RATS tourniquet case studies or actual use reviews

PM07

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This article was recently posted on ITS. I have no dog in this fight except that people need to research their tools carefully and ensure it meets their mission requirements. I left the link cold but you can find it easily enough. www.itstacticaDOT com/medcom/medical/is-the-r-a-t-s-tourniquet-misleading-consumers-with-tccc-approval/

" I have an issue with the R.A.T.S. Tourniquet and what I feel is misleading information in regards to the company’s “TCCC Approval” marking. You might too once you read what I have to say.

First off, I’d like to explain what the Committee on Tactical Combat Casualty Care’s guidelines are, because it’s important to understand the development of this committee and all they’ve done for tactical medicine. I’ll also note that the guidelines are commonly referred to as TCCC guidelines and were designed to provide U.S. Combat Medics and trained military personnel with a framework to manage combat trauma on the battlefield.

TCCC Guidelines
The TCCC guidelines have three primary goals. Treat the casualty, prevent additional casualties and complete the mission. The most critical phase of care in combat is from the time of injury until the patient reaches higher echelon care, or a surgically capable medical treatment facility. The guidelines break this critical time into three definitive phases; care under fire, tactical field care and tactical evacuation care.

If you’ve been reading ITS for the past six years, you’ve probably read our articles that have kept up with the CoTCCC’s updates to their guidelines, which have been in a constant state of evolution since the original TCCC guidelines were published in 1996. The CoTCCC is composed of trauma surgeons, emergency medicine physicians, combatant unit physicians, combat medics, corpsmen and PJs. It has representation from every branch of the Military, all having deployment experience. For an idea of just what the committee does when it meets, check out the minutes of their latest meeting. Also, if you’ve never read over the TCCC Guidelines, you can find the most recent updates here on ITS.

CoTCCC vs USTCCC.com
Now that you’re up to speed on what the CoTCCC is and what the guidelines they release are, let’s get into what’s causing confusion. There’s a commercial company named Tactical Combat Casualty Care that has trademarked the words “Tactical Combat Casualty Care (TCCC).” As a fellow business owner, I understand the need to trademark what you’ve worked hard to create, but I question the decision of this particular company to trademark these words.

trademark.jpg

I primarily call this into question because the trademark was filed on March 20th, 2012. When filing a trademark, a company has to describe a class of goods and services they want a trademark to protect and in this case, the company chose to go into Class 041, which falls under educational services. Additionally on a trademark application, a company is required to list the date they first used the desired trademark and the date they first used the desired trademark in commerce. In the case of the company Tactical Combat Casualty Care, the first use date was February 1st, 2006 and the first use in commerce date was March 1st, 2006.

Looking at the timeline of 2006 when the company, Tactical Combat Casualty Care, is claiming they first used the name and added it to a product for sale commercially, you’ll see this is ten years after the CoTCCC first established it in their TCCC guidelines. As I mentioned in an example a few weeks back with my Wounded Warrior Project Article, I also believe this to be a non-enforceable trademark against the CoTCCC, because of the date they first started using the term. I’m not a trademark lawyer, so this is purely my own opinion on the matter, based on my knowledge of trademark law that I’ve had to educate myself on with owning my own business.

Our Law Enforcement Correspondent, Eric S., regularly attends the Special Forces Medical Association Scientific Assembly and wrote a great article at the end of last year about just what the TECC is and their updates from SOMA. During TECC meetings he heard first hand from CTECC and CoTECC members about trademark infringement claims by the company Tactical Combat Casualty Care and their opposition to the TECC and CoTCCC using the term “TCCC.”

Approval vs. Recommendation
Trademark disputes and the long backstory aside, the real crux of my issue comes from what the company Tactical Combat Casualty Care is doing with their approval on a product called the R.A.T.S. Tourniquet. The R.A.T.S. Tourniquet is now printing “TCCC Approved” on the tourniquet, which I believe is misleading considering it’s not approved by the CoTCCC. It is approved by the company Tactical Combat Casualty Care.

The CoTCCC (Committee on Tactical Combat Casualty Care) doesn’t approve medical devices. In the case of tourniquets, they’ve only ever “recommended” specific tourniquets and the only two that are currently recommend in their guidelines are the CAT (Combat Application Tourniquet) and the SOFTT (SOF Tactical Tourniquet).

