TQ use quick AAR

[voodoo_man]

Description of event:

Male was observed struck by loose metal tubing in underground subway station. Male was struck on the left arm, about two inches above the elbow on the inside of the arm. Male began to bleed profusely at a rate consistent with arterial bleed (observation only).

Actions taken:

Application of SOF T Wide (http://www.amazon.com/gp/product/B003YDSO1W/) above the wound after cutting his shirt sleeve off with sheers. Bleeding stopped nearly right away after proper application. Black sharpie was used to write time of application on male's forehead. Male was transported to local hospital shortly after, medics duct taped TQ in place.

Observations:

Having my pack with me I had access to sheers and disposable gloves. Without either one of those this would have been pretty messy. Having a sharpie is essential. Medic response was 15 minutes after event.

Areas for improvement:

Having a TQ on you means you can quickly respond and allow for application without delay.

Carrying a TQ in your edc kit is essential. Having gloves and other PPE is also imperative. I will be carrying a ziplock bag with a TQ and a pair of gloves from now on just in case I don't have my pack.

I could probably have cut the shirt off or ripped it off but sheers worked well.

All medical items are disposable and should be considered as such.

I was off duty and on my way home so I did not do any follow up on his status, but will try to tomorrow when I get on shift.

Just to add, this is the TQ I got from my PF secret Santa.

[RoyGBiv]

Secret Santa FTW!

Well done Sir. Well done.

[TGS]

Awesome sauce! Man, are you a shit magnet or something!? That's a pretty gnarly subway ride!

Check out the ankle kits that have been discussed recently. I carry it everyday....gives me a compression bandage, gloves, 2 tourniquets, duct tape and quick clot. I have a rescue hook on my knife that fills the role as shears. Totally concealable and so comfortable that I don't notice it. I keep an agency specific trauma kit in my man bag when on the job, as well.

FWIW, "T" and time can be written on the forehead with a gloved finger dipped in blood, so don't get too hung up on the sharpie. ;)

[Totem Polar]

This is a very good post. I'm reasonably up on current TQ use, but the idea of duct taping it down to keep Vics from goofing with it is still another level that I haven't heard. Thanks for posting, and good job.

[Clay1]

Kind of like using your firearm, I hope that I never get the chance to use my kit. I have one and have done a simple 8 hour class on its use, but I sure hope that I don't have to use it. I also know that I need more training. Congrats on doing the right thing. Cool Beans!

[MolonLabe416]

Which ankle kit are you running?

Thx

[voodoo_man]

I don't run an ankle kit, though it may be a good idea. I am nearly never without a bag off duty but when I am without one I have a TQ, gloves and a sharpie in a pants pocket.

I've had to apply TQs on several occasions, on and off duty and it's just been something that I have grown accustomed to carrying in my edc setup. Hopefully if anyone does not carry any type of kit they start to because it's the first and often times most important line of medical defense.

Having one in your car as a spare in a kit is also important.

And yes, I think I am a shit magnet at times...lol

[KeeFus]

Yep, hes a:

8182

[Hizzie]

If I may?

If you reasonably believe you have an uncontrolled arterial bleed don't waste time cutting off a shirt (or pants). Hasty TQ nice and high.

[SLG]

I'm not a trauma doc, and I don't play one at home in the evening either...so don't take this as criticism.

I agree with Hizzie, and was wondering why you cut the shirt? At a hospital, or maybe even as EMS, I can see wanting to see more, as you may be able to do more, but as the off duty cop, what could cutting the shirt have done for you? I'm asking so I can learn.

Good job, regardless.

[voodoo_man]

I like criticism.

I considered the long sleeve shirt to be an obstruction and decided the three seconds it took to remove it will benefit the overall wound management until he was transported to the hospital for treatment. I've seen t shirts cause even well tightened TQs to move and I didn't want to risk it as I knew EMS was going to take a while to get here.

Also the bleed did not initially present itself as an immediate action required injury.

Just an update - I contacted the ER he was transported to and they couldn't give me any info because around the same time three serious traumas came in, two from accidents and one shooting victim so they couldn't tell me. I didn't get a name either so they couldn't tell me what happened. They did confirm no traumas died though. So win?

[SLG]

I like criticism.

I considered the long sleeve shirt to be an obstruction and decided the three seconds it took to remove it will benefit the overall wound management until he was transported to the hospital for treatment. I've seen t shirts cause even well tightened TQs to move and I didn't want to risk it as I knew EMS was going to take a while to get here.

