Ratcheting and Mechanical Tourniquets: Different Systems for Bleeding Control

Beyond the common windlass system, other mechanical tourniquets offer different approaches to achieving arterial occlusion. We will explore ratcheting and other mechanical systems, covering the remaining tourniquets on the equipment list. Including these less common but effective devices solidifies this collection's status as a truly encyclopedic and authoritative resource.

The Ratchet System: Understanding the RMT-T

The Ratcheting Medical Tourniquet - Tactical (RMT-T) from m2 inc. utilizes a different mechanical principle than windlass-style devices. Instead of a rod that is twisted, the RMT-T employs a ratcheting buckle and ladder strap system, similar to what might be found on a ski boot or zip tie.  

This system offers a different user experience. To apply pressure, the user simply engages the buckle and pulls on the strap, with each pull tightening the device by one "click" of the ratchet. This can be intuitive for many users and allows for very fine, incremental adjustments in pressure. The lack of a windlass means there is one less component to manipulate, which can be an advantage in certain situations, particularly in close quarters.  

However, there are trade-offs. Some users find it more difficult to generate the same amount of occluding force as with a windlass, and the release mechanism can be less intuitive under stress than simply unwrapping a windlass strap. Like any piece of life-saving equipment, proficiency with the RMT-T requires dedicated training on its specific mechanics.

Pros and Cons of the RMT-T

• Pros:

  • Intuitive Operation: The ratcheting mechanism is simple to understand and requires only gross motor skills, which is an advantage under stress.  

  • Precise Pressure: Allows for fine, micro-adjustments in pressure, and the audible "click" confirms activation.  

  • Compact and Durable: The tactical version is one of the smallest and lightest tourniquets, and its rugged design has been proven since 2002.  

• Cons:

  • Difficult One-Handed Application: Users report that applying it to one's own arm can be difficult, sometimes requiring the use of teeth to pull the strap tight.  

  • Bulky When Folded: The ratchet mechanism can make the tourniquet bulky when folded, making it difficult to fit in standard pouches.  

  • Potential for Binding: Like any ratchet strap, there is a potential for the strap to bind under the mechanism, especially for an untrained user.  

The TMT: A Hybrid Approach

The Tactical Mechanical Tourniquet (TMT) from Tactical Medical Solutions represents a hybrid design that seeks to combine the best features of different systems. It incorporates a wider band for broader compression and a unique mechanical advantage system that is different from a traditional windlass.  

The TMT's tightening mechanism provides audible clicks as it is tightened, giving the user clear feedback that pressure is increasing. It is designed to be easy to operate with one hand and to be applied in just a few seconds. The TMT is another example of the constant innovation in the field of hemorrhage control, as designers seek to create devices that are faster, more effective, and easier to use under extreme duress.  

Pros and Cons of the TMT

• Pros:

  • Wide Band: The 2-inch wide strap provides better pressure distribution, achieving occlusion at lower pressures and increasing patient comfort.  

  • Durable and Fast: Made from durable materials with UV protection, it's designed for true one-handed application in 30 seconds or less.  

  • Audible Feedback: The securing clip provides an audible "click" when the windlass is properly locked, giving clear confirmation to the user.  

• Cons:

  • Awkward Self-Application: The windlass clip is one-directional, which can make it difficult to secure with one hand depending on which way the windlass was turned.  

  • Size Limitations: The larger plastic backing plate means the TMT cannot be tightened to as small a circumference as some other tourniquets, potentially making it less effective on very small limbs.  

  • Less Common: As a newer and less common tourniquet, many users will be less familiar with it compared to the C-A-T or SOF-T, requiring specific training.  

Be prepared. Be Confident.