I believe from my own opinion as a consumer that the TCCC Approved label on the R.A.T.S. Tourniquet is misleading, as it implies approval by the CoTCCC. As mentioned earlier in this article, the CoTCCC came out with their original guidelines in 1996 and since that time has been regularly releasing updates to their TCCC guidelines. This predates the company Tactical Combat Casualty Care’s first use in commerce of 2006. Labeling this device with this approval mislead me into believing they’d somehow received an endorsement from the CoTCCC.

Being in the military prior to 2006, TCCC was already a recognized term to me, which I associated with the CoTCCC. I’d argue many others with and without a military background believe TCCC to refer to the CoTCCC as well.

RATS_Tourniquet_TCCC_Approved_02.jpg

“TCCC Approved”
Just to be clear, I’m not calling into question the efficacy of the R.A.T.S. Tourniquet, simply the manufacturer’s choice to label it TCCC Approved. The R.A.T.S. Tourniquet has many resellers, including the very Tactical Combat Casualty Care company which approved it. This makes it a more serious issue in my opinion. Having the TCCC Approved label without disclosing what that approval actually means is misleading in my book.

The company Tactical Combat Casualty Care has recently published an open letter addressing their affiliation, or lack thereof, with the CoTCCC. I found the position by their owner, Raffaele DiGiorgio, to be unnecessarily defensive. In the letter, which you can read here, Mr. DiGiorgio states that people’s frustration around his trademarking of TCCC is out of “jealousy that they didn’t think of it first” and that his company isn’t given the same consideration as larger entities when it comes to the enforcement of its trademarks.

He goes on to further call into question the endorsement (read recommendation) of products by the CoTCCC by citing examples of CAT Tourniquet failures in the field and the CoTCCC’s “dubious support” of Combat Gauze when a Z-Medica director sits on the committee. I’m not quite sure what all this has to do with the flack he’s catching for his trademarks though. I believe that it has nothing to do with jealousy or not feeling that Mr DiGiorgio’s rights to enforce trademarks are legitimate, it’s more so his reasoning for trademarking TCCC in the first place.

That and providing a TCCC approved endorsement for products like the R.A.T.S. Tourniquet. Perception is reality and in this case I feel the public is being led to perceive the R.A.T.S tourniquet carries an endorsement that it doesn’t.

What do you think? Is the R.A.T.S. tourniquet misleading consumers with their TCCC Approval?"
 
There is not one peer review study of the RATS. I found this paragraph from the Havok Journal rebuttal disturbing:
"According to Mr. Kirkham, “At this time we have no plans in place to pursue a DoD contract. Our current market is civilian EMS personnel, as that is a growing market now that the use of the tourniquet is becoming more accepted, and there is less red tape and politics involved compared to large DoD contracts.”"
So basically they are bypassing a military study and saying they are marketing this to civilians. What medical director in their right mind would approve a medical device with no data to back it. Military or otherwise?
Yeah a tourniquet falls outside the normal requirements for a "medical device", but lets get real. No true medic is going to use a untested medical device on an actual patient. Try it on your boy, try it on yourself, but try it on a patient and have it not work is a law suit waiting to happen. Now the military can test things outside the normal FDA channels, so why not take the RATS that direction?
Those companies selling the RATS might want to think about the possible liability they may incur when some poor cop buys one under the implied impression it was TCCC approved. The cop uses it on himself, his partner, or the public and it fails. Now the cop has taken a NAEMT TCCC class and has the card to prove it. That in itself may (or may not) relive the RATS company because they have that BS disclaimer card to go with it. But now the cop wonders why the TQ failed and starts digging. A good lawyer will certainly dig. As a reseller how can you sell a medical device that has no data to back it up? Does your insurance cover you for this? Why would you even let things get to that point in the first place? You are selling a potential life saving device that has no data to back it.
The CoTCCC sets the standard for tactical medicine and their "recommendation" is the golden standard, like it or not. These are evidence based recommendations with the peer reviews to back them.
The RATS company know exactly what they are doing and using shady marketing tactics to lure uninformed buyers into buying their product is shitty. This Havok article is nothing more than Marty trying to do damage control for his boys. I get it, but come on, at the expense of someones life? Show me the data!
I'm fired up because I'm a cop and I know my brothers and sisters don't keep up with this stuff and may be duped by slick advertising. If Jeff really cared about what was important, saving lives, he would pull the TCCC label and get a peer review study before selling another tourniquet.
 

mark1911

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http://www.havokjournal.com/nation/when-its-tactical-attacks-other-veterans/

This is more information related to the RATS ITS article.

