Tourniquets Jun 15,2017

Medical ( Hemorrhage Control )


TOURNIQUETS

You Can’t Live Without Them

By Patrick O’Neil

 

The tourniquet has evolved into the single most important piece of equipment for saving lives on the battlefield.  It also has proven itself in civilian trauma and is now routinely found in ambulances and police vehicles across the nation.  It has changed the way we treat casualties and changed our way of thinking regarding this technique.    But first, a little history and background.

Military medicine has produced some of the most significant advances in medicine in the last 150 years.  Most of those advances have been in the area of trauma medicine, just as one would expect.  It seems as if every time we enter into a new conflict, we develop new techniques or new equipment to better treat our battlefield casualties.  These advances then find themselves filtering over into the civilian sector and onto the ambulances and emergency rooms across America.

For quite a number of decades, the tourniquet was treated like the proverbial "elephant in the room."  We all knew it was there, but nobody really wanted to talk about it.  We were trained in how to improvise a tourniquet by using a cravat or bandage, along with a wooden dowel or stick.  But, it was always considered as last resort measure to be avoided for fear of losing the limb. 

As a young medic, I had it beat into my head the principles of Elevation of the extremity, Pressure Points, Direct Pressure, Pressure Bandage, and then the “dreaded” Tourniquet.  I even had an instructor once tell me that if I ever had to resort to using a tourniquet that I should consider myself a failure as the other methods would surely work.  (Obviously, this guy had never seen any real combat)

The military was so against tourniquets that they were not given to the individual warfighter.  Only the Medic or Corpsman might have one in their bag.  I carried one, but it was an absolute piece of junk.  The buckle failed quite often and on a person with a big thigh, I could not generate enough pressure to stop the hemorrhage.   I eventually stopped carrying it because it didn’t work worth a damn.   Amazingly, this anti-tourniquet mentality persisted throughout WW I, WW II, Korea and Vietnam.

In the mid-1990’s, the thought process started to change within the Special Operations community.  Multiple Operations throughout the world were causing the military medical community to take pause and look at the deaths we were experiencing on the battlefield.  Some important questions were asked when they reviewed the data, and one of these was:  Why are we losing people from extremity wounds?

So I am going to just throw this out here and make the statement:  Nobody should die from an extremity wound.  Period!  If enough pressure can be applied to the extremity, the artery will compress against the bone and bleeding will stop.  It is as simple as that.  No rocket science.  No advance medical degree needed.  It is a simple matter of applying substantial pressure to compress the artery.

Yet, if it is that simple, then why were we losing so many personnel?  The answer was in how we trained and outfitted our personnel.  The warfighters were taught it was “a bad thing” to put on a tourniquet.  So while they were wasting precious time trying to stop a major arterial bleed using inadequate methods….the red stuff that you want to keep in the body was spilling out all over the ground.  If you lose too much of the red stuff, you die.  Again, this is not rocket science.

As we entered into the Iraq and Afghanistan Wars on Terrorism, the military was already in the midst of changing how they trained and equipped the warfighter.  Everyone was issued new Individual First Aid Kits that included a Combat Application Tourniquet (CAT).  The military looked at many different tourniquets and selected this one for a variety of reasons.  It had to be able to be “self-applied” by the wounded warrior utilizing only one hand.  It had to be very durable.  It had to be able to stop both arm and thigh arterial bleeding.  Finally, it had to be easy to use so the personnel would not readily forget how to apply it.

Combat Application Tourniquet

With the new training and everyone on the battlefield carrying a CAT tourniquet, survival rates soon went up dramatically.  This was even more impressive when you realized that the enemy was using extremely powerful explosive devices against both personnel and vehicles.  It was fairly common to see multiple traumatic amputations on a single casualty.  These warriors were surviving injuries that would have meant sure death in previous conflicts.  The tourniquet had proven its worth and we even started seeing warfighters carrying two or three tourniquets on their body armor.

As far as I am concerned, every First Aid Kit should have at least one tourniquet.  I believe in keeping it simple, so this is the tourniquet that I recommend.  The military did a ton of research on which tourniquet would best meet the needs of their personnel.  Consistently, this has been the one chosen and it has proven its worth over the course of these wars.  

Now, beware of CAT imitations!  We had an issue in Afghanistan with cheaper versions that units purchased thinking it was the same thing.  They were defective and failing on the battlefield.  An immediate safety notice had to be issued and every one of the fake CATs had to be identified and removed from the units.

I have placed a link to the CAT website where you can obtain more info on the product and also watch some videos on how to apply it.  One important thing to remember is this:  You will want one to train with and that will be its only function.  Technically, once you use it, you aren’t supposed to use it again for life saving purposes.  So buy as many as you need for the home, car, office, backpack, etc.   Make sure you have one that is used only for training.  These things aren’t cheap, but this is not one of those items that you want to cut corners on to save some money.  When you need a tourniquet, you want to make sure it will work right the first time…..and that it won’t fail you.

Here is the link:  http://www.combattourniquet.com/

The website will have some videos that show you how to apply the tourniquet.  They do a great job of showing the technique. 

    

Another tourniquet that is currently used is the Special Operations Forces Tactical Tourniquet – Wide (SOFTT-W). This is another fantastic tourniquet.  This one is a little more durable with a detachable metal buckle.  It can also be applied with one hand and is the same width as the CAT.  One of the things I really like about this tourniquet is it has no Velcro.  There have been times when the Velcro has been a real pain in the rear as the tail tends to stick to itself.  If there is a drawback, it is that the strap is fairly slick.  In the video where I show self-application of the SOFTT-W on an upper extremity, I had issues with it sliding as I tried to pull traction.  Not a huge issue, but it did slow down the time it took to have it secured in place.  There have been those that have said these tourniquets do not work well on children.  This has been debunked by videos showing these being placed on very small children with success.  In those instances where you have an infant with an arm that is too small, an improvised tourniquet can be utilized very easily.  There is also a video where I will be showing the correct application for both of these tourniquets.

 

 

SOF-Tactical Tourniquet wide

The only thing I want to add is that tourniquets cause a lot of pain.  They hurt like hell!  As I am starting to put the tourniquet on, I am telling the person, “Hey, buddy, I got you and I’m putting on this tourniquet to stop the bleeding and save your life.  It’s gonna hurt, but I need to get it on.”   This helps the patient to understand the seriousness of what you are about to do and to prepare for a whole lot of pain.  It doesn’t matter if the patient is screaming or writhing in pain, you must make sure the tourniquet stops the bleeding.   You might as well not even put the thing on if it isn’t applied correctly and with sufficient pressure to stop the hemorrhage.

 

Amateurs train until they get it right.  Professionals train until they can’t get it wrong.

 

Other hemmorrage control devices / recommended for you basic trauma kit

         

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