As I’d mentioned last year, it seems like tourniquets are sort of a ‘newest and coolest’ sorta thing for the ‘serious’ first aid kit. I’ve been into survivalism for a long time and any references in fiction and non-fiction to tourniquets was almost always of the ‘loop a belt around it’ sort of variety. There were no ‘dedicated’ or purpose-built tourniquets that were readily available for Joe Sixpack survivalist…or if there were, you seldom read about them or came across them.
Cut to today’s episode. I’m talking with a fella I know and ask what’s up in his world. Turns out, his adult son had to go to the emergency room last night. Why? He was home, had a deer hung up and was cutting it up when he came to a frozen part of it. He put some extra oomph into his cut to get through it and the knife went into his wrist and severed a radial artery. Being alone and not precisely sure of how much damage he’d just inflicted on himself, he wrapped a towel around it and applied pressure. And applied. And applied. And the puddle at his feet just grew larger. So, he walks over to his neighbors house where the neighbor takes one look at him and calls 911. Medics arrive and….they apply a tourniquet …since at this point he’s about a quart low. They hustle him to the hospital and stitch up the leak. How close was he to cashing in his chips? Hard to say, I wasn’t there. But I am told that the amount of blood loss was rather significant and without something stopping it he probably would have been in some big trouble.
So, apparently there is a reasonable chance of need for a tourniquet outside of the apocalypse. Its not something I ever really thought to add to the first aid gear I keep around here because…well…it never seemed terribly likely to be needed. That mindset has now, of course, been kicked to the wayside. I’ll be finding a reputable vendor (to avoid Chinese fakes) and ordering a couple up for myself and one for a friend.
In talking to a few other people, it seems that severe cutting injuries resulting from deer processing/skinning/butchering are not that uncommon. Makes sense. Some guy standing alone in his garage with a hanged deer or elk slips and cuts himself deeply…I can totally see finding him the next day or two later laying DRT on the floor. Never thought about it before, but I can see it happening.
This is how you learn.
Maybe I’m just dense. but why wouldn’t a piece of rope work just as well? The trick is in knowing when and when to do.
A rope causes significant crush damage to the flesh directly underneath it. A modern tourniquet is wide enough to stop the blood flow without destroying the flesh underneath it.
It’s important to completely stop an arterial bleed, you don’t want leakage. The leakage can lead to tissue damage, which could lead to amputation. Rule of thumb anything short of an arterial bleed you can control through direct pressure and clotting bandages. You will need a good quality tourniquet for arterial bleeds, a belt or rope will not completely stem the bleed. What’s your life worth? Oh, also get training on the use of tourniquet. A lot of stop the bleeding training classes out there.
Trying stopping blood flow on your arm, single handed, while it’s covered with something slippery using a rope. Be sure to have the rope stowed in a pouch and not conveniently laying on the table. You can have someone feeling for a pulse, or use one of those fingertip oxygen meters, to tell you when the blood flow has been cut off.
Next try the same thing with a real tourniquet.
See which works better. Then decide if the thirty bucks you’d spend on the tourniquet is worth it.
Because the TCCC (tactical combat casualty care) studies done during the GWOT and during testing in live animals have shown that the constricting band should be 1.5-2 inches wide, and that without a proper windlass the bleeding is more often than not uncontrolled, and if the patient lives, more damage is done to the affected limb causing the need for amputation in many cases. Buy proven TCCC approved tourniquets from reputable vendors and then get training.
Many years ago, while I was working as a missionary in Asia, an elderly woman sitting next to me on an inter-city bus had her arm out the window. It was August, and the road was muddy from the warm monsoon rains.
As another bus going the opposite direction slowed down to pass us on the one lane road, it slipped in the mud and just barely bumped our bus – right where her arm was.
A necktie will work as a tourniquet, but it isn’t as good as the real thing, particularly when everything is slick with blood. Ever since then, I have made a practice of always have a tourniquet handy.
You just never know when you might need one.
North American Rescue C-A-T is a very good one. Buy directly from them as amazon has fakes.
RMT is the jam…
I get most of my tourniquets from Chinook Medical Gear. The price are good as are the people.
Matt
https://www.chinookmed.com/index.php?page=seek&id%5Bm%5D=pattern&id%5Bq%5D=tourniquet
Second on the Chinook Medical. No BS there, MANY of the items on that site are also in my ambulance.
Having recently taken an excellent class from our Emergency Service Unit called TCCC, tactical combat casualty care which had heavy focus on keeping the red stuff inside you, i highly recommend you pick up a bunch…North American Research CAT 7 and Tac Med solutions soft t wide gen 4 being best most tested and on the approved list by med professionals. Also find a proper holder to carry them …i keep a couple in my truck and carry multiple on patrol. Improvised tourniquets sound smart until blood starts squirting and the clock ticks. Many years ago I lost a friend who had an AD while cleaning his weapon and bled out before help could arrive. This was before tourniquets became fashionable and training available. A happier tale was a coworker who while on vacation was riding a scooter and got hit by a taxi. Broken leg with a femoral bleed. Being a big buff had carried a tourniquet and self applied saving leg and life. Said he never imagined needing it for himself on vacation. Get some and hit up your local emts for some learning. Be well.
Israeli Army Bandages work very well. I know.
Regards
https://www.narescue.com/
Has had them available for about 10 years
I keep one in my chainsaw chaps. Deep in the woods, no one will hear the screams. Could very well save your life.
“I keep one in my chainsaw chaps” <---- wise man.
Hey Brother,
Long time, first time. I went to the desert for the first time in 2004. To that point in my life, a tourniquet was a last ditch, you’re going to lose the limb if you utilize this, but it might save your life deal. The CLS (collar life saver) course that was Army doctrine at that time had 1 tourniquet in each CLS kit, minimum 1 bag per convoy. By the time I get ready to leave I was sold.
