Level of training required for safe use of tourniquets & israeli bandages?

[Dr. No]

Who teaches medicine to tactical medics?

Doctors.

Whose protocol do tactical medics adhere to?

Doctors.

Tactical Combat Casualty Care TCCC TC3 And Wound Treatment, Page 2-23

With that said, refer to my previous statement:

I don't disagree that Doctors are giving protocols that suit their ideal conditions. Luckily for the hundreds of men saved by TQ's, most practitioners have come to understand that these are not being applied in an OR, and sometimes doing things in a less than ideal fashion is better than screwing it up completely.

I completely agree with your statement.... which was my point as well. TQ's are just like CPR and the Heimlich, everyone should know it.

[ST911]

What you state here is what is being taught by doctors, but not by tactical medicine practitioners.

It is taught by both, and reflected in TCCC, CLS, PHTLS, civ EMS protocols, assorted DOD manuals and curriculum, NTOA and JEMS pubs. See also the links I posted above.

I also fail to see how denying oxygen to an area of a limb for a short duration is going to cause damage. This study from 2004 says necrosis does not start developing until after 3 hours ... http://www.ncbi.nlm.nih.gov/pubmed/17433166

Cool. As I noted, it's not an absolute. It's a possibility. And the current recommendation of those much smarter than I. Don't involve tissue that doesn't need to be to manage the possibility.

[TGS]

It is taught by both, and reflected in TCCC, CLS, PHTLS, civ EMS protocols, assorted DOD manuals and curriculum, NTOA and JEMS pubs. See also the links I posted above.

Just to reiterate, I posted a link to an actual DoD TCCC manual stating 2-4" above the wound, if anyone is interested.

Cool. As I noted, it's not an absolute. It's a possibility. And the current recommendation of those much smarter than I. Don't involve tissue that doesn't need to be to manage the possibility.

Do no harm.

Think I heard that somewhere!

[butler coach]

Dark angel teaches high and tight. Use to stop bleeding that you can not stop anyway else. When in doubt tq till blood stops.
Blood in body good


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[SeriousStudent]

I took a TQ class a month or so ago from Kerry Davis at Dark Angel Medical.

Excellent class, great teacher, and lots of good tips and techniques. Kerry's a solid guy, and so is the rest of his crew.

Tom - I would be very interested in buying a few more TQ's. Do you think you can also include some of the blue trainer models? Thanks very much for the offer. I hope Robin, Bronson and yourself are all doing well.

[808sheriff]

Rescue essentials has 4.99 flat rate shipping

[Don Gwinn]

Tom - I would be very interested in buying a few more TQ's. Do you think you can also include some of the blue trainer models?

SeriousStudent, what's the difference between the blue trainers and the standard tourniquet? You're talking about the SOF-T here, right? I just did a quick Google search and the ad copy I found stated that the color was the only difference--what's the significance?

On the original question--I've been a volunteer EMT in the sticks for ten years or so, had never used a tourniquet or been trained to use one, and had been taught the standard (at one time) EMS thinking that tourniquets were likely to cause more harm than help. As time went on, I suspected that wasn't proving true in the military theater, and then it became clear that the research was going the opposite way. But I still had no confidence in my own ability to use one effectively, and I avoided them. However, I took Kelly Grayson's class at NRAAM, which spent maybe 45 minutes or so split between lecture on tourniquet use (including his preference for the SOF-T over the CAT) and hands-on practice applying the tourniquet. I now feel confident that I could apply it as well as many other medical interventions I've had to try for the first time in the field and better than many. I'm not doing EMS anymore, but I expect tourniquets to begin showing up in the protocols around here eventually. We're a lot more likely to see an amputation or penetration from a farm accident or motor vehicle crash around here than a gunshot, but the blood doesn't care what made the hole. Change happens slowly here, though.

[Paul D]

Not to side track to much: This thread reminded me of a conversation I had will a colleague who is chief of trauma at my hospital network. I asked him to critique my IFAK. He agreed with more than one TQ available, chest seals, bandages, etc. We agreed that if you got shot in the brain or heart, you're pretty much hosed. I asked him how to stop bleeds in abdominal and pelvic wounds. He said not much can be done if it is a big arterial bleed except for scoop up the injured and run to the hospital. For hits to the liver, splenic artery, mesenteric arteries and the aorta, it is hard enough to stop bleeding when the abdomen in opened up in surgery. For hits in the iliac arteries (which are the large arteries supplying the legs located below the belly button and above the groin), he stated that the military have tried a "super TQ" like device in Afghanistan which compresses the aorta at the belly button and occludes all flow below that point. He states it has shown some success. He states that probably will never be available in the civilian market though. With that in mind, the next purchase for my IFAK is a plate carrier with armored cummerbund.

[SeriousStudent]

SeriousStudent, what's the difference between the blue trainers and the standard tourniquet? You're talking about the SOF-T here, right? I just did a quick Google search and the ad copy I found stated that the color was the only difference--what's the significance?

On the original question--I've been a volunteer EMT in the sticks for ten years or so, had never used a tourniquet or been trained to use one, and had been taught the standard (at one time) EMS thinking that tourniquets were likely to cause more harm than help. As time went on, I suspected that wasn't proving true in the military theater, and then it became clear that the research was going the opposite way. But I still had no confidence in my own ability to use one effectively, and I avoided them. However, I took Kelly Grayson's class at NRAAM, which spent maybe 45 minutes or so split between lecture on tourniquet use (including his preference for the SOF-T over the CAT) and hands-on practice applying the tourniquet. I now feel confident that I could apply it as well as many other medical interventions I've had to try for the first time in the field and better than many. I'm not doing EMS anymore, but I expect tourniquets to begin showing up in the protocols around here eventually. We're a lot more likely to see an amputation or penetration from a farm accident or motor vehicle crash around here than a gunshot, but the blood doesn't care what made the hole. Change happens slowly here, though.

I was at Caleb Causey's Lone Star Medics Tactical Medical Conference a few weeks ago. Kerry was there, and there was a interesting conversation with him and Caleb and some other folks who had used TQ's a lot.

There recommendation was that it was a good idea to buy a practice one and "get reps" with it. You can just buy a production or normal model, but they pointed out that the nylon stretches when used. That a practice unit is not going to work as well after multiple sessions. Since we had a biog stack of "real" and practice units on hand, you could see exactly what they were talking about.

On one of the blue units, the way the webbing was set up with the buckle was also easier to release tension. It's honestly beyond my poor communication skills to paint a picture with words and describe it. But they did look different to me. Kerry also recommended setting up the TQ for deployment ahead of time, to save important seconds.

He also reminded people that UV sunlight degrades plastics, and that leaving the TQ where the sun can hit it full force may not be a great idea. When you are cranking that windlass with the force of two mules and an ape, you probably want 100 percent of the material strength to be there.

That's really all I want to go into, I hate spilling the secret sauce from an instructor who makes their living teaching something.

As a side note, we also got to use an incredible training dummy to practice on - Quik-Clot bandages with spurting simulated blood. You had to put on the TQ's and pack the wounds with Quik-Clot gauze in time, lest one get sprayed in the face with red stuff. We were told we were the only civilian group that had ever seen this training aid, much less worked with it. Good times!

And be sure to ask Kerry about his daughter's belt-fed machine gun.

[Totem Polar]

Hey man, never know....some people are into that asphyxiation thing.

In the class I mentioned taking earlier, we referred to the CAT as "Carradine Action Toy"...
--
On a more serious note, I'm also following regarding the SOFFT group buy. Thanks for looking into that, Tom.