Page 40 - JSOM Summer 2023

TABLE 2 CAT vs MTET Performance
CAT MTET, success MTET, failure
(n = 50) (n = 40) (n = 10) p-value
Time (seconds; median, range) 29.03 35.27 72.26 0.0012
(18.63–59.50) (17.00–58.90) (62.84–3.96)
Reason for Failure N/A N/A 7 (70%) Mechanical and Time N/A
3 (30%) Time

FIGURE 3 Scatterplot of application times and medians (BLACK FIGURE 4 Findings of mechanical failure points in the windlass
LINES) for (LEFT TO RIGHT) the CAT, MTET successful application, (RIGHT), buckle (TOP LEFT), and stitching (BOTTOM LEFT) of the
and MTET failed application. MTET after user self-application.

MTET, Military Tactical Emergency Tourniquet
Actions have been taken by producers to impede the marketing
CAT, Combat Application Tourniquet; MTET, Military Tactical Emer- of counterfeit tourniquets. This includes a 2019 federal lawsuit
gency Tourniquet by Composite Resources, the manufacturer of the CAT, against
Recon Medical, a China-based CAT look-alike manufacturer,
Post-investigation analysis found that the MTET demon- for their tourniquet model. 12,16 In December 2021, Recon Med-
strated significantly longer application times (p < .0012) and ical was handed a permanent injunction against further tour-
lower rates of successful application (p = .0001). Failure of niquet production for intentionally deceiving consumers into
MTET application was not significantly correlated with user believing their tourniquet was identical to the CAT. However,
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thigh circumference (p = .9428). as evidenced by the search of Amazon retailers in this study,
a copycat market remains for other overseas manufacturers.
Discussion
The ability to produce a product such as the MTET, which is
This study demonstrated that the MTET, a mass-produced, substantially less expensive but visually nearly identical to the
readily available, and popular CAT look-alike tourniquet, CAT, leads to suspicion of material inadequacy, engineering
proved to be less successful than the CAT in application time shortcuts, and production flaws. There is no listed patent or
and to have lower rates of success for extremity arterial oc- in-depth product description for the MTET at the time of this
clusion when self-applied by experienced US Army combat study to provide a material comparison of the devices tested.
medics. Furthermore, while the CAT did not show any me- However, given the significant difference in observed mechan-
chanical defects in all observed single-use applications, the ical failure rates between the CAT and MTET (0% vs. 14%),
MTET demonstrated a 14% mechanical failure rate on self- obvious concerns arise.
application. MTET failure did not show any statistical correla-
tion to user thigh circumference. Continued employment of the CAT as one of several CoTCCC-
recommended tourniquet devices currently used by the US
Emergency-use limb tourniquets are devices intended to stop Military is largely because of its documented success in labo-
arterial blood flow. [AU: Per a reviewer, “references 15 and 16 ratory testing and battlefield conditions. 2,17 The CAT, as well
are not sources for a definition of ‘tourniquet.’ I don’t believe as other CoTCCC-recommended devices, such as the SOF
you need references for this sentence, so I recommend simply Tactical Tourniquet–Wide and the Tactical Mechanical Tour-
deleting the two reference numbers and renumbering refer- niquet, have been repeatedly tested, compared, and reviewed
ences accordingly.”] Suboptimal tourniquet pressures do not by expert panels for inclusion in the treatment of prehospi-
halt the arterial flow but can impede venous return, leading tal extremity hemorrhage. With the continued use of Internet
to venous congestion, ongoing or resumptive bleeding, shock, mass markets such as Amazon.com and other online retailers,
compartment syndrome, and death. A critical requirement for previously unknown companies can establish commercial ad-
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CoTCCC consideration is ≥3.81cm width, given that tourniquet vantage through several means, including low prices, paid-for
width demonstrates an inverse relationship with the pressure search engine result placement, and customer feedback met-
necessary for arterial occlusion. 2,15 The CAT and MTET both rics. This allows for improved product placement not only to
meet recommendations for tourniquet width, and this identical laypersons but also to military personnel searching for less
characteristic may deceive purchasers into further considering expensive alternatives to CoTCCC-recommended devices in
the MTET to be an inexpensive alternative to the CAT. challenging economic times.

38 | JSOM Volume 23, Edition 2 / Summer 2023