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Combat Application Tourniquet fares well in a chemical, biological, radiological or nuclear dress state
  1. Alastair Beaven1,2,
  2. E Sellon3,
  3. M Ballard3 and
  4. P Parker2
  1. 1 Clinical Department, 202 Field Hospital, Birmingham, UK
  2. 2 Trauma and Orthopaedic Surgery, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Radiology, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Alastair Beaven, Clinical Department, 202 Field Hospital, Birmingham B14 6NY, UK; alastairbeaven{at}


Introduction There is a need for a military tourniquet to control catastrophic haemorrhage in a chemical, biological, radiological or nuclear (CBRN) threat environment. No published data exist as to the efficacy of tourniquets while wearing British military CBRN individual protective equipment (IPE).

Methods 12 volunteers from the counter CBRN instructors’ course allowed testing on 24 legs. A Combat Application Tourniquet (C-A-T) was applied to all volunteers at the level of the midthigh. 12 legs were tested while wearing CBRN IPE (both operator and simulated casualty), and the control group of 12 legs was tested while wearing conventional combat dress state (both operator and simulated casualty). The order of leg laterality and dress state were sequenced according to a prerandomised system. Efficacy was measured via use of an ultrasound probe at the popliteal artery. Tourniquets were considered effective if arterial flow was completely occluded on ultrasound imaging. Data were collected on time to successful application, failure of tourniquets and pain scores as rated by the visual analogue scale (1–10).

Results There were no failures of tourniquet application in the CBRN group, and two failures (17%) in the control group. Failures were pain threshold exceeded (n=1) and tourniquet internal strap failure (n=1). The mean application time for the CBRN group was 28.5 s (SD 11.7) and 23.7 s (SD 9.8) for the conventional combat group. There was no statistically significant difference (p=0.27). The median CBRN pain score was 2.0 (IQR 2.0–3.5). The median control pain score was 4.0 (IQR 3–6). This was a statistically significant difference (p=0.002).

Conclusion C-A-Ts applied to simulated casualties in CBRN IPE at the midthigh are at least as efficacious as those applied to the midthigh in a conventional combat dress state. The pain experienced was less in CBRN IPE than when in a conventional combat dress state.

  • C-A-T
  • CAT
  • CBRN
  • IPE
  • all hazards approach

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  • Contributorship AB: concept, design, data collection, data analysis and manuscript preparation. ES: data collection, data analysis and manuscript editing. MB: concept, equipment and manuscript editing. PP: concept, design and manuscript editing.

  • Funding statement The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics statement Ethical approval was granted by the Ministry of Defence Research and Ethical Committee (reference number 817/MODREC/17). All participants gave informed consent before taking part.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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