Thursday, February 25, 2021

Medical Tip: Tourniquets Work!

One of the local constabularies recently encountered Nameless Crazy Person with butcher knife in hand, agitated and in a stabby mood. Despite repeated commands, NCP refused to drop knife, and/or broke the containment bubble, whereupon officer plugged NCP. Unknown number of rounds fired, but two connected. 

One to each arm. (-25 points for lousy marksmanship at knifefighting - which is knifefight dying - distance. Bonus points for unintended humanitarian efforts.)

One nicked the right outer bicep. Literally, a flesh wound. Rub some dirt on it (or, in this case, a wad of 4x4s) and walk it off. No harm, no foul.

Other round: in the stabby knife-wielding arm, 9mm or 40SW pellet entered the upraised left arm proximal to the inner elbow, and travelled along the near-horizontal upper arm, and exited just below the left armpit (axilla for medical types).

Neither round close to anything obviously vital, except...

Round #2, during its journey through the meaty bicep area, must obviously have punctured/torn/lacerated the L brachial artery, i.e. the one what all the blood from Mr. Heart travels in to arrive in the rest of Mr. Arm.

Result: a steady blurp-blurp-blurp of bright red blood, all over the ground.

To his everlasting credit, Constable quickly applied first an Israeli Battle Dressing to the arm of the now knifeless suspect, to whom the application of lead had reduced his crazy efforts noticeably. Which IBD application slowed the blurp-blurp nary a whit.

So, reverting to academy-standard (nowadays) training, he whipped out his CAT Tourniquet, and lashed that sucker down just like in training videos, and turned off the blurp-blurp in about 6 twists of the windlass, despite the pained response from NCP.

Medics brought NCP to our world, where our trauma nurse and trauma doc were certain that applying a TQ was waaaaaay overkill, but "Bless their hearts for doing too much instead of too little". So, they untwisted that TQ, and were immediately rewarded with blurp-blurp-blurp of bright red arterial blood, again.

I twisted the TQ back on and tightened it, and we sent NCP directly to trauma surgery for vascular repair, so that he could continue to be crazy with two functioning arms.

And I told the paramedics and the PD officer responsible for the TQ that they'd saved an actual life with that thing, because NCP would have died at the scene in about two minutes if they hadn't tourniquetted off the flow of arterial blood from a "mere" arm wound. Which not only saved his life, it prevented about two trees-worth of resultant officer-involved homicide paperwork.

Put the effing TQ on if the bleeding doesn't stop with pressure, and make it holy by cranking the hell out of it.

You needn't carry four TQs on your body, but you have four limbs, so if you like them, and you enjoy living, you'd be well-advised to have four TQs somewhere close by, like kit/pack/bag, etc.

Not at home in your medicine cabinet 20 miles away.

When you need one (or, God forbid, more than one) it will be Right Effing NOW, and not "in twenty minutes or so".

If you'd rather ignore that advice: Suture self.

FTR, trauma literature based on medical trauma data from Sandbox I and Sandbox II have documented applications of as long as 4 hours before removal in surgery with no residual harm of any kind to extremities as a result of the TQ application, in young, otherwise-healthy, military-aged troops. YMMV, but they are not in any way "sacrificing a limb to save a life", anytime in the last 20 years. If you're within that time span for arrival at definitive medical care, and it's medically justified, it's better to slap one on than watch your patient exsanguinate and die.

And now, refresher training for those who wish it:

"This sh*t works!" - everyone who's ever needed one.

Thus endeth the lesson.


Divemedic said...

I would add that the current rule of thumb being taught through TCCC is: apply a bandage impregnated with QuikClot (or something similar) using direct pressure. If that fails to stop the bleeding within seconds, apply the TQ.

FYI: My kit has TQ, the aforementioned QuikClot gauze, an Israeli battle dressing, and a pair of Hyfin chest seal occlusive dressings. This weekend's training minute during the Blogshoot will be addressing this exact topic.

Aesop said...

All my best to youse guys, DM.
Don't shoot your eye out.

Phelps said...

TQ sooner than later. Try pressure, actually put pressure on, and if it still isn't working, TQ.

When applying TQ, if they are conscious and not screaming, you aren't done twisting.

Oneissuevoter said...

Thank you Aesop.

BigCountryExpat said...

Yep, They got so useful that mid 09 in Iraq, there were issued Multicams for the convoy kids that have the TQ built in on the arms and legs. REALLY useful if they got blowd up on convoy... expensive as all get out, but worth it. We used to wear them as a precaution on all long distance trips outside the wire. They also sell them made by Blackhawk...

Mike Doyle said...

I hate to sound stupid, but ...

I upgraded to a kit with a CAT, QuickClot gauze, Olaes bandage, Hyfin seals, and shears. The kit also has an NPA and a decompression needle that a) I wouldn't use, because b) I was never trained on using them. Rather than pulling a Gilligan and possibly killing the guy I might be trying to save, should I shitcan the NPA and needle, or should I try to track down additional training? If the answer is training, who's a legitimate source for that? Bear in mind that I've never been qualified as a medic.

Old NFO said...

Thanks for the reminder... I only have three in the car, guess I need to get another one. My 'pocket' kit for the range has the same thing DM's has.

Unknownsailor said...

You would be interested to know that as recently as 2014 onboard Naval ships there are no TQs anywhere in any of the wall mounted medical kits throughout the ship. I was a stretcher bearer for general quarters, and the corpsman I had assigned to my team didn't have a CAT in her aid bag. I asked.

TQs were not taught as immediate bleeding control technique, just direct pressure and pressure points. I had (and still have) two CAT mounted on my plate carrier at home, but at work, my aircraft carrier didn't have any that I was aware of.

Always 30 years behind, the Navy is.

Aesop said...

@Mike Doyle,
You're not stupid, just not trained. That's fixable.
The Army (Big Green) teaches 10th grade dropouts with a GED TCCC: Tactical Combat Casualty Care. It includes uses of tourniquets, use of chest seals, and use of chest decompression needles. ALL of that info is findable in mere mouseclicks online, and I've linked to it on this site as well.
Anyone can type "TCCC" in the "search blog" bar at the bottom of the page of this blog, but to make it easy, here's needle decompression, in 3 minutes and 21 seconds:

@unknown sailor,
While they risk suffering traumatic casualties every time they put an unqualified female watchstander on the bridge while underway, Big Blue hasn't had actual naval combat since 1945. They are thus mostly ignorant (outside the SEAL and Marine corpsmen community) of what the rest of the world considers old news. 245 years of tradition, unimpeded by intelligence or progress. There are advantages to being outside of that chain of command.

carolina TURTLE said...

as a USN VBSS team member, i carried at least one, usually 2 TQ's on mission. Never had to use it. Heck, i never even fired my M4 in anger! (this was 2008/2009 persian gulf) There have been a few times i've been curious how a TQ feels, yikes! I hope i never need one for real BUT i'm thinking it only needs as much tightening until the blurp-blurp-blurp stops? (Unless you desire to inflict some ADDITIONAL pain on that individual???)

On the other hand, during my rent-a-cop days, there i was (posted at medium-size city's ER) and the paramedics bring in a DOA. He had bought his first pistol that night. He had a self-inflicted ND that entered his upper leg (or so i was told) and tried to tough it out telling his family members he was okay and didn't need to go to the hospital.

Yeah, that's my story and i'm sticking to it!