Tourniquet Use in the Civilian Sector

Should you be concerned with carrying an effective tourniquet?  We think so.  Short transport times do not stop bleeding, effective tourniquets do. In fact, studies have shown that ineffective tourniquets can INCREASE your rate of bleeding.  If you think a short transport time is a given, or that tourniquet effectiveness is a small concern, then read the below email we received from an NY State officer and the corresponding NY Times article(nytimesarticle1.pdf): 

“I thought you might like to know, that your product, the SOF tqt was utilized successfully on 4/25/07.  While conducting a search of a residence located in a rural area of upstate NY, several of my teammates came under fire from a subject armed with a 30.30 rifle, and a 22 cal pistol.  One operator was struck by a 30.30 rifle round in his L/distal humerous.  As the round passed through the operator’s arm, approximately 2” of his distal humerous was completely blown out, along with a large amount of soft tissue.

The brachial artery was also severed.  After retreating to a position of cover, the operator attempted self-aid by applying an SOF tqt superior to the wound.  After being assisted by another operator, the tqt was properly applied, and the operator was able to successfully tamponade the severed artery.  The wounded operator was evacuated and airlifted to a regional trauma center, and he remains in stable condition (he’s going to need several more surgeries, but it looks like he is going to keep his arm)  The trauma doc stated that the application of the Tqt probably saved the operator’s life.   I’m attempting to convince my supervisors to purchase apprx 100 more of tyour SOF tqts.  Thanks.”

Should you be concerned with carrying a tourniquet and its effectiveness?  

Next time, we will address tourniquets and scientific studies.

To Pack or Not to Pack: That is the Question

Hemorrhage control is one of the most important aspects of tactical medicine. As studies suggest, exsanguination from extremity wounds is the leading cause of death on the battlefield. Therefore, effective hemorrhage control is of upmost importance in the field. With this in mind, we must assess the most effective way to control hemorrhage.

As most of our readers know, in the Care Under Fire (CUF) phase of treatment, a tourniquet should be the first tool used for catastrophic-hemorrhage control. Should the care provider fail to achieve hemorrhage control using a tourniquet, or the location of the hemorrhage contradicts its use, then the use of a pressure dressing and/or a hemostatic agent is the next step in the CUF phase, if the situations allows, of course.

With that said, how does one achieve and maintain hemorrhage control with a hemostatic agent or a pressure dressing? First we will explore the use of hemostatic dressings. If the care provider were to just expose the wound and dump the hemostatic agent directly into the wound, the pressure of the bleed could wash it away, thereby negating its positive effects. To prevent this from occurring, the careprovider needs to apply pressure to the wound site, so as to ensure the hemostatic agent remains in place. The most effective way to do so is to pack gauze in the wound, on top of the hemostatic agent. Doing so will provide the requisite amount of time needed by the majority of approved hemostatic agents in the field to work. If a medic decides that the situation dictates a pressure dressing, what are some of the considerations before applying a pressure dressing? If the wound is the result of high-velocity penetrating trauma from a projectile, for instance, one must remember that the projectile has produce two cavities: the permanent and the temporary. The permanent cavity is caused by the projectile coming in direct contact with tissues. The temporary cavity is caused by the lateral energy produce as the projectile passes through the body. Consequently, while a wound may appear to be a simple entry/exit type of wound, thereby requiring that application of a simple dressing, it might be deceiving. In fact, the cavitaion produced by the projectile may have extensively damaged the tissues with which it came in contact (See Figure 1).

With that said, how does a medic achieve hemorrhage control when the wound appears manageable from the outside, yet continues to bleed within? Direct pressure on the wound site might achieve it, but not likely. Should a medic then apply a dressing that is nothing more than a wound pad attached to elastic? Maybe, but that offers little more than circumferential pressure. Inadequate circumferential pressure provided by an elastic bandage is as useless as an ineffective tourniquet, because neither are going to stop bleeding. Additionally, it fails to actually apply pressure to the damaged tissue that is bleeding within the wound tract. Essentially all one has done by applying a elastic bandage to a wound that requires a pressure dressing is applied an expensive dust cover, which might provide a false sense that one has achieved hemorrhage control. A medic must apply pin-point pressure to the wound. To do so, one needs pack the wound with gauze. The illustration below speak volumes. Medics must carefully, yet aggressively go after bleeding! Packing wounds with gauze has been the cornerstone of hemorrhage control for years in the special ops medical community. Until recently, an elastic bandage and a role of gauze has been the treatment of choice for wounds that neither require nor are accessible to other methods such as tourniquets. Unfortunately, some civilian medical directors frown upon medics packing wounds in the filed. Instead, medics are directed to apply direct pressure to wounds. As mentioned above, although direct pressure is useful sometimes, medics must get pin-point pressure on wounds. All is not lost; the tides are slowly shifting. The more medics we come in contact with the more we learn of a paradigm shift toward wound packing within the military and law enforcement medical communities. In the end, whether acting as an adjunct to a hemostatic agent in gaining hemorrhage control or stopping bleeding by exerting pin-point pressure, wound packing is a necessary step that must be considered. pack

(Figure 1)
(Reprinted From Husum H, Gilbert M, Wisborg T, Saving Lives, Saving Limbs, TWN Penang, 2000) )

Hello and Welcome

Hello.  Welcome to the Tactical Medical Solutions Blog.  The purpose of the TacMed Blog is to serve as a conduit between combat and tactical medics in the military and law enforcement communities around the world.  Our hope is that the information here will enhance your abilities to minimize preventable deaths by offering educational dialogue regarding issues faced by medics in these communities.  We welcome you to comment on our entries, request that specific topics be covered, and even become a guest poster.