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Tourniquets?

Discussion in 'First Aid Station' started by filjos, Jul 25, 2012.

  1. Lannister
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    I agree with your take on the TQ in an urban environment. Very few instances apart from traumatic injuries (amputation or partial amputation) would require the application of a TQ. They are also limited to limb injuries. Never use on a neck bleed :rolleyes_revamped:. Direct pressure works sometimes on minor to medium bleeds, for anything above, less efficient, but still useful.

    When it comes to FA, I always try to impart the following on people when it comes to FA and medical interventions: The fact that you can buy the kit doesn't mean you can or should use it and even carry it. This is why some kits/items are only available to professional and/or under prescription from a Doc. Kit acquisition should always come with proper training. The corollary to that, as I mentioned in my post, is that to use a TQ, you have to know how and when. In FA there is a definite potential to do more harm if you engage in "care" without knowledge. You have most likely heard of the Motto: Do No Harm, Do Know Harm....

    As an aside, I strongly believe that First aid, CPR and the use of AED, (even though they are pretty much "moron proof") should be thought in school.
     
  2. JIM
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    How long does it take to bleed out? There's your answer.
     
  3. Flight-ER-Doc

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    Depends on whats bleeding....but eve a TQ isnt the be-all, end-all....there are critical places that can bleed that a TQ won't reach.
     
  4. ac7ss
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    jugular. :) I suppose you could TQ. :devil:
     
  5. NCMedic

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    There is some research to support that rapid application of a TQ before the patient becomes "shocky" their survival chances are increased. Also application in a urban environment with limited help frees you up to do other functions, you can't evacuate a casualty and provide direct pressure effectively.

    Sent from this... Using that...
     
  6. KB3UBW

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    It depends on who it is...:devil:
     
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  7. VinnyP
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    It's taught in a lot of "Standard" first aid courses now thank god. Very rarely necessary is not unnecessary, where it's necessary it is genuinely the difference between life and death. This is a forum where many people carry guns, whatever your viewpoint if you prepare for the rare scenario where you might need a gun, then you probably should prepare (And train) for the far less rare scenarios where you need a TQ especially as weapon injuries are often one of the occasions when you will reach for one. I am not sure of your response times but if it's 5 minutes from the call or 5 minutes from the injury then the time from the injury to the time that the responder can get a TQ on is a lot more than 5 minutes. Direct pressure can slow or even control some catastrophic extremity bleeds but if a TQ is an option it is the far better option.
     
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  8. Flight-ER-Doc

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    Very well said.

    And I've discussed the problems with direct pressure earlier, as well as blowing out clots.
     
  9. ac7ss
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    Next spring, I will address those concerns to my instructor. (That is when I am due for a refresher.)
     
  10. JIM
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    True, fortunately the tq (and hemostatic agents) keeps developing:

    http://www.speeroptech.com/page6/index.html
     
  11. SurvivePenna
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    I had given up on including a tourniquet in my FAK that I'm putting together. Then when I received the packet with my Student Handbook (and a Quick Reference Guide) for my upcoming first aid class, I was sort of surprised to see the use of tourniquets listed as a common "procedure" both in my handbook and even more surprisingly in the Quick Reference Guide. My first aid class is a very basic (stadard) first aid class payed for by my employer (the company) and it's taking place in-house. Class materials (Student Handbook, Quick Reference Guide etc.) is supplied by The American Heart Association.

    www.heart.org

    I opened the QRG first and opened the page that said..."Bleeding You Can See and Tourniquests". Beneath that it says..."What You Do"
    I'll quote it like it appears in my QRG :

    • Apply a dressing and put pressure on it.
    • If bleeding continues, add more dressings and press harder.
    • Use a tourniquet if needed. Place it 2 inches above the injury if possible. Tighten it and note what time you put it on.
    • Check for signs of shock.
    • Phone or send someone to phone your emergency response number (911).........

    I would really like to hear your thoughts and input on this. I have taken the time to read this entire thread and done some additional research. I'm not a doctor, nurse or medic etc. The only training that I have is the standard CPR/AED class that I have been taking and re-certing every 2 years for many, many years.

    Now...don't get me wrong... I'm happy that I will be taught how to use a TQ, but after reading this thread I'm not quite sure if it is not a little crazy and extreme...I mean we are talking about basic first aid...right ??? I guess my point is that if I'm being taught this...then gramma and your 14 y/o son or daughter...anybody... will be taught the same if they attend a class like this.
     
  12. Flight-ER-Doc

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    Yeah. So?

    Tourniquets save lives. Simple as that. There are instances where direct pressure will not control bleeding. Unfortunately, accident victims lack the power to schedule who their rescuers are. And using a TQ isn't rocket surgery.
     
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  13. ac7ss
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    Better to have it and not need it (they are small) than the other way around.
     
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  14. ChaseKenny

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    Doc, I just want to touch on this a bit.