Also the bleed did not initially present itself as an immediate action required injury.

Just an update - I contacted the ER he was transported to and they couldn't give me any info because around the same time three serious traumas came in, two from accidents and one shooting victim so they couldn't tell me. I didn't get a name either so they couldn't tell me what happened. They did confirm no traumas died though. So win?

Copy, thanks.

[Hizzie]

8186
8187

Notice what's first on the To-Do List?

--------------------------

Your follow up clears things up a bit. You weren't hurt so either ways it's a win.

[TGS]

I considered the long sleeve shirt to be an obstruction and decided the three seconds it took to remove it will benefit the overall wound management until he was transported to the hospital for treatment. I've seen t shirts cause even well tightened TQs to move and I didn't want to risk it as I knew EMS was going to take a while to get here.

Sounds like an informed decision, and probably the best one.

If space, force, time considerations were different, the desired action would probably be different. Arterial or heavy venous bleeding on its own does not automatically mean you have to act hastily.


8186
8187

Notice what's first on the To-Do List?

--------------------------

Your follow up clears things up a bit. You weren't hurt so either ways it's a win.

I don't follow the point you're trying to make.

[voodoo_man]

I am not a medical professional nor do I play one in real life, I have enough real world experience from seeing lots of trauma and seeking training to aid me in positively affecting those injuries that I know a thing or two. I always default to the medical professionals and if this had been a call or on duty incident I'd have transported him to the ER myself after making sure he was stable and the scene was safe.

[Hizzie]

Sounds like an informed decision, and probably the best one.

If space, force, time considerations were different, the desired action would probably be different. Arterial or heavy venous bleeding on its own does not automatically mean you have to act hastily.



I don't follow the point you're trying to make.


The point is that controlling bleeding is placed before making sure PT is breathing.

[voodoo_man]

The point is that controlling bleeding is placed before making sure PT is breathing.

While that may be the case that chart is designed for medical professionals.

Making sure the scene is safe and getting communications out to first responder's is before any of that.

[ST911]

Solid job by OP. Adding...

No harm in removing clothing layers if they may interfere, something needs to be visualized, and it can be done quickly. (To paraphrase TGS, a hasty application doesn't mean acting hastily. What you can/should do depends on what's occurring and your judgement and abilities as the provider.)

The MARCH mnemonic and its many variations is useful at every level, including lay provider. Many of my soccer moms have remembered it.

Like removal of clothing, communicating to outside resources may be useful or not. It's generally waaaaaay down my list, as I want to minimize distractions to my pt and safety SA, and there's not a lot useful to say until I actually have info. I also don't want a dispatcher in my ear reading off an EMD card. Grab a parrot (bystander) to stand nearby and talk for you.

[TGS]

The point is that controlling bleeding is placed before making sure PT is breathing.

Dude, ffs, I understand what the MARCH algorithm is.

What I don't get is why you posted it.

[EMC]

8186
8187

Notice what's first on the To-Do List?

--------------------------

Your follow up clears things up a bit. You weren't hurt so either ways it's a win.
This is a much better acronym than the "evaluate a casualty' acronym we had to memorize in 90's army basic training.
As I recall it was RBBSFBH (really big boobs should fit both hands).

Check for:
1. Responsiveness
2. Breathing
3. Bleeding
4. Shock
5. Fractures
6. Burns
7. Head injury

[Hambo]

Great job, Voodoo! Ordering some extra shit now.

[JCS]

Description of event:

Male was observed struck by loose metal tubing in underground subway station. Male was struck on the left arm, about two inches above the elbow on the inside of the arm. Male began to bleed profusely at a rate consistent with arterial bleed (observation only).

Actions taken:

Application of SOF T Wide (http://www.amazon.com/gp/product/B003YDSO1W/) above the wound after cutting his shirt sleeve off with sheers. Bleeding stopped nearly right away after proper application. Black sharpie was used to write time of application on male's forehead. Male was transported to local hospital shortly after, medics duct taped TQ in place.

Observations:

Having my pack with me I had access to sheers and disposable gloves. Without either one of those this would have been pretty messy. Having a sharpie is essential. Medic response was 15 minutes after event.

Areas for improvement:

Having a TQ on you means you can quickly respond and allow for application without delay.

