Skill Sheet – Combat Application Tourniquet (CAT)
One Handed Application
Learning Objective:
Demonstrate the proper technique and procedures for applying a CAT to the arm
References:
TECC, TCCC and manufacture guidelines
Evaluation Method:
Students will be evaluated as a Pass/Fail (P/F). The instructor will verify the accuracy of the
student’s ability to apply a tourniquet effectively on the specified limb by means of observing
the student’s procedures and technique.
Materials:
Student checklist
Tourniquet
Instructor Guidelines:
1. Provide each student with a student checklist
2. Ensure student has all student-required materials
3. Read the learning objective and the evaluation method to the student
4. Explain the grading of the exercise
5. Have student perform tourniquet exercises on self
Performance Steps:
1. Review general tourniquet rules (high or die, apply over clothes,20 seconds to apply,
where and when to apply additional TQs, tighten until bleeding stops)
2. Identify bleeding extremity on self
3. Grab tourniquet by folded tab section
4. Loop tourniquet over arm
5. Pull tab midline (towards body) as tight as possible, should only require 1 to 3 turns of
the windlass to stop bleeding
6. Mate Velcro on tourniquet band from buckle to windlass clip
7. Apply pressure with windlass and secure in windlass clip(tighten until bleeding stops or
it is determined that an additional TQ is needed)
8. Secure tourniquet band inside windlass clip
9. Apply securing strap over windlass clip
10. Check need for additional tourniquets (still bleeding) explain use of gauze or other
material over pressure point to improve success of second TQ, explain location of
subsequent TQs
11. Note time
1
CAT Application – One Handed
Task
Completed
1st
2nd
1. Review general tourniquet rules
2. Identifies bleeding extremity on self
3. Grabs tourniquet by folded tab section
4. Loops tourniquet over arm
5. Pulls tab midline (towards body), explains need for tightening
strap prior to using the windlass
6. Secures tourniquet band with Velcro only from buckle to
windlass clip (the friction buckle is not utilized for one handed
self-application)
7. Applies pressure with windlass until bleeding stops or
windlass cannot be turned further
8. Secures windlass in clip then places tourniquet band in clip
9. Places windlass securing strap over clip
10. Checks need for additional tourniquets (still bleeding), explains
correct location for placement of subsequent TQs, explains
adjunct for improving probability of success for second TQ
Instructor advises bleeding has stopped (if applied correctly)
11. Notes time
Overall Grade
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
P / F
Critical Criteria:
Did not go “high or die”
Did not pull tourniquet tab to midline
_____ Did not secure tourniquet strap inside windlass clip
_____ Required more than 3 turns of the windlass to adequately tighten tourniquet
Evaluator's Comments:
2
3rd
NOTES:
1. Explains concept of “go high or die” (used during Direct Threat application because no time is taken
to complete a bleeding assessment, going high insures bleeding is stopped from all wounds to the
extremity; exit wounds, multiple gunshot wounds, additional wounds caused by path of bullet)
Explains application of tourniquet directly over clothes for Direct Threat application, no time is
taken to expose wound. Explains need for a quick inspection of site to remove obstacles to
tourniquet application such as rigid items in shoulder pockets. Explains 20 second rule, addresses
need to stop bleeding as quickly as possible as well as need to get back on your weapon as soon as
possible.
2. Explains that during self-application the only thing you are identifying is the injured extremity.
There is no need to take time to identify the actual hole since you will be going as high as possible
regardless of the location of the bleeding.
5. Explains need to tighten tourniquet band securely prior to using the windlass. Tourniquet should
only require 1 to 3 turns of the windlass to stop the bleeding if it is properly applied. More than 3
turns could result in tourniquet material bunching up and interfering with the application of
pressure. Additional turns will also cause the circumferential band to twist inside the outer band
reducing surface area pressure being applied. In training, requiring more than 3 turns of the windlass
is a fail point. During actual application if more than 3 turns is required to tighten the tourniquet
continue turning the windlass as much as necessary however; be prepared to apply a second
tourniquet since this will be a clear sign that the tourniquet may be ineffective.
10. Explains additional tourniquets are placed adjacent to and as close as possible to the initial
tourniquet without overlapping. Explains use of rolled gauze or other material such as a rolled sock
to assist in applying tourniquet pressure to the brachial or femoral arteries. Rolled material is placed
over the artery and under the tourniquet to assist in applying more directed pressure on the major
artery. For a patient with large arm or leg muscles this technique is useful because tourniquet
application can cause the muscle to roll over the artery producing a channel that blocks pressure
from being exerted onto the artery.
11. Note time if possible. This is not a critical failure however; the time of application is useful
information for follow-on care. Explains the noting of the time of application is only for information
purposes for follow care. Once an officer places a tourniquet on a patient the tourniquet is not to be
loosened or removed.
3