Haemorrhage Control Using Combat Application Touniquet

Question 1

Indications for CAT

Answer 1

Uncontrolled haemorrhage from limb despite direct pressure

Multiple casualty scenes where pt numbers dictate simple haemorrhage control measures can not be individually applied

Question 2

Contraindications for CAT

Answer 2

Bleeding that can be controlled using basic first aid measures

Question 3

Clinical precautions for CAT

Answer 3

Do not apply over wound or joint

Once applied must be visible - can not be covered by clothing or other bandages

Deployed in critical situations - requires regular practice to maintain familiarity and skill at quickly applying whilst under stress

Primary reason for failure of CAT is excess slack in the strap when first applied. Other reasons are too few turns and failure to correctly work the strap-buckle

Question 4

Equipment required CAT

Answer 4

CAT

Question 5

Prepare patient CAT

Answer 5

Limb haemorrhage which cannot be controlled identified - life threatening and requires urgent management

Question 6

Application of CAT

Answer 6

Pass band around limb approx 5-7cm proximal time bleeding site (or as high as possible on the limb)

Directly against skin

Feed through slit of buckle

Ensure band is not twisted

Grasping buckle, pull band tight around limb and secure with Velcro allowing for three fingertips to slide underneath

Twist rod until bleeding stopped or loss of distal pulse (3-4 turns)

Feed remaining band through rod clips and secure on Velcro

Note time of application

Question 7

Ongoing considerations CAT

Answer 7

Ongoing assessment of haemorrhage control

Once applied it should remain insitu until medical clearance

Consider replacing with simple haemorrhage control measures if the reason it was applied initially was because this was not possible - if serious bleeding reoccurs reapply CAT and leave until medical clearance

Check tourniquet after each patient move

Conscious patients may require analgesia to tolerate

Consult for ongoing care if time will exceed two hours prior to arrival at hospital

Potential for crush injury after extended times mean i should only be removed in hospital