Carrying a TQ in your edc kit is essential. Having gloves and other PPE is also imperative. I will be carrying a ziplock bag with a TQ and a pair of gloves from now on just in case I don't have my pack.

I could probably have cut the shirt off or ripped it off but sheers worked well.

All medical items are disposable and should be considered as such.

I was off duty and on my way home so I did not do any follow up on his status, but will try to tomorrow when I get on shift.

Just to add, this is the TQ I got from my PF secret Santa.

Great job stepping in and taking action!
Did you try direct pressure or go straight for the tq? Arterial bleeding tends to be bright red and squirting.

Applying a tq can't really hurt anything unless it's been applied for like 6-8 hrs. Being on the inside of the arm sounds like it could've been the brachial artery!


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[Irelander]

Nice gift, PF Secret Santa.

And awesome job, VDM!

[DpdG]

Another AAR for TQ deployment:

On duty (PD) medical aid call- comes in as a male who punched his own house window trying to get in, bleeding from right arm. On arrival, I find a male on a front porch, which is covered in blood. Like someone spilled a mop bucket full of Bill Cosby's left-over jell-o jigglers. The patient is a 6" tall redneck of about 220-240 pounds in that backwoods farm-boy strong but not lean sort of way. His two friends (all of whom are intoxicated) have fashioned a makeshift TQ and pressure dressing out of a belt, t-shirt, and standard issue eastern white pine stick, as found on the ground. "TQ" in place just above elbow.

I know the FD is less than 30 seconds behind me, so I QUICKLY have them lift the t-shirt to access the wound. Instant arterial spray from medial side of elbow, assuming brachial or ulnar artery. Laceration of approximately 2-3" long and spread to about 1/2-3/4" wide. I had the less drunk friend resume hard pressure with t-shirt.

FD arrived, I grabbed their blow-out kit from the first due bag and update their medic. For whatever reason, I got delegated TQ application. Unfortunately, all the FD had was a MAT TQ, which SUCK. Put in place just below armpit. I got the MAT strap as tight as possible before tightening the ratchet, but hit that highly frustrating feeling when you know the ratchet mechanism is about to break because you didn't get the strap tight enough. Patient is still bleeding and I can't ratchet it down any further. Had to loosen ratchet, tighten strap, then ratchet again. Bleeding controlled when combined with professional pressure dressing from FD.

Moral of story- don't punch out your own plate glass door when you lock yourself out of your house. If bleeding is controlled in any way, do not expose wound. Also, carry a good TQ, not cheapest junk available (MAT). Finally- the bending strength of an eastern white pinch branch is less than the force necessary to tighten a pants belt enough to stop an arterial bleed on a lumberjack type.

Follow up- heard he went straight to vascular surgeon, full recovery, cool scar.

[voodoo_man]

Great job stepping in and taking action!
Did you try direct pressure or go straight for the tq? Arterial bleeding tends to be bright red and squirting.

Applying a tq can't really hurt anything unless it's been applied for like 6-8 hrs. Being on the inside of the arm sounds like it could've been the brachial artery!


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Like I said I didn't immediately see a clear bleed. I wanted to ID what I had before I acted.

[voodoo_man]

Just to add, I was in a class over the weekend and a rats TQ was suggested. I ordered one when I ordered another SOF T Wide TQ. Will report with opinion.

[orionz06]

The rat is worth digging into, quite a few folks seem to be questioning it. I'll see what I can't pass along.


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[HopetonBrown]

A few months ago I took a 1 day casualty care class from a 20 year 18D Special Forces medic. He was pretty adamant that the RATS TQ didn't provide enough surface area and that it could lead to nerve damage. He also didn't like the CAT TQ because the plastic windless was prone to breakage. He liked the Revmedx (http://www.revmedx.com/#!rmx-tourniquet/cj9i) and SOFT-T TQs instead.

[voodoo_man]

A few months ago I took a 1 day casualty care class from a 20 year 18D Special Forces medic. He was pretty adamant that the RATS TQ didn't provide enough surface area and that it could lead to nerve damage. He also didn't like the CAT TQ because the plastic windless was prone to breakage. He liked the Revmedx (http://www.revmedx.com/#!rmx-tourniquet/cj9i) and SOFT-T TQs instead.

Nerve damage? I'd take nerve damage over dying or losing a limb....

