"... A more recent study from the campaign in Afghanistan found that in 83% of CAT applications distal pulses were present, indicating ineffectiveness...
It was found that the leading cause to failure was applying the device loosely ...
Furthermore, excess wind-lass twists might cause the cat to roll and even break."

"Between February and May 2010, 1st Battalion, 6th Marines reported a 10% (10/92) breakage rate for tourniquets. "

"A recent analysis of combat casualties indicated a 21% failure rate for the Combat Application Tourniquet (CAT) ... However, even after 4 days of training, one-in-four participants failed in pulse elimination using the CAT"

"Ninety one percent of participants achieved effective occlusion pressure with the IST compared with 73.1% with the CAT. Our findings negate the common belief that windlass tourniquets, such as the CAT, are superior for controlling bleeding in thigh injuries."

"45 of 179 user performances (25%) were competent. Users who reported high confidence had only a slightly higher chance of achieving competence in tourniquet application ...
The most common reason for failure was excess slack in the CAT's strap (experts 55%, users 39%), and too few turns of the windlass (23% and 31%, respectively) was the second most common reason. "

" Tourniquet application is an easy, fast, and cheap method for prehospital control of perfuse limb injuries and might be live-saving ...
Nevertheless, to minimize complications, ischemic time should be as short as possible"

"The CAT, SAMXT, TMT, and SOFTTW all failed on the 5.08 cm diameter mannequin."

"On the upper arm, the silicone ring tourniquet was associated with a significantly lower pain score than the pneumatic tourniquet. The incidence of paraesthesia was also lower with the silicone ring tourniquet. ...
the incidence of paraesthesia was again lower with the silicone ring tourniquet."

"Patients demonstrated quick application, superior exsanguination and that the device could be placed on the forearm instead of the upper arm. No side effects or complications were noted."

"SMART™ tourniquet provides a good intraoperative haemostasis and is easy to apply."

"We outline the reasons of why we feel that this device provides a safe and effective bloodless field and the benefits of its use."

"The data described above clearly document the superior safety track record of the elastic exsanguination tourniquet (S‐MART/HemaClear) over the wide tourniquet ...
The fact that the patient’s skin tolerates the SMART/HemaClear better than the wide tourniquet cuff ...
These features are accompanied by other advantages: the overall lower volume of tissue that is under compression"

"CONCLUSIONS: We conclude that this sterile elastic exsanguination tourniquet is effective and safe in preventing bleeding during (ForeArm Upper arm: dialysis access procedures)"

sa "...better pain tolerance and produces less parasthesias as compared to pneumatic tourniquet."

"This preliminary study shows that the use of the new silicone ring tourniquet may present with some advantages over the use of a standard pneumatic cuff tourniquet"

Many of the fake CAT Tourniquets appear legitimate and could pass a casual inspection. But they are not reliable due to the quality of materials used and the methods of production and assembly. Counterfeit tourniquets are known to fail — the windlass may break off in your hand or bend so that it cannot be secured, the buckle may fail, and internal stitching can come apart. If the tourniquet fails, severe bleeding will resume, endangering the injured person and decreasing their chance of survival.