I'll offer this in reference to tourniquet use. There were a lot of people in the tactical medical arena that were very opposed to the use of tourniquets prior to the war. Time has passed, lessons have been re-learned. Back then, I heard quite a few uneducated offerings about tourniquet use, and concerns. Limb amputations, death, etc. Now, tourniquet use is more accepted and understood. Some people have had their minds changed.

It is my understanding, in domestic medical practices, to have the overseeing medical administrator or medical head to approve medical techniques, procedures, and equipment. This is often a medical doctor. This doctor, and there is one for every EMS provider, is the doctor that establishes the standards of care for their respective area of responsibility. It is this doctor that must be convinced of the efficacy of treatment, standards, and care. Rather than some body certifying or approving that the doctor then must follow. Again, medical doctors are giving their approval at a local and regional level for the care in their area.

It has been my experience, with people seeing the RATS for the first time is, they are skeptical. I was too. I'd recommend examining one, and getting training on a RATS. You might be surprised. I also understand we have natural biases towards gear we are familiar with and have trained with. I'd suggest keeping an open mind and getting training. Not every piece of gear works or fits with what everyone thinks is their need. I train, use, understand the limitations of the gear I use, including tourniquets.

I really like the RATS, others I respect really like the RATS. I know the RATS is faster and less expensive, more compact than other tourniquets.

For disclosure: I consider the inventor of the RATS, Jeff Kirkham, to be a friend. I'm not a doctor or a medical guy, this is one guy's opinion.

Regards, mark
 
True Mark, it comes down to the medical director dictating what protocols will be followed under that medical director's jurisdiction. That only covers medical providers, which law enforcement are not. For example, the medical director in charge our agencies SWAT Medics, has no say what so ever in what the Sheriff decides we are going to do at our agency medically on the street, as Deputies.
Do you are correct, the medical director can do what ever he wants and does not worry about what the CoTECC says. In fact most area's are still not allowing commercial tourniquets of any kind. I would however challenge anyone to find a medical director stateside that would allow a medical device to be used on patients that has absolutely no peer reviewed data to back it up.
The military can work outside the FDA approval process (like getting X Stat testing in the field prior to FDA testing) but once you direct that product to the civilian market that device needs to be vetted properly.
If the RATS is better than the current commercial tourniquets out there, then great. The ITS article says nothing about the efficiency of the RATS. The entire issue is the "TCCC Approved" label which is bound to cause confusion on the civilian side.
I don't see any other medical product that a civilian tactical medic or street cop would use that uses this type of shady marketing. Why would the RATS company care about putting the "TCCC Approved" label on something that, by the Havok article quote from Jeff himself, says is directed to civilians in the first place?
 

mark1911

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Ok, a Sheriff can decide medical protocols within his jurisdiction; a non-medical guy deciding protocols. I have no issues with that, that a part of his responsibilities. One thing to consider is the difficulty in having everyone agree on what and how certain protocols are interpreted, and then executed. So, when studies are conducted, who says and who listens to the studies? To some, a medical study conducted by the military would be enough, others it would not be considered as it was not a civilian medical doctor. Hence, my reference to the medical director being responsible. At least this is how I understand the issue. Again, I'm not a medical guy or a doctor, just my observations.

What is the efficacy of the RATS? If you've used one or received training with one, then one can make a first hand judgement. The study protocols, etc. are beyond my area of expertise by a long stretch. The design is simple, very rugged, easy to apply, etc. To me the lack of pulse when applied, use of a simple pulse oximeter, shows the results. Similar to a cravat and a stick, CAT, or a SOF-T, etc. Just one guy's observations.

The trademarked TCCC issue, is the issue of who owns the rights to market using that term. It sounds like the guys owning the trademark also sells medical training. He's approving his training and products, meaning owner of the trademark, as a private entity. The CoTCCC is a governmental organization. A Google search brought this link up, from the trademark holder.

https://www.ustccc.com/an-open-letter-from-tactical-combat-casualty-care-tccc/

I don't know if Jeff said the RATS is directed at civilians, rather than the military. I believe the article says, he's primarily marketing to the the civilian side, because he doesn't want the issues with governmental contacts, at the present time. At least that's how I interpreted the article.

I think this has been a good exchange, and is about the limit of my technical understanding of things. I like the tourniquet, and am offering this because I think it fits for what I think I need.

Regards, mark
 
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I'll just say that this technology has had at least six years to gather peer reviewed medical studies. Today we have the same product (as far as I can tell) with a slick (and suspect) marketing campaign and all of a sudden it's the bees knees.

