tourniquet: a device for stopping the flow of blood through a vein or artery, typically by compressing a limb with a cord or tight bandage.
Note the keyword "limb". Neck tourniquets are saved for use on murderers, terrorists, traitors, serial rapists, child molesters, politicians, telemarketers, people who drive 40 in the left lane, and any other of the most egregious criminals in society.
Historically, tourniquets were considered the Dark Arts in medicine, esp. field medicine, because you were "sacrificing a limb to save a life".
That's how they used to be, mainly because they were done with actual cord, wire, leather straps, and narrow bandages. And thusly set up, sacrificing a limb is exactly what they do.
Do NOT do that.
A) Because you're a dumb@$$ if you do.
B) Because we have far better materials, and much more knowledge, training, and recent experience, plus hugely better examples to work with nowadays.
Peer-reviewed medical journal articles, and better equipment, have documented conclusively that tourniquets applied in battlefield situations have been left in place for up to six hours, with no neurological or functional deficits noted afterwards. Six hours from application to removal in surgery is one helluva window for first aiders.
So how can you take advantage of it?
CAT
The original, and gold standard. For sale by North American Rescue for $30@.
You can put it on one-handed, crank the windlass until the bleeding stops, velcro it down, and drive on. One and done. You have four limbs; you would be well-advised to have four tourniquets handy, somewhere nearby. (Not all on your weapon, belt, etc., but one on the weapon, one on the belt, and two more nearby in a kit/pack/car would be a great way to go. When you need one, you'll need it right effing now, not in 10 or 45 minutes.)
How easy is it to use?
One-handed, total time (with slow instructions), 00:01:15 to apply, from on to done.
You should carry extras.
I probably have a dozen or two of these, including a couple of orange ones I use just for training.
Why so many?
Power tools: in the shop FAK.
Vehicle kits, each, and extras.
Chain saw: on the chaps belt.
Shooting range cart: a mittful of 'em.
Big Boy Military Rules: your tourniquet is for you, your buddy's tourniquet(s) are for him.
He doesn't have any? How much do you love him?? Srsly. Explain the facts of life to him, and wise him up.
You only have one? How much do you love yourself??
These have been around for years. They're already up to generation 7, or more (I forget). Older ones still work. Why are they generally single-use? Blood contamination/decon. Critical life support gear. You already wrote the time applied on the used one.
But after TSHTF, when re-supply is a critical problem, you may be less finicky about throwing them away after a single use vs. attempting to decon and re-use them.
***Important safety tip: Beware of Chinesium fake versions!***
They're out there, and in abundance, especially from the idiots at Amazon and affiliates. Buy yours from a reputable brick-and-mortar or online dealer. (Hint: "Reputable" does not mean "cheapest". That's a fool's economy.) I have a 5.11 store nearby, and NAR has a solid gold rep online. So do some others. But a Tupperware bin from Bubba's Qwality Medikal Emporium And Knives at the gun show is caveat emptor, unless you know Bubba personally, including his home address, and trust him with your life. YMMV.
And if you ever get stuck with one you can't get a refund for, smash it and burn it, just like you should for unfixably bad weapon magazines. Like fake $20 bills, don't palm off your bad counterfeit on some other unlucky schmuck. Take one for the team, and fold, spindle, and mutilate those POS fakes, with extreme prejudice.
If you find someone selling them, tell them.
If the seller doesn't offer a refund, or fold up their tent, out them ruthlessly and often until they do one or the other.
SOFT-TW
Same idea (not better per se, just different, IMHO) than the CAT, with an aluminum (versus hard nylon) windlass. And again, about $30 from Tac-Med.
Application? Pretty much the same.
Unlike the CAT, it comes pre-threaded. It's beefier. It has a belt-and-suspenders method to secure it. And comes in a couple more colors than the CAT.
It's also heavier, and tiny bit bulkier.
You pays your nickel, and you makes your choices. There's nothing wrong with either one, and I'd be fine using either one. I don't care which one you like better. It's a chocolate/vanilla question.
X8T
Stick it in and give it a spin. Click and crank.
Just another way to skin the cat. About $38 at Rescue Essentials.
Others
There are also straps, like the Touniq-Kwik/TK4, and the SWAT-T.
The TK4 is really just a strap that you shove something in and twist, which is a flashback to 1940.
