Is the R.A.T.S. Tourniquet Misleading Consumers with TCCC Approval? - ITS Tactical
 

Is the R.A.T.S. Tourniquet Misleading Consumers with TCCC Approval?

By Bryan Black

RATS Tourniquet TCCC Approved

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

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

“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?

References

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Discussion

180 comments
Bzil Maf
Bzil Maf

Not even and original idea. Bungees in one form or another have been used for this for decades going back to Vietnam. More recently the adjustable bungees with plastic hooks. Even his "three finger loop" is based on the hooking of the above mentioned tie downs. I've seen bicycle tubes carried and used. To use the term is misleading and potentially negligent without a disclaimer.

puma
puma

I've messed with one and it feels more like a movie prop than something I'd roll out the gate with strapped to my kit. Seems to be a very shady business practice, which is no surprise you can find it double price at refactortactical.com.

abruno415
abruno415

i think its a cool idea, my only concern is will it work over my uniform? i will buy one and try it out and see how it goes. as far as what the article is talking about, yes i agree with you that is some shade ass shit. they knew it when they did it it is fraud and if you had half a brain you would see it as well. 

Pappa Delta
Pappa Delta

Having never used a tq. I do carry one, a swatt, on duty, and have trained with the cat during my tccc mass casualty training. I carry the swatt because it has multiple users and is fairly easy to apply. As far as a test on what works best I saw a you tube of a doctor testing the swatt. He used a Doppler on his wrist. He applied the swatt and placed the Doppler on his wrist before and after the application. Pulse before and no pulse after. Easy test. Apply the tq and take your pulse. As far as one company saying they are approved by whatever body, in the end it is subjective and based on best practices and technology at the time and is always subject to change. I do agree that the average consumer could be confused by the claim, but the educated should know better.

Joseph Behm
Joseph Behm

^Really? Liking your own comment? Lol

Jeffrey Hensley
Jeffrey Hensley

Wayne nice try to spin it and attacking my reading comprehension that's real intelligent. You fail to list any specific fact extrapolated from the study to support your assertion. Same as before the elastic nature is one characteristic...repeated wraps don't make it "wider" and change the occlusion / tissue pressures. It's too short and too narrow! And docs are paid endorsements!!! Not clinically objective studies.

Eric Southland
Eric Southland

Wayne, just because you can does not mean you should. Anyone with any sense and see what RATS is up to.

J.B. Knopp
J.B. Knopp

This entire thread as well as the subsequent threads outside this thread is making my head hurt. LOTS of people talking WAY outside their "lane". Just finished a busy night shift. Will process this and try to reply later.

Jason Crist
Jason Crist

Paging Dr. Knopp, Director of Trauma Services Dr. J.B. Knopp , please throw this entire thread off with some actual fucking expert testimony.

Jeffrey Hensley
Jeffrey Hensley

Nope try again!!! The elastic nature is merely one characteristic of a tqt! RATS IS TOO NARROW AND TOO SHORT. Its crap!!! Its claims re: TCCC is crap I know the difference between TCCC and CoTCCC.

Philip Lee
Philip Lee

The CAT is DOD approved...by regs the only one issued, and combat proven...that aside, if I don't have my IFAK I'll use what I have available to stop bleeding...

Jim Stutzman
Jim Stutzman

Lot of people here that have no idea what they're talking about. Shocking.

Aaron Furey
Aaron Furey

Garrett, i have extensive experience in EMS and surgery. I prefer the RATS for my personal kit and have multiple. YMMV Real world testing of a TQ is not difficult. Elevate limb, squeeze out blood, apply TQ, check for pulses and skin color.

Wayne LeKnux
Wayne LeKnux

SurvivorMed you are mistaken they are proven on the battlefield, you should do some research and you can find multiple highly experienced medics from Afghanistan and Iraq who have used them. Check you facts

Wayne LeKnux
Wayne LeKnux

Its sounds like you have used them incorrectly which is a short fall of the RATs, it is very easy to assume what the proper way is when actually it is not. I would want to confirm that you used the three finger loop and formed a truckers hitch. If you did, it would preclude the issues that you discussed above (tightness and stability in position)

Wayne LeKnux
Wayne LeKnux

Jeffrey Hensley the article you posted actually makes a great case for the RATS due to its elastic nature ....

Wayne LeKnux
Wayne LeKnux

Eric Southland once again, saying you are TCCC without the endorsement of the copy write and trade mark holder is a crime and I am sure RATS does not want to end up in a litigation case. We are a country of laws and just because you dont like the law does not mean that it is not enforceable. In my opinion RATS is doing the right thing by following the USPTM office's ruling.

Wayne LeKnux
Wayne LeKnux

Your article clearly states you have never touched a RATS much less tested one

Wayne LeKnux
Wayne LeKnux

Survivor Med, by you stating that you are teaching TCCC you are guilty of the same marketing you are bashing RATS over. If you are not currently in the military or a contractor to the military and CURRENT you are not qualified to teach TCCC. SO you stating that you hold TCCC classes is actually a marketing ploy that is illegal by way of copy write infringement. Like it or not we live in a nation of laws.