Listen, I'm a veteran and I hope every veteran out there is successful with their endeavors (including Jeff), but non of us gets a free pass. It doesn't matter if you were a Unit guy or a grunt, if you are doing something suspect be ready to get called on it. We aren't talking about stealing someones nylon IFAK idea, which is a huge issue in the industry, we are talking about a medical device that has the potential to save someones life.

Why add something like the TCCC label when the product should speak on its own?

https://web.archive.org/web/20101221203804/http://www.bhigear.com/bungee_tourniquet.aspx

https://web.archive.org/web/20150607045017/http://www.bhigear.com/pdf/BungeeTourniquet-web.pdf
 

mark1911

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@CENTCOM_Survivor

Can you help me, and other readers, understand your affiliations?

I got your PM with some of your affiliations. Can you post them in this thread?

Regards, mark
 
Sure, my name is Eric S. and I work as a detective at a Sheriff's office here in Florida. I'm a member of our "Medical Working Group" which is setup to help our COC and admin with TECC related training and equipment for the agency. I'm a graduate of the Florida SWAT Association's TACMED school and I'm also a volunteer cadre member there. I hold a TCCC card though the NAEMT. I've put myself through EMT school with JTM Training group and I was a combat lifesaver in the Army in my past life. I'm a member at SOMA and have been attending the SOMSA (formerly SOMA) events here in Tampa for the last three years.
I'm also the Law Enforcement Correspondent at ITS Tactical where I've written several TCCC/TECC related articles.
I also am a member of a group called Tampa TACMED which is a medical networking group on FB.
Mostly I'm just a LEO who is passionate about getting all my brothers and sisters thinking about tactical medicine. I am far from a medical "expert" but I know what is going on from the law enforcement side of things, and think its critical that cops make informed decisions on equipment and training.
 

WhiskeyDeltaGulf

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The lack of peer reviewed evidence or study on the RATS relegate it to a curiosity as a medical professional.

The application of a TQ is a medical act, regardless of the tactical situation. The use of medical devices with proven efficacy is a requirement for all with medical training.

Anything else is malpractice and hold personal liability.
 

Bourneshooter

Blue Line Sheepdog
I am impressed the idea of the RATS. Impressed by price and ability to carry it in places that a CAT or SOFT-W wouldn't work (run band down into pants and have H clamp sticking out of waist).

Sadly all there is are verbal statements that it has been tested at two wet labs. The people I've had tell me that, I trust. That said I want to see the results.
 
I would be interested in seeing if there are any published real world use cases available for review. We have lots of documentation of the CAT and SOFTT being used and can see the results. Absent a peer-reviewed study verifying its effectiveness, real world case studies would make me take a look at this as an effective replacement for my CAT or SOFTT.


I am nothing but a former EMT qualified guy that shoots, for the record.
 

Ephraim R.

Newbie
I've been asking AR MEDCOM and AMEDD Center and School and they are not teaching it or even have it on their radar for testing.

Hell, I work here in the footprint of Army Medical land.

If dude has some testing I would like to know from who because all the medics here, both instructors, students, testers and branch ain't talking about it.

I stopped asking because it's a self licking ice-cream cone. If the studies have been done, I haven't seen them or talked to anyone who has.

If someone has a name for me to track down its very simple to do. I have the run of this place. Until that time, I want nothing to do with something that is possibly shady. I'll stick with my SOFT-W.
 

Bronson

Fury
I spoke via FB with the inventor of the RATS and followed up via E-mail reference his experience.

The FB conversation was very strange and evasive. I asked direct questions and wouldn't receive direct answers in return; mostly non-replies and claims I couldn't substantiate. He made mention of a FT Sam study on re-bleeds I couldn't find any information on whatsoever and he refused to divulge who the authors of the study are or when/where it would be published, and that the best flight surgeons in the world changed to the RATS but wouldn't specify who that is exactly.

It's the exact opposite of behavior I would expect from a company that provides life-saving devices. It's shady. If you have claims, they need to be substantiated. Alluding to things doesn't cut it. To be clear - I have no industry affiliation with any company. All I care about is Soldier Survivability. I want the best, proven, most efficient means of providing successful interventions in that regard.

These are the answers he gave to my questions on the email which were more direct (note the year 2005 - CAT's have been upgraded multiple iterations since then)

-How they were stored?- IFAK completely covered, and sometimes still in the plastic.