The SWAT-T is really more like a phlebotomy tourniquet on steroids, allowing you to make a pressure dressing, but probably a lot less occlusion of bleeding possible than a CAT or SOF-T-TW, and if you try, you're warned not to pull it that hard by manufacturer materials and videos. But it could replace or supplement ACE wraps, etc., in a kit where space is at a premium.
Getting into the Stupid Zone, there's the SAM Junctional Tourniquet. It's a bona fide medical device, complete with BP cuff inflation bulb, and works for pelvic fractures and other hard-to-tourniquet spots like armpits. But that complexity makes it iffy in hard use, and more failure prone. Plus, with a price tag of $350-$400+, each, (yes, you read that right) it's geared towards hospitals, public agencies with deep pockets, and solo users with generally more money than brains.
There are probably eleventy others if you dig deep enough, which I won't. These are the best quality of what there is, and most of what's out there, until someone else builds a better mousetrap. IOW, unless you've markedly improved on anything listed, IDGAD. As it is, I wouldn't use some of the above, but the information is there for those who march to a different drummer (or have their choices dictated by fiat from on high).
All of the above have How-To videos available on YouTube, etc.
TL;DRs
1)Get tourniquetSSS.
Plural. From many, to a metric fuckton, depending on what you do or think (or fear?) you'll be doing.
2) Train On/Learn How To Use Them.
On every type you have. Including one-handed, for self-rescue.
Not just watching the videos.
3) Practice with them.
Frequently. Get a dedicated trainer model, and practice hands on. Nothing less will suffice for mastery, especially bearing in mind that you or someone else will be screaming, in excruciating pain, and gushing blood when you're doing it. This is NOT something you want to re-familiarize yourself with OJT on the day, under those conditions. Learn now, succeed later.
With ALL of your tribe. Family. Co-workers. Team. Neighborhood security group. Hunting buddies. Circle of fellow BSers. Everyone who knows how to use one is one more person who could save lives if things get sporty. Teach people in non-tactical circumstances: power tools, chainsaws, auto accident response, CERT/earthquake/disaster preparedness. You don't have to approach everything like Paul Blart - Mall Cop, Tacticool Timmy, or Gunkid with his Tactical Wheelbarrow(tm). Exsanguination happens all kinds of times and places.
4) Stock them EVERYWHERE.
For all of the above reasons. In job lots.
Imagine you were a bystander at the Route 91 Harvest Music Festival. Or a cab driver nearby afterwards. Not just the staff at Sunrise Med Center ER. You don't have to be able to save everyone. But what if you could save one person? What if it was a family member, or friend? What if they could save you, the next time?
Get busy.
14 comments:
I have 3. Gonna buy more now.
Side note. I never thought much about chinesium knock off but recently a veteran friend wanted to recreate his service rifle. Gun show contact loaned him an aim point to look at. He noticed a different tint in the glass, called aim point gave them the serial number and yes he was correct. Pisses me off but made me more leary in purchases and who I buy from. If its cheaper buyer beware.
Thank you, thank you! I will be buying one of these wide ones to replace the narrow thing that is in my purse. I took training a few years ago after one of the church mass shootings, and at that time the trainer said the person would lose the limb if we used a tourniquet. Full stop. That bit of knowledge was never covered in our old Campfire Girls First Aid training, and it caused me to feel even less prepared than I was before the class.
Of course better than bleeding to death but still a sobering thought that would mean making a terrible choice whether or not to do something for likely the only time in my life while under deadly strain.
"have documented conclusively that tourniquets applied in battlefield situations have been left in place for up to six hours, with no neurological or functional deficits noted afterwards. Six hours from application to removal in surgery is one helluva window for first aiders. So how can you take advantage of it?[Image]CATThe original, and gold standard."
With this new bit of knowledge AND good, modern tourniquets, at least my imagination can calm down.
Aesop: Thank you for this, and a question: I got a CAT trainer and tried self application. All went well standing and seated. Then I tried one handed application while lying on the ground, and mostly couldn’t get it done applying to my L thigh with my R hand or vice versa, especially if my thigh isn’t flexed. (My spine is seriously messed up and just won’t turn or bend enough.) Two handed is not a problem.
