Revolutionizing Hemorrhage Control: Moving Beyond the Rag and Stick in Tourniquet Design

Ryan Hogan
Apr 16
4 min read

Ryan Hogan, Founder of Pressure Medical Speaking at U.S. Department of Homeland Security with FedTech

For decades, tourniquets have served as the cornerstone of prehospital hemorrhage control, particularly in austere environments where rapid intervention dictates survival. While current windlass-based designs like the Combat Application Tourniquet (C

AT) and Special Operations Forces Tactical Tourniquet (SOFT-T) have saved countless lives, their fundamental mechanics—a fabric band tightened via a rigid rod—remain rooted in principles dating back to the 18th century (6,12). As Ryan Hogan, a pioneer in trauma device innovation, aptly observes: “When I asked my customers what they wanted, they said a better rag and stick.” This sentiment underscores an urgent need to reimagine tourniquet technology for modern combat medicine.

The Legacy and Limitations of Conventional Tourniquets

Historical Efficacy and Persistent Shortcomings

Windlass tourniquets, such as the CAT and SOFTT, have demonstrated 100% efficacy in occluding blood flow during controlled testing (3,7,13). Their adoption by military and tactical units worldwide has significantly reduced mortality from extremity hemorrhage, with studies attributing a 67–85% survival rate to timely application (12). However, these devices rely on a design paradigm that requires precise manual dexterity: securing a strap, twisting a rod, and locking the mechanism under duress. In real-world scenarios, factors such as operator stress, environmental contamination, and anatomical variability can compromise efficacy. For example, improper slack removal or inadequate windlass turns may fail to achieve complete arterial occlusion, particularly in patients with high muscle mass or circumferential wounds (8,12).

Complications of Prolonged Ischemia

The Journal of Vascular Surgery has long emphasized the delicate balance between hemorrhage control and ischemic injury, noting that tourniquet durations exceeding 2 hours correlate with nerve damage, compartment syndrome, and reperfusion injuries (9,12). Traditional designs lack integrated monitoring systems to assess distal perfusion or alert providers to impending complications. This deficit becomes critical in prolonged field care scenarios, where evacuation delays are inevitable. Furthermore, the absence of standardized training protocols for windlass use—evident in studies showing inconsistent application times among novice users—heightens the risk of iatrogenic injury (8,10).

The Case for Innovation: From Mechanical to Intelligent Systems

Redefining User Experience

Hogan’s critique of the “rag and stick” model highlights a fundamental disconnect between device design and end-user needs. Special operations medics frequently operate in low-light, high-stress environments where one-handed application and rapid slack adjustment are paramount. Emerging solutions, such as ratcheting mechanisms and auto-securing straps, aim to eliminate the windlass entirely. For instance, prototypes like the XForce Tourniquet utilize a self-tensioning band and tactile feedback indicators to ensure uniform pressure distribution, reducing application time to under 15 seconds (12).

Integrating Telemedicine Capabilities

Next-generation tourniquets are exploring embedded sensors to monitor occlusion pressure, limb temperature, and ischemia time. These data streams, transmitted via Bluetooth or satellite, could enable real-time decision-support for en route care teams. A 2025 pilot study demonstrated that “smart” tourniquets with GPS tracking reduced median evacuation times by 22% in rural trauma scenarios by optimizing route planning (12). Such innovations align with the Journal of Vascular Surgery’s call for “dynamic monitoring tools to mitigate ischemic complications”(9).

Addressing Junctional and Non-Compressible Hemorrhage

While current tourniquets excel in limb hemorrhage, they falter in junctional zones (e.g., axilla, groin). The U.S. Army’s adoption of the Combat Ready Clamp (CRoC) for pelvic bleeding underscores the need for modular designs adaptable to diverse anatomies (12). Hogan’s development pipeline reportedly includes a hybrid device combining pneumatic pressure with hemostatic agents—a paradigm shift from passive compression to active clot augmentation.

Toward a New Standard: Clinical and Operational Implications

The evolution of tourniquet technology must be guided by three principles:

Simplicity: Devices should require minimal training and function reliably under physical or cognitive fatigue.
Adaptability: Systems must accommodate anatomical variability and evolving injury patterns (e.g., blast trauma).
Integration: Tourniquets should interface with broader telemedicine ecosystems to enhance situational awareness.

Preliminary trials of ratcheting tourniquets have shown a 40% reduction in application errors compared to windlass models (12). Furthermore, integrating tourniquets with wearable sensors could enable automated hemorrhage detection, a capability critical for unmanned missions or mass casualty events.

Conclusion: A Call to Action for Special Operations Medicine

As combat medicine advances, so too must the tools upon which medics rely. The rag-and-stick tourniquet, while revolutionary in its time, now represents a bottleneck in hemorrhage control innovation. By embracing intelligent designs, modular architectures, and telemedicine integration, the next generation of tourniquets can transcend mere mechanical compression to become holistic lifesaving systems. As Hogan’s work illustrates, the future of trauma care lies not in refining the past but in reimagining the possible.

“The measure of a tourniquet is not in its simplicity,” Hogan remarks, “but in its ability to disappear into the medic’s workflow until the moment it’s needed—then perform flawlessly, every time.” For special operations providers facing ever-complex threats, that moment cannot come soon enough.

References 1,3,6,7,8,9,12,13