-Were they exposed to UV?- No

-How old were they?- Less than 2 years

-What generation? - That was 2005

-Where they brand new?- Yes and yes in original packaging

-Were they used in training?- No because of widespread warnings that were put out, training TQ were kept separate.

-Specific failure points?- See below

Windlass would bend in half
severe pinching between tri-gldie and base plate (this caused multiple issues both in training scars and in actual use.) Velcro attracted dirt and debris when covered in blood allowing it to slip

Velcro was a nightmare under stress-
tri-glide threading was a failure under stress especially at night.

Multipele re-bleeds (you and I discussed the latest study and the flash of the obvious of why this
 

Ephraim R.

Newbie
This was still bugging me so I walked over to the Directorate of Training and a current sitting member of the TCCC board. The SWAT-T and RATS were specifically named as not recommend.

No study was done by them nor anyone they knew here as well.

I have the newest guidance and recommendations that I will upload once I return to the office.

So until that time that the RATS is "approved" like the bandwagoneers say, I'm not fucking with it. It falls into the category of "I guess it's better than nothing" but why use it then if only to save space at the loss of capability.

If anyone wants to argue this information, I am still stationed here and know the people personally. I am open to discussion.
 

hill2jb

Newbie
Here is the video I made comparing the use of a RATS vs a CAT on an upper arm injury with nerve damage and complete paralysis of the affected arm. This was also posted on Facebook in Gear before the Medical page was created.
 

tdb

Newbie
This was still bugging me so I walked over to the Directorate of Training and a current sitting member of the TCCC board. The SWAT-T and RATS were specifically named as not recommend.

No study was done by them nor anyone they knew here as well.

I have the newest guidance and recommendations that I will upload once I return to the office.

So until that time that the RATS is "approved" like the bandwagoneers say, I'm not fucking with it. It falls into the category of "I guess it's better than nothing" but why use it then if only to save space at the loss of capability.

If anyone wants to argue this information, I am still stationed here and know the people personally. I am open to discussion.

Going a little necro-post here, but... Could you point me to a .pdf or something put out by the CoTCCC that specifically names the SWAT-T and RATS as not recommended? Would love to have that on hand to pull out every time someone says the RATS is better than a real TQ ...
 

JUDAN

Member
I personally use RAT's along with my agency. Jeff is nice enough to provide at cost pricing and IMO it's easier to deploy. Cost alone is a huge factor let alone being able to deploy one-handed.


You can see a page of endorsements


http://ratsmedical.com/pages/medical-endorsements



I also find it interesting that RE factor states " Q: Who currently uses the R.A.T.S.?
A: Many teams in the SOF community, DOD, and LE."



The R.A.T.S. (Rapid Application Tourniquet System) was designed based on feedback from the battlefield where soldiers required a tourniquet that could be easily applied and offered a low profile carry. The tourniquet is already in use around the world by varying SOF elements and has been proven on the battlefield. The R.A.T.S. can fit just about anywhere on your kit and can be quickly applied to an extremity using one hand.

  • 1/2″ Flat Bungee Cord quickly stops the bleeding
  • Low profile carry
  • Robust locking system
  • Half the price of traditional tourniquets
  • Made in the USA

Q: The band looks very thin. Will it cause tissue damage?
A: No. The R.A.T.S. tourniquet is designed to expand with tissue as it swells from injury. Traditional nylon tourniquets cannot accommodate the swelling tissue, and can potentially cause damage. The elastic used in the R.A.T.S. will more effectively allow for tissue expansion without the pressure of the tourniquet increasing.

Q: The band is not as wide as a standard tourniquet. Will it stop heavy femoral bleeds?
A: Yes. The R.A.T.S. measures at .5” wide. The repetition of wraps is so effective because it functions in principle like “tandem tourniquet placement”.

Q: Is this TCCC approved?
A: TCCC does not approve or deny any medical equipment for the military as it is no longer a function of the committee. Authority lies with the medical director of each area or jurisdiction. With that said, the R.A.T.S. is currently undergoing evaluation by TCCC. So far voting members of TCCC have tested and recommended the R.A.T.S. for use.

Q: Can this be used on children and K9s?
A: Yes. The design of the R.A.T.S. allows for it to be used on smaller extremities where as current issued tourniquets, to include the CAT, SOF-T, and METTs, do not.

Q: Who currently uses the R.A.T.S.?
A: Many teams in the SOF community, DOD, and LE.



https://www.refactortactical.com/shop/rats-tourniquet/
 
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