Wayne LeKnux
Wayne LeKnux

Simon-Luc Lavoie you need to go to the site and see the multiple testimonies by MDs that have confirmed .... check your facts

Wayne LeKnux
Wayne LeKnux

Pitre, if you are interested in your brother why do you push a TQ that has a 10% failure in combat? ( https://www.naemt.org/docs/default-source/phtls-tccc/10-29-14-tccc-updates/cotccc-meeting-minutes-1402-final.pdf?sfvrsn=2 ) that was Ranger Regiment 2014, and has serious effectiveness issues when used under stress ( http://publications.amsus.org/doi/pdf/10.7205/MILMED-D-13-00311 ) or has ranked low in tests by its evaluators? ( http://www.gohandh.com/wp-content/uploads/2010/06/TQKREPT2007.pdf) you sound like a smart guy ... there are multiple examples and studies of the failure of the CAT and SOF-T by doing just a cursory search. Think twice before disparaging another TQ (or any other thing) that you have never actually trained with your self.

Wayne LeKnux
Wayne LeKnux

Jeffrey Hensley I read your article, and I think you need to read it too. If anything it is an article in favor of the RATS due to its elastic nature. The RATS width is made up by multiple wraps. Um ... bad example

Eric Reineke
Eric Reineke

The tccc os also now a NAREMT program last I checked.

Garrett Goodwin
Garrett Goodwin

So you've actually used RATS in a field environment and applied it to PT's ?... How many times ? What where the injuries ? Ect ....

Eric Reineke
Eric Reineke

I've seen this. I like the rats tourniquet. But I do agree it is misleading.

Roy Sargent
Roy Sargent

The issue is more at work then not. We aren't permitted to visibly carry a tourniquet (I know it's backwards and it isn't right but policy is policy) so this under the belt is just about the only option to have one on me that is readily accessible with either hand.

Hooch Jones
Hooch Jones

Why does this feel like a weaver vs isosceles argument lol.

Tom Mason
Tom Mason

Just to the right of your belt buckle on a horizontal carrier designed for this purpose. Works pretty good for a low viz setup.

Mike Foster
Mike Foster

Yeah its small and compact for EDC, but what if your unconscious and need it applied to you? Will someone be able to? This isn't a normal TQ.

Joshua Payne
Joshua Payne

In a hospital environment Philips healthcare cardiac monitors can use the NiBP to apply a TQ using the cuff.

Eric Southland
Eric Southland

Yep, it was obvious who ever was posting for RF that day was out of their lane when replying. If you sell a medical product and someone asks for data on it there should be a professional response. Problem for the RATS and all their resellers is the data doesn't exist.

Aaron Furey
Aaron Furey

ITS Tactical, I always value your opinions, and I know you do your homework. However, with experience I have come to doubt most "Approvals" and find that they are usually a minimum standard at best. Since this thread has turned into somewhat of a TQ war, my f/u question would be: Do you have the specific TQ standards and testing procedures used by both parties in question? It's not uncommon for independent companies to have higher standards than the current "authority" in any given topic or product. Your thread calls the integrity of the inventor into question, but without knowing what the testing standards were, we have no idea where his true intent lay. Remember that ALL leading approval authorities started out small at one point and all testing standards are essentially made up. IMHO this would be the only way to make an "apples to apples" statement.

Aaron Furey
Aaron Furey

Eric, Every piece of gear has different requirements depending on intended use, budget, amount of real world data, etc. Each product would require a separate answer to your Q and could be a paragraph, or a page. Do you have a more specific Q?

Ken Bass
Ken Bass

Someone asked REFactor, they flipped out on them and berated them and asked if they required medical verification on their band aids as well.

Ross Elder
Ross Elder

If people aren't smart enough to know the difference or are too lazy to research a product, I don't want them in charge of my urgent care either. Just sayin. Explaining a dislike of a product based on the stupidity of care givers doesn't do much to instill confidence in our first responders.

Eric Graves
Eric Graves

I'm curious Aaron, how do you conduct testing or those products? And what standards have you established?

Nathaniel Welsh
Nathaniel Welsh

I take the time to research any product I by to ensure it is of the quality I want/ can afford, therefore laziness doesn't qualify as an excuse to me

Eric Southland
Eric Southland

This is exactly why this article calls it like it is. Saying that people are not smart enough or lazy because they don't follow the industry is crazy. Do you follow every medical study on the food you eat?

Nathaniel Welsh
Nathaniel Welsh

Does it say CoTCCC? No it says TCCC it is only misleading to those who are not smart enough to realize there is a difference or those who are to lazy to care to know any better, at this point it is all conjecture anyways until a proper stud has been done by someone other than a CATs or soft-t loyalist, to ensure that the data is not tampered with

GeorgePotash
GeorgePotash

Nathanial Welsh, I have to wonder about your association with this company. I was in the LE tactical world for a while, and have just started to move in those circles again. I was familiar with CoT-triple-C for years, but I've NEVER heard of TCCC (the company) EVER. Except for this article, I would NEVER have realized the RATS was not approved by CoTCCC, as that is the ONLY T-triple-C I've ever been familiar with. Mr. DiGiorgio is OBVIOUSLY trading on peoples' familiarity (or passing familiarity) with CoTCCC. My opine? Tactical Shiestmeister. RATS looked good, but Digiorgio's game has turned me off of it. This is good intel, and I'll be passing it around.

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