BACKGROUND: Damaged arteries bleeding can cause a life-threatening condition and it is one the main causes of death which can be prevented both on the battlefield and in the civilian environment. In case when severe external bleeding in a limb cannot be controlled by direct pressure a tourniquet should be used. The purpose of this study was to test four different types of tourniquets and to determine which type of tourniquet is effective to be used in the Army of the Czech Republic.

METHODS: Four different types of tourniquets were tested: SOFTT, C-A-T Generation 6, C-A-T Generation 7 and the CZ Tactical tourniquet. 59 students of military medicine (35 males and 24 females) from the Faculty of Military Health Sciences volunteered for the study. Each student applied all four types of tourniquets by self-application on the non-dominant upper arm. 20 students applied all four types of tourniquets on the arm as a buddy aid. Tourniquets order was determined by randomization. Time to placement, effectiveness and a subjective assessment of the application were recorded.

RESULTS: The C-A-T 7 tourniquet was the fastest applicable one, with 52, 5% of students being able to apply it up to 30 seconds. In the range of 31-60 seconds, 66, 1% of the C-A-T 6 and 54, 2% the CZ Tactical tourniquets were applied. On the contrary, the SOFTT tourniquet, as the only one, 5, 1% exceeded the application time of 2 minutes. The C-A-T 7, the C-A-T 6 and the CZ Tactical tourniquets were more effective (95%, 95% and 86%, respectively) compared with the SOFTT (56%). The correct application was found in men in 89% of the cases, while in women in 74% of the cases. A higher rate of failure was recorded for women in all types of the tourniquets. Average subjective students´ score was in the tourniquet SOFTT 3, 46 (assessment between neutral and difficult), the other tourniquets were assessed between easy and very easy (C-A-T 6 1.63, CZ Tactical tourniquet 1.46 and C-A-T 7 1.34).

CONCLUSIONS: The C-A-T 7 tourniquet was best evaluated, followed by the CZ Tactical tourniquet, the C-A-T 6 and the SOFTT.  A significant difference between C-A-T 7, CZ Tactical tourniquet and C-A-T 6 on one side and SOFTT one the other side and a significant difference between male and female correct tourniquet application was found out. TRIAL REGISTRATION: The trial was approved by the IRB of the Faculty of Military Health Sciences of the University of Defence, Czech Republic (No. MO 4330/2017-2994 HK).

Keywords: Tourniquet; SOFTT; C-A-T; CZ Tactical tourniquet; time of application; effectiveness; subjective assessment of the application simplicity; self-application; buddy application