[HopetonBrown]

Nerve damage? I'd take nerve damage over dying or losing a limb....

Why is it one or the other? I'd take neither, which is why a wider TQ was recommended.

[Hizzie]

A few months ago I took a 1 day casualty care class from a 20 year 18D Special Forces medic. He was pretty adamant that the RATS TQ didn't provide enough surface area and that it could lead to nerve damage. He also didn't like the CAT TQ because the plastic windless was prone to breakage. He liked the Revmedx (http://www.revmedx.com/#!rmx-tourniquet/cj9i) and SOFT-T TQs instead.

Gen7 has been tested and released. Much more beefy.

[HopetonBrown]

Gen7 has been tested and released. Much more beefy.

He brought a Gen 7 as a demo and discussed it. I'm sorry if I've hurt anyone's feelings regarding TQs. I'm just passing on info I was given.

[voodoo_man]

Why is it one or the other? I'd take neither, which is why a wider TQ was recommended.

Hence why I run a SOF-T Wide...covers all the above.

Sometimes, however, you do not get to choose, like the poor fellow that was on the receiving end of my TQ. If I had a RATS in my pocket, that's what he would have gotten or a CAT. So while we can talk about it here, the average person the street probably won't have a TQ at all and if for some reason someone does and you need it applied on you because for whatever reason you do not have one on you then any TQ is better than no TQ.

[HopetonBrown]

Hence why I run a SOF-T Wide...covers all the above.

Sometimes, however, you do not get to choose, like the poor fellow that was on the receiving end of my TQ. If I had a RATS in my pocket, that's what he would have gotten or a CAT. So while we can talk about it here, the average person the street probably won't have a TQ at all and if for some reason someone does and you need it applied on you because for whatever reason you do not have one on you then any TQ is better than no TQ.

I don't understand why you're taking time out of your busy schedule to tell us that. The same reasoning could be applied to a North American Arms derringer vs. a Glock 19. What you have on you when you need it is what matters. If all someone had was a shoe string, it's better than nothing. But carrying a shoe string as a TQ wouldn't make much sense, when they could simply carry a TQ.

Either way, I'm sure they all photograph pretty good.:)

[JCS]

Never heard of this rat tourniquet. The cat works great. We carry it in all our bags as does the ambulance service. I would be concerned the rat wouldn't cut off the blood supply properly. I need to do some more research!


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[ST911]

Elastic TQs are great when you're severely space or budget limited. They have significant application quirks otherwise. Deliberate 1- and 2-handed practice, in a variety of body positions and states of disability, quickly distinguishes all of the TQ products available from each other.

[Hizzie]

He brought a Gen 7 as a demo and discussed it. I'm sorry if I've hurt anyone's feelings regarding TQs. I'm just passing on info I was given.

Feels?

Lolz. Nope. I've trained with 6's and 7's. I've deployed 7's for real. CAT or SOFFTW doesn't matter to me for applying to another person. Self application I much prefer the CAT. The SOFFTW gives me trouble putting on my own arm.

[ST911]

The SOFFTW gives me trouble putting on my own arm.

Tell me more. Where does it go awry? How is it positioned on your arm, precisely?

[Hizzie]

Tell me more. Where does it go awry? How is it positioned on your arm, precisely?

Trying to get the windlass locked into the little triangle.

[SLG]

I've always liked that CAT. It seems to have fallen out of favor, but I'm not sure why and have had good luck with it.

[ST911]

Trying to get the windlass locked into the little triangle.

Try this. All directional references are your own view.


Orient the tunnel of the SOFTT-W (flat pad everything is attached to) along the inside of the arm, on the flattest spot available. The triangle should be oriented up/forward, buckle down/rearward. It's much easier to work inside than outside over the top of the arm.
Pull the strap downward, taking the excess of the loop through the buckle closing the circumference, making it as tight as possible.
Turn the windlass clockwise until occlusion, then another 1/4 turn or so past the triangle.
With the windlass in that position, snag the triangle with your first finger or thumb depending on digit length.
While you have the triangle snagged, pull the windlass rearward toward you in a brisk tug. There's a quantity of space/play in the slot of the windlass you're taking up.
Allow the windlass to rotate counterclockwise that 1/4 turn back to where it is inline with the triangle.
Lift the bottom end of the windlass away from the tunnel driving the upper portion to the tunnel.
Pull the triangle to the windlass end with your finger/thumb and/or push the windlass forward into the triangle (again, manipulating the play in that slot).



