Friday, April 6, 2012

Tourniquets for emergency trauma to extremities

First, let me say that I am not a medical professional and am not qualified to give medical advice. I do have some very basic training in trauma medicine.  I am posting this to get you thinking about this subject, but you really need to do your own research and ideally get some professional training.  Tourniquets can be dangerous and should only be used by those with basic training in their use.

Why tourniquets?
It's best to have a well rounded medical kit for your range bag, and probably on your person while undergoing firearms training.  But tourniquets have a special place in emergency trauma, and I would recommend having multiple tourniquets on your body while training.

Some advantages they have:
- They require relatively little training to use properly.  Note: it is very important to at least have some training and a firm understanding of where to place the tourniquet given different locations of wounds.
- They can be applied very quickly to one's self even with only one hand(since you may have lost the use of the arm that got injured).  Using bandages is relatively difficult and slow one handed, and may not stop the bleeding with large wounds.  Also, bear in mind a gunshot wound usually has an entry wound and an exit wound.  It would be very difficult to bandage both wounds properly and quickly, especially with one hand. With a tourniquet, it doesn't make much difference that there are two wounds.
The speed with which you stop the bleeding is very important.  I couldn't find a reputable citation with a quick search but with femoral arterial bleeding it seems generally accepted that it's possible to bleed out in under 3 minutes, and to lose consciousness well earlier than that.
- They are effective in preventing blood loss in most extremity wounds (wounds to the arms or legs).  Extremity wounds comprise the majority of traumatic injuries in US armed conflicts.  See
Extremity wounds are easier to self-treat than torso or head wounds.
- They are very light and compact (about the volume of two fingers, and weighing about two to five ounces)
- They are inexpensive.  The CAT or SOFT-T can be had for about 25 to 35 dollars.
- You can train with them to some degree without using them up.  You can practice putting a tourniquet on without worrying about wearing it out or getting it un-sterile. Obviously if you put a tourniquet on 100 times, that might start to wear it out, but a certain amount of training is fine. For fast access, you can easily connect it to the outside of your gear or rifle. See the "How to carry tourniquets" section below for more.   Compare this to bandages; they must be kept in their sterile packaging so to take one out for training or leave one exposed outside of a pouch would ruin it.

But what about the risk of losing the limb?
The old school of thought was that tourniquets should be a last-ditch solution, and that use of a tourniquet would necessitate amputation of the limb. Recent military experience has shown that modern tourniquets can be in place for at least two hours with a very low risk of losing the limb as a result of the tourniquet. See the links at the end for references.
"A series of studies have looked at the efficacy of prehospital tourniquets and their safety.(16–18) The conclusions are overwhelmingly in favor of applying tourniquets to control severe extremity hemorrhage. In addition, they highlight the near-total absence of significant complications attributable solely to the use of tourniquets. ... Instances of effective tourniquets being placed for up to 20 hours have been recorded with complete viability of the limb and return to full duty."

Which tourniquets?
Specific tourniquets I recommend are the CAT or SOFT-T Wide.
Between the two, the CAT is lighter because it has a plastic windlass, but the windlass is less durable for the same reason.  The SOFT-T has an aluminum windlass.  I would take the SOFT-T unless you are very concerned about a few ounces of weight, or if you're going through a lot of metal detectors.
The SWAT tourniquet has its place, but consider that it will be difficult to apply one handed, and since it has no windlass, you can't fine tune the pressure that is applied.  See also "Risks of Rubber Band Tourniquet Use"

If you're going to carry one tourniquet, you probably should consider carrying two.  Your legs are very close together and if someone's taking multiple shots at your legs, if one leg is hit there is a pretty high likelihood that the other will be hit as well.

How to carry tourniquets:
- In a pocket.
- In a medical kit pouch
- On MOLLE: The Blue Force Gear Tourniquet Now! or the Mayflower tourniquet holder.  Or you can rig your own using shock cord:
Any closed-top single pistol mag pouch would probably work as well.
Thinking about making sure you can access the tourniquet with either hand in case the other arm is injured.


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