I can manage a RATS one handed on those sites, so my current plan is RATS on my belt and CAT(s) in the bags. It looks to me as though four turns with a RATS should give wide enough compression area.
Does this seem reasonable to you?
The FD that sponsors my CERT team bought a bunch CATs. Issued to each CERT member and spares kept in our deployment med supplies bags.
We got some great training on using them from an Army SF team practicing giving training to "indigenous personnel" prior to deployment. (Which is what prompted the FD to buy the CATs)
I have old school medical training. I have read some articles on the, for me, new products to stop bleeding, sponges and powders, and the superglue wound seal. They seem like amazing products. However, both of these products require the wounded be taken to an ER, or to the trauma tent.
If you couldn't get to the hospital for weeks and had to attend someone with these products being used, what would you do different then st31-91b U S special forces medical handbook?
Of course I have acquired the new products for my kit, but I keep the old as well.
@Peter:
That only works if you're skinny. Try a RATS on a fat guy's thigh, and get back to me.
@stormsailor1981,
I keep ST31-91b as a paperweight, and historical reference.
Get (beg, borrow, or steal) the most recent update of the 2001 version of Special Operations Forces Medical Handbook.
It's 60 years newer.
Selling ST31-91B now, 60 years later, should be punishable at law for any use other than levelling table legs or a library of the archaic.
It would have been like referring to a surgery manual from 1900 at the time ST 31-91 was written.
Antibiotics alone have progressed three generations in the interim, and that's just for openers.
That said, some wounds are always going to require surgical intervention, or something like it.
Take a peek at my post in response to NC Scout's OP last week for some rough guidelines.
Doc- My Father used to say "now you're cooking". IMHO this kind of post is the reason G-d gave you your writing talent. Let's call it "Applied Professional Practical Guidance".
With two school age kids, and with volunteering in my kids' school, I have been looking for a tourniquet that would work on their MUCH smaller limbs. The intarwebs have leaned toward one of the stretchy bike innertube types, but I haven't seen anything definitive.
On the plus side, our school district is FINALLY* deploying bleeding control kits. Every AED cabinet district wide got a bag with a CAT style TQ, bandages, gloves, etc. It's not first aid, only bleeding control. The Director of Safety gave me two, so I have one in my classroom/lab and I gave one to my favorite gun store for behind the counter. Ultimately I'd like to see a kit with every fire extinguisher in every building district wide, but it's a better start than most.
n
*I was advocating and instigating, bringing it up with teachers and other parents to build the momentum, grass roots as it were. IDK if they were just working their plan, or if my agitating helped, but it probably didn't hurt.
(also, the teachers all got some Stop the Bleed training as part of the school year startup. Finally.)
When you suggested four, the first thing that came to mind:
ARTHUR: Now stand aside, worthy adversary.
BLACK KNIGHT: 'Tis but a scratch.
ARTHUR: A scratch? Your arm's off!
BLACK KNIGHT: No, it isn't.
ARTHUR: Well, what's that then?
BLACK KNIGHT: I've had worse.
-JW
Excellent article!
A very clear explanation of the concepts and tools available. I need to go spend some money. Thank you so much for posting this!
I hope this article is widely read.
@Aesop
Found this:
Special Operations Forces Medical Handbook 1 June 2001
https://www.sv-zanshin.com/r/manuals/sof_medical_handbook.pdf
Am I correct in assuming this is the correct Special Operations Forces Medical Handbook?
I didn't open the pdf, but that looks like the one.
@JW,
Don't get me started with Monty Python references.
It's like potato chips: there's always room for another one, and there's no end to them.
Stop it! It's getting silly.
See what I mean?
"...throw out yer dead" - or words to that effect. that pdf is a big file. stay safe everyone.
@Grandpa Special Operations Forces Medical Handbook is only 39.8 MB - Will easily fit on any 4/8/16 GB thumb drive along with all the other information in pdf format we should be grabbing and saving while they are available.
It is a whopping 723 pages to print the whole thing out. I would think using three-hole printer paper and a 1.5" three ring binder would work best in that case.
However the Trauma, Procedures and Appendices sections only are from pages 508 - 648 (a bit more manageable 140 pages / 70 double sided pages).
Aside from all that I would think that hands on training would be very important. We all have lots of stuff to do in an ever shortening short period of time.
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