I gotta say, based on the feedback I’ve seen online regarding the counterfeit tourniquets, it looks like there is a lot of hate for tourniquets out there. What’s the deal guys?
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Should be no hate toward a properly placed TQ. Problem people run into is inexperienced people putting these things on and cause horrible tissue damage. I would not trust anything that is not the real thing ether. The original C.A.T. Has save many a lives and I have seen it work first hand on more the one occasion. I have also seen soldier die from exsanguination from improperly secured TQ. Just IMO
TQs save lives – when properly applied, and when recognizing their inherent device-specific limitations. I have no hate for TQs – but I do dislike the pseudoscience used to justify or damn them.
As with any medical device, they take initial instruction and practice, practice, practice. My rule of thumb is that whenever you’re practicing something as frequent as mag changes or weapons transition – which EVERYONE who wears body armor for a living ought to be doing very regularly – you have a friend help you drill out TQ placement.
Here’s how I do it: Practice per usual, using your own familiar method. A friend standing nearby calls out something akin to, “Boom. Major bleed to right thigh, you’re down”, and after falling to the floor more or less appropriately, apply a CAT to the appropriate extremity. Don’t do this, obviously, until you’ve gotten appropriate instruction from an appropriate body on the proper way to execute it.
If it needs to be said, don’t tighten the thing all the way, either, not in practice.
The only way to become smooth at a mechanical skill such as TQ placement (or mag pulls, or transitioning from rifle to pistol, or a thousand other things) is to practice it a really lot of times. Not till you can get it right, but until you can’t get it wrong.
At least on the civ LE side, I’d really like some insight into how often they are used, and to what effect. The traumatic amputations at Boston were one of the first events I can think of where there would be multiple needs. The only times I’ve had anything approaching a need involved things like chainsaw accidents and swimmers going through boat props. Domestic GSWs to extremities just aren’t that serious, unless they hit a major vessel. The odds of that are far less than that same vessel being severed by an IED.
I carry them, and took the course, but sometimes i wonder if they are one of those spill-overs from the military that worked wonders in that milieu, but aren’t needed that frequently at a domestic shooting. The mechanisms and severity of injuries are so different, and while some say that they can’t do any harm, others don’t seem so sure. The trauma doc who taught us said to use them whenever we felt like it, but he couldn’t cite many times that they’d been used, nor whether the same bleed couldn’t have been controlled by direct pressure.
I’m waiting for some well-intentioned but over-equipped cop to try and pound a needle through somebody’s trauma plate to do a chest decompression after the victim was shot in the shoulder with a .25
The TQ’s I carry are in general for me or my compadres. I would use them on someone else, but due to response times that’s unlikely.
They do a job. If you can stop it using pressure, then you should use that. If not, a TQ will do the job. A GSW that is serious will have you dead pretty quickly without stopping blood loss. Try ripping your shirt and using your ASP to tie a TQ in 30 seconds under normal conditions. I’d bet my miniscule paycheck you can’t do it. Guessing whether or not you get shot and whether or not it’ll be serious is a silly game to play. It probably weighs less than 8 ounces, how hard is that to carry?
In general 99% of the trauma calls in the civilian world have no need for a TQ. I know as a paramedic in Aurora, CO I have yet to come across the need to use one yet but as a Army Medic I used them a lot. But I like knowing that I have it on the civilian side if and when I need it. Every system has differant protocols on the use for them.
Thing is, if all you need is compression, slap an Izzie on it and elevate the part with the hole in it. Gravity can be a cruel mistress, but she’ll help out if you give her the the rough stuff.
TQ use *can* be unnecessary in the “if I don’t do this, this kid is gonna die” sense, but if what you need is to stop an extremity bleed RIGHT NOW and get back in the fight (first line treatment for potential new victims is your weapon), then apply a CAT quickly (if your guy cannot) and Carlos Miguel.
Overall, use your head. Once a TQ is on, it’s on until you get your kid to definitive care. If you do something silly like, I dunno, loosen it because it’s “been on a long time”, you just release a big bag of potassium into your patient.
While that will definitely shorten your patient care time, it will generally make whoever does it miss that elusive “Team Player Of The Quarter” board.
I like the fact you’re questioning things Bill, but some of your assumptions are contradicted by mountains of data. It’s not just blast injuries that require tourniquets, but GSW’s. GSW’s can be very severe with life threatening hemorrhage, and direct pressure doesn’t allow you to get your gun back up. Besides, do you know how to apply effective direct pressure? And how long can you maintain it? Especially when it is self-aid! You have to look beyond local case studies to national and international events and you’ll soon realize the magnitude of requirement.
The USAISR, and specifically Jim Kragh has compiled more data documenting efficacy and safety of tourniquets than at any other time in history, it’s any wonder how there is still anti-tourniquet dogma circulating. Or for that matter, doubting the requirement. I would also argue that with the advent of super fast working hemostatic dressings, that those two pieces of gear should be mandatory for anyone wearing armor, carrying a gun and putting themselves in harms way on a daily basis. It weighs next to nothing, and cost is minor when you compare having it and not needing it to needing it and not having it.
My agency went department wide with tourniquets around 7 months ago. Prior to that, only our SRT folks had them and we still managed 4 legitimate uses is about a 4-5 year period.
4 uses may not sounds like much, but in the civilian world, for one agency, it is huge. The injuries encounteres were stab wounds with confirmed arterial bleeding and two shootings with severe, undetermined bleeding.
Everyone gets a set amount of medical training in the academy plus an hour block of instruction dedicated to tourniquets and the do’s and don’ts. This gets refreshed every 3 years by cycle. So far, so good.
Also, for a better illustration check out Pima County, AZ’s program. They have several confirmed saves during the Gabby Gifford’s incident.
My agency (fed le) has a POI based on TCCC. We issue an IFAK. We have had several successful TQ uses due to GSW’s.
Any chance of getting a look at that POI? Would like to compare it to some other LEO based POI’s I am working on with other guys. Thanks
I try to carry a TQ whenever I carry concealed. I also keep one in my car. A CAT fits very conveniently in the carpenter pocket of carhartts or any utility pants. I figure I have no reason NOT to carry one.
To be honest SSD, I think there is just a lot of ignorance and misinformation floating around out there about tourniquets. Part of the problem is a lack of training or training conducted by companies that run cookie cutter, regurgitation curriculum without any critical development. The instructors teach the curriculum but don’t know the ‘why’ of the content they are teaching. The vast majority have not read, not are versed in the plethora of data from studies that have been conducted on tourniquet use, nor are they able to discern which of those studies are good and which ones are bad or biased. Why do you teach that? Because that is what the TCCC curriculum says (and even then, far too often misquoted or misinterpreted). Companies teach bad things, like regardless of injury location, place the tourniquet as high as possible on the limb. And I bet that someone will argue that here! Ridiculous! And that’s just one example. Honestly, in my biased opinion, it’s ignorance of true facts, current data and a lack of quality training.
So do you guys hate pencils for making spelling mistakes too?
Anyone who “hates” a TQ or shits on their value has likely never been in actual combat with people getting shot and/or blown up.
30 years Full time EMT Medic & field Sup. Oakland and San Francisco. TQ use is very rare to say the least. But when you need one you really need it. BP