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So I’ve had annual tourniquet training in the military, used to wear one on my vest, but that one is now in a backpack elsewhere in the vehicle and current job doesn’t require the vest. Besides, I’m thinking I should carry one in civilian clothes, too.
How do you guys carry one without printing or showing it? Pretty sure a tourniquet is a dead giveaway that I’m either an (at best) EMT or a tactical Tommy.
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Praise be to the LORD my Rock,
who trains my hands for war,
my fingers for battle.
-Psalm 144:1
Ankle holster, for me. I've been using the one from Rescue Essentials for 3 years, daily, and am happy.
In certain circumstances I'll just put one on my belt (flat folded SOFT-W, mounted horizontal) by way of elastic straps. Rubber bands can accomplish the same thing, as a more expedient method if you just want to try it out before dropping cash.
Last edited by TGS; 11-03-2019 at 10:38 PM.
"Are you ready? Okay. Let's roll."- Last words of Todd Beamer
Thank you! This advice is solid gold imho.
We use the SOFTT-W in our ER (I'm an RN) and the 4 EMS services we are affiliated with use them as well. I teach TQ application and wound packing (among other things) to our staff 4 times per year (will be doing so on Wednesday of this week).
While I've made and used improvised TQ's in the past I am 100% in agreement that most folks, especially those without professional training, would serve the wounded better with direct pressure vs improvisation.
But carrying a quality purpose made TQ really isn't difficult. I carry a SOFTT-W in my right hip pocket each and every day. Heck we have them all over our house and in our vehicles as well, but I always have at least one on me and it's a low profile as it can be.
I've seen the end result of inadequately applied and secured improvised TQ's and it's not pretty. TQ's generally hurt when applied to a conscious patient. I've even seen medics and nurses not apply sufficient torque because the patient was yelling... Sometimes you gotta hurt to help. Beats the alternative.
On a slightly tangential note, I am really sold on carrying a peds-sized TQ in addition to/as backup for a standard adult TQ. Did a bunch of messing around with a few different TQs recently (RMT, CAT-T) and found that none of them do a great job when you get to more distal extremities (ankles, wrists), at least with my build (5'10 165).
The CAT-T can be wound tight enough for me to lose my radial/DP/PT pulses but the windlass is very insecure as it doesn't really fit well into the clasp at such a small diameter. Would be very concerned that it would spontaneously unwind during transport. The adult RMT simply doesn't provide enough circumferential pressure; can still feel pulses even when its ratcheted all the way.
Peds sized TQ fixes all of this. Obviously if you're gonna carry one on your person, make it the adult TQ, as you can always move more proximally until you can get adequate pressure for hemostasis. However, for vehicles or other medical kits I'd definitely encourage you to add a peds sized TQ. For distal injuries (eg hand/foot amputation) they will work much better, and in some patients (kids or very thin women or older adults) it may be the only thing that works.
Last edited by Nephrology; 11-04-2019 at 08:51 AM.
Great post Nephrology.
Which peds specific tourniquet do you recommend? We rarely (Thankfully) receive traumatic peds patients, but certainly have plenty of emaciated elder patients and patients of small stature.
Our regional Children's Hospital carry the SWAT TQ on their "Baby Bus" and in their ER. They cut them in two long ways, then cut them down the middle to make them 1/2 width. This is "workable" in a controlled environment, but obviously less than ideal. Any suggestions would be appreciated.
TIA
This is what I have. No experience with alternatives but adult RMT is CoTCCC approved, so I have confidence in it.
Last edited by Nephrology; 11-05-2019 at 08:14 AM.
With the understanding that different skill levels and different contexts change this, for the layman I think the second part is best practice. Just to go as near the torso as possible from the get go. I get that the farmer who's hand got stuck in a combine probably doesn't have secondary wounds leaking further up his arm, but someone with trauma from an active shooter, a motorcycle crash, etc. may very well have new leaks above the tourniquet from wounds not originally spotted. We're currently taught not to spend time looking, if a limb is bleeding just tourniquet as high as possible and move on. If it's in a crease where a tourniquet can't go, pack the wound. If it's in the torso or head, no packing or tourniquet. With these bright line rules we aren't spending time evaluating injuries further than we need to at our level and aren't having to apply multiple tourniquets to the same casualty where one would have worked.
Sorta around sometimes for some of your shitty mod needs.
Agreed for an adult that peds TQ is probably unnecessary as moving proximally is easier/more field expedient. I probably emphasized this point a little more than I should have.
The bigger issue is working with kids or very thin adults (esp. the very elderly or chronically ill), where an adult sized TQ even placed all the way up to the top of the bicep may not be able to provide adequate circumferential for the reasons previously described. In that case, there really isn't a great substitute for a peds sized TQ, IMO. Israeli bandage might work OK in a pinch.
Kids and the elderly are statistically much less likely to be shot/stabbed/etc than, say, the average adult male, but sadly we all know it certainly happens. Something to consider.
Last edited by Nephrology; 11-05-2019 at 09:39 AM.
Tourniquet use on skinny folks or very young kids was discussed in a Dark Angel class I took last month. Their take is to stick with a CAT, even in kits put together with those potential victims in mind. It's been proven effective down to a limb circumference of five inches, which can include arms on kids well below a year old.
What they teach, and what I've seen recommended by others in the field, is that if a limb is too small for a CAT to work on then it's small enough that pressure will work. I don't mean pressure directly on the wound, but basically going high and tight with your hand and squeezing it off. Obviously there may be cases where you need both hands to be free so there's also the option of using something like a roll of gauze against the limb to increase the circumference.
Mean circumferences of 4,027 children.
CM Inches
Upper Arm Circumference 0-3 Months 10.9 4.3
4-6 Months 12.9 5.1
7-9 Months 13.6 5.4
10-12 Months 14.8 5.8
https://www.jems.com/2018/11/01/pedi...ourniquet-use/