire hydrant with it.
You're the first person I've heard who a) has first-hand experience with the RAT, and b) has something positive to say about it. I'm intrigued now; it just didn't look very secure or effective to me, but I may have to give it another look.

I work for a fairly busy city/county EMS system (we ran 115,000 runs last year), with a good bit of trauma. I work shootings regularly, though most shootings are 15 minutes or less of code-3 driving from a level 1 trauma center. We issue CATs for regular use on the truck, and have a mix of CATs and SOFT-T W TQs in our active aggressor/active shooter gear (we follow the Rescue Task Force concept for those who are familiar, with tactical armor with rifle plates and more "tactical" med kits/gear for deployment on those instances). I've used CATs twice; both on motorcycle wrecks where the patient had mangled legs. I've also trained a bit with the SOFT-T W. After using both, I'm personally more of a fan of the SOFT-T W. They have been a lot easier to get applied properly under stress (applying on another person; I have zero personal experience with needing to apply one to myself) than the CATs. I like the buckle feature, that doesn't require the velcro to be wrapped all the way (or most of the way) back around to get enough stability to engage the windlass. I had one instance of a CAT trying to pop off when the windlass was tightened because there wasn't enough velcro engaged to hold it (guy was in the back of the truck on a long spine board, covered in blood (did anybody mention just how slick blood is?), and was a fairly stout dude to begin with, and I was trying to apply it to his upper leg). I was able to reapply it with good effect, but it wasted time.

So that's just been my experience with them in a fairly busy city EMS environment. Take it for what it's worth. Whichever you choose, get a trainer version, and PRACTICE. If you have to use it for real, it may just be the worst day of your life, with it getting worse by the second. You don't want the further added stress of unfamiliar equipment added to the mix.

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Re: CAT or SOFT-W tourniquets

Post by jdev » Tue Sep 20, 2016 6:18 pm

IANMCDEVITT wrote:Thanks for the info. That's actually one of the rare places I've never worked or visited....is there any way you can just use your steps to control bleeding along with hemostatics to control the bleeding instead of immediately jumping to a TQ ?......See, if you have a conscious patient, in a safe area, there is an extremely large percentage of the time that bleeds can be controlled with just your normal steps.....direct pressure, pressure dressing, initial pressure point, elevation, hemostatics, wound packing.......See, I use the TQ because I have too. Either someone is trying to kill me, my patients, or both of us, or I have multiple patients with Multisystem trauma. Either way, with your extended transport time (3 hours possibly), the tourniquet must be reduced. You'd be doing yourself a favor to use your steps.....but, like I say, I 've never been there. If you care too, go to war tems. On Facebook, you can see why I have to use the TQ's.
Just a side note on this: Hemostatics and wound packing is considered outside the scope of practice for pre-hospital EMS providers in some places--my place of employment included. Not just for BLS providers, either; ALS included.

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