    Initially we were told one or two TQ's in the IFAK like you mentioned. I always thought that was stupid to have them locked up in a pouch that had a buckle that was near impossible to open under the perfect circumstances. So I always carried mine around my midsection where they were readily accessible (I also tried to carry 4 when possible, we have 4 limbs right?). After we started taking so many casualties (3/5, Sangin) unit SOP changed real fast. And from then on out all across the board thankfully all I have heard is carry them on your body where they can be easily seen, and grabbed. Its too bad that it takes a number casualties for people up the chain to realize what they had preached before, turns out to be a bad idea.

    Also I hate CAT TQ's, velcro is a terrible mechanism to use on such a critical piece of gear. It snags on it self when you're trying to loosen the TQ and apply it, velcro fails and the TQ loses (loses looses? just MF'd myself) tension when covered in blood, the end of the velcro tab will easily snag on other gear, branches, twigs, weapons, gloves, etc and rip open your TQ losing all tension. Once we received the SOF T's, I threw out all the CAT TQ's. I dot want my life in the hands of velcro, so why would I entrust my buddies lives in it to?

    And I can't say enough good things about how well a properly applied TQ works. I have unfortunately had to treat one of my fellow Marines, double leg amputee just above the knee. We applied SOF-T TQ's to both legs in under 60 seconds, effectively stopped almost all the bleeding. He was bleeding about as much as a very small nosebleed, and was completely conscious during the hour and a half it took us to carry him and fight our way back to the FOB.

    After seeing the effectiveness of TQ's first hand on multiple occasions, I will never be without one somewhere close by. I personally know many double amputees, a few triple, and one quadruple amputee that have survived and are living healthily today because of TQ's and proper training.
     
    Last edited by ChaseKenny, Nov 28, 2012
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  15. SurvivePenna
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    Thank you for your input. A C-A-T tourniquet it is...
     
  16. ChaseKenny

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    No problem. Shoot, if I was home I would toss one in the mail and send it your way. I have 4 or 5 CAT's still brand new in the plastic wrap sitting in my CLS bag. My Doc was a little upset when he found out I snuck that brand new stocked bag home. :) Suppose I should save them for Zombie Apoc or something anyways.
     
  17. SurvivePenna
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    I'm fighting some problems with my internet connction tonight. I made my post at the same time as you, but took my time as I was pondering my answer and then I had problems with my connection and when it finally posted...you had called my choice of tourniquet a "terrible mechanism to use on such a lift critical piece of gear". I guess I'll have to do some more research. Perhaps a great place to start is to attend my first aid class first...and then go from there. One of the good things I have heard about the C-A-T is the ability to place it on yourself in a real bad situation where you are all alone. Your post is very compelling and I thank you for it.
     
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  18. ChaseKenny

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    No worries!

    Dont get me wrong, the CAT is still a good TQ but for my uses in a very harsh environment, I just didn't like them. In normal day to day scenarios, I'm sure they will work just fine. In extreme scenarios is where they tend to be an issue, you wont normally be dealing with mud, excessive blood, dirt, debris, moving the casualty hastily out of a kill zone, gear and weapons flopping (I hate 1 point slings) around snagging on them, mandatory fuzzy nomex gloves love to stick to everything velcro, etc etc etc. There's so many factors that play into my dislike for the CAT that probably wouldn't even exist in a civilian type scenario.

    And for self application, I also prefer the SOF T. We would prep our TQ's so that the male end was threaded through the buckle just enough to get a good grip on it with your hand. Tighten the tensioner screw down all the way, you can still freely jerk the TQ tight and it will not back out when done this way. Then you slide the entire loop over the limb up just above the injury with the buckle oriented towards your good arm. Then you give the male end a few swift jerks (male end and swift jerks shouldn't be in the same sentence ;)) closing the loop and tightening it as much as you can before cranking the handle down to get the TQ nice and tight. Then secure the winding with the securing rings, check to make sure the tension screw is still tight, and get yourself to some help.

    This also reminds me how much easier SOF T's are to apply than the CAT's, when pulling a CAT tight before cranking on the winding, the velcro likes to grab and bind up on itself making it much more difficult to get snug before the final tension is applied. I have seen many many Marines while practicing think they have tightened the CAT tight before twisting the handle, but in fact it is usually so loose I can fit my hand between the TQ and the leg of the practice partner. I usually let them continue and they try to tighten the winding down as much as they can until they run out slack, and in the end they still have a loose TQ. If you dont catch this on the initial application, you will waste critical seconds by having to undo the winding, go back and try to get the TQ as tight as possible, then continue to re tighten the winding once more.

    I hope all of this makes sense, and If it doesn't please let me know! And thank you for the kind words, I am just glad I can share my experiences and help others.
     
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  19. Joelski

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    I've placed a lot of TQs and never once have I personally seen a CAT fail. To each their own, but I think if your tq is saturated in blood to the point the velcro fails, you can probably call it a day on that'n.
     
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  20. VinnyP
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    What he said. I marginally prefer the SofT but both work really well and the Cat is half the weight and a wider band. Whilst even in reaI wet and muddy places the velcro hasn't failed I can't get my head around the velcro issue at all; you can leave the end dangling and it will still work fine so functionality is not really impaired either way.

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