When practiced in such a manner, placement and orientation consistent with the above is conditioned so there's no extra brain-work. This method has helped a number of folks I've worked with.

[texasaggie2005]

Using this method, I was able to self apply the SOFTT-W in less time and more consistently.


http://youtu.be/drOMjWNWECc

[voodoo_man]

Using this method, I was able to self apply the SOFTT-W in less time and more consistently.


http://youtu.be/drOMjWNWECc

That's the method I practice and show for self aid.

[ST911]

Using this method, I was able to self apply the SOFTT-W in less time and more consistently.




That's the method I practice and show for self aid.

(+) Pulling the strap across the body (again, working inward) makes taking the slack out of the loop easier. Leaving too much strap loose is a critical error many make, resulting in excess windlass turns, gathered material underneath, and a more difficult time securing the windlass.

(-) It leaves the tunnel atop or on the outside of the arm, again making you work away from the body where you aren't as strong, dextrous, nor where it's visible. Note SBS's struggle with that.

(+) Having it on top or outside does make it easy to lever the windlass to the triangle.

(alternative) Place the tunnel atop the arm, pinning it in place with your chin/face, and pull downward or inward as you prefer. Rotate it to the inside.

One way to mitigate some of the strap and buckle issues is to pre-work the TQ before placing it in your gear. Remove and reattach the buckle until it pops more freely. Pulling the strap back and forth through the buckle smooths that travel up a bit too.

[philpac33]

I am very much interested in some feedback on the RATS TQ from some names I trust(i.e. well established P-F members). There are reviews available, both negative and positive, but I don't know them or if they have any motives and/or biases. I have a couple CATs but they're in an IFAK on a padded belt or in a pack, neither of which are with me very often. On the other hand I routinely carry a CLEER Medical EDC Pocket Kit containing a RATS TQ(pro tip from ToddG) simply because it's so small and convenient.

[ST911]

I am very much interested in some feedback on the RATS TQ from some names I trust(i.e. well established P-F members). There are reviews available, both negative and positive, but I don't know them or if they have any motives and/or biases. I have a couple CATs but they're in an IFAK on a padded belt or in a pack, neither of which are with me very often. On the other hand I routinely carry a CLEER Medical EDC Pocket Kit containing a RATS TQ(pro tip from ToddG) simply because it's so small and convenient.

Happy to help, but there's a point at which discussion/explanation runs out of gas. This is the best way to find out what works for you and not, from my earlier post.


Deliberate 1- and 2-handed practice, in a variety of body positions and states of disability, quickly distinguishes all of the TQ products available from each other

Buy a RATS, bury it in your pocket, then... "Massive hem to your R upper arm. EXECUTE." Left arm. Lights on. Lights off. Hands covered in gun lube. Standing, prone, supine, fetal. Just go do it.

[voodoo_man]

Instead of starting a new thread.

Description of event:

Male suffered a severe laceration to the hand. Laceration was deep enough to cut an artery which produced thick red blood squirting from the open wound.


Actions taken:

Application of SOF T Wide TQ was immediately done over a sweater at the high bicep area. TQ was tightened until it could not be tightened anymore. Arterial spray became sporadic, but continued. Second TQ (CAT) was applied directly above the first TQ. This stopped the spray, male was rushed to ER and directly into surgery from which he was in stable condition.

Observations:

Wearing the Ryker AFAK allowed me to almost instantly apply the first TQ. It was off my ankle and on his arm in less than two seconds. Second TQ was supplied by another officer.

Males sweater may have caused the first TQ to be ineffective or diminished it's effectiveness.

Areas for improvement:

My other TQs were in my bag in my car. If I had been the sole responding officer I'd have needed to run back to my car to deploy another TQ. Maybe carrying two TQs in my AFAK would work better than carrying one and an extra bandage?

The quick response was the saving factor here, he would have bled out if anyone in the chain took their time and/or did not have the proper ability to apply a TQ quickly. I was not the first on scene and those before me did not do anything.

[Pennzoil]

VoodooMan

Thanks for sharing the AAR and great job!

[OnionsAndDragons]

Way to be JohnnyOnTheSpot, VDM!

Keep doing the good work!

[voodoo_man]

Did a quick post on my site: http://www.vdmsr.com/2016/11/tq-use-and-considerations.html