15 years of battlefield data later they’ve proved to be something that everyone can apply, to their buddy, to themselves, to others that really changes incident outcomes. They work, they’re cheap, you don’t need to worry about losing the limb for many HOURS.
I have one in every car I own. In my desk at work, and in my luggage when I fly. CPR had a success rate under 20%, tourniquets (on limbs) stop the bleeding almost every single time, as long as you can get a couple inches above the wound. They hurt like a b!tch as you get them tight, but that pain will subside a bit (not go away). But alive and in pain beats dead everyday of the week.
Think about spinal injuries before you start flopping someone around, but any bleeding you can’t get stopped with pressure within 60 seconds slap it on and let professionals decide if you overreacted.
I’ve thumped a great many people under some pretty wide circumstances. I’d say a %20 CPR success rate is probably a little high. I’ve only brought back about %10. However by the time they need me to thump them, they’re in pretty dire shape.
The one time a doc told me “You’ll likely bleed out before you can get to help if that lets go” was a spot that I couldn’t use a tourniquet. Figures.
Hiking friend and I both got Professional CPR qualified; she’s current while I’m lapsed. She tells me “If you have a heart attack while we’re on the trail, you’re gonna die; the success rate is too low to bother and you’re too fat to drag out”. Stupid fragile human body mumble grumble.
30 years as a paramedic. Here is a good rule of thumb: Apply direct pressure to a serious bleed using a Quick Clot type of bandage. If bleeding isn’t nearly completely stopped within 30 seconds, apply a tourniquet. Tourniquets can be in place for well over an hour with no permanent effects. That is plenty of time to get to a hospital.
1) North American Rescue, Chinook Medical, and anybody with an actual brick and mortar store are generally reputable suppliers, even on Amazon. Anybody without one are selling Chinese fakes, whether they know it or not.
2) Rope and other idiot solutions guarantee amputation, as they create nerve and tissue damage that cannot be reversed. Tourniquets as currently iterated are not an accident or afterthought.
3) The current medical literature (vs. idiots on the internet bloviating) notes that zero problems or after-effects are expected with application of a quality tourniquet for up to 6 hours. Short of that, no problems. After that, the old “apply tourniquet, sacrifice a limb” rule of thumb begins to apply.
4) Anyone can learn to use one in about five minutes spent on YouTube. Not learning this is akin to being a moron, and self-selecting for death.
5) You have four extremities. While one tourniquet immediately available is a minimum, having three more handy (not necessarily right on your hip, but rapidly available, like in a pack, or dedicated FA Kit or car kit) would be prudent. Extras beyond that number for others, to include significant others/family members or random victims are at your discretion. Otherwise, just like with multiple kids, decide which limb you really don’t want that much, and kiss it goodbye.
6) This evolution will be graded pass/fail in the real world, at a random time and place of Mr. Murphy’s choosing. Skeptics: suture self.
Thanks to all who responded to my question about using rope.
Now let me ask why a belt wouldn’t do, and prevent crush damage as well….. (and I don’t mean one of those limp wristed boy belts).
Hi Winston!
The chance of your limb being large enough for the belt tongue to reach a belt hole is pretty darn slim!
A CAT is not an insurance policy –
It is a life-saver…
All the best!
A belt has no way to secure the level of tension in place. Remember that your arm is significantly smaller than your waist…
The majority of belts (remember that gun belts aren’t cheap) that CZ’s readers wear cost more than the $30 for an actual CAT-7 TQ runs.
Steelheart
Again, try it. I think that you might finding a belt tight enough to stop the blood flow is gonna be way tougher than you think. If you don’t want to try it and just hope that it does, well . . . .
Once again, what is a life worth?
Matt
These folks have been everywhere of late including schools to ensure even the younger kids have an idea of what to do. Good resources at their site…
https://www.stopthebleed.org/
Recently went through the EMT course in my state and they are now teaching to use tourniquets early and often. Same for TCCCs. Get a good one an take class for either training/ refresher.
Check out the Stop the Bleed for a course that will train you for free.
https://cms.bleedingcontrol.org/class/search
Stay safe everyone!
Gideontactical.com
Search tourniquet tons of kits or individual parts. All from the real manufacturers. Monitor for some great deals.
Important tip: if you buy a tourniquet (or one in a kit) take it out, loosen it up and put back. Easier to slide an arm into a big loop and cinch it down. Compared to loosening and tightening when things are slick and you may not be thinking straight.
I never go anywhere without at least 1 tourniquet and pack of hemostatic gauze, haven’t figgered out how to easily carry more given limited belt space but I’m working on it.
Pro Tip: A tourniquet (and hemo-gauze) should NEVER be farther away than 2 steps, and that’s pushing it. “There’s one in the IFAK kit in the car when I’m at the range” is delusional – if it’s a femoral or brachial artery bleed, that person is down to the last 2 minutes of their life. 120 seconds. If it’s 30 seconds to your car and 30 seconds back you’ve spent half of that person’s remaining lifetime just getting the tool.
Adult humans contain about 5 quarts – +/- a little – of blood. Losing half of it can be fatal.
Reminder: Don’t use your primary tourniquet to train / practice with.
Manufacturers and trainers recommend using a dedicated tourniquet when training to keep your primary one the most effective. I know North American Rescue sells bright blue colored ones to designate for training or just put some kind of identifying mark on one to differentiate.
Good advise and don’t reuse tourniquets. Once used and cleaned of blood you can move it to “training use only”.
The CAT-Ts have reusable trainer versions that come in blaze orange for the same purpose.
search skinnymedic’s youtube channel for tq or tourniquet for some good info. I treat them like life straws, and I have been buying them and stashing them…
I carry one when in public, especially in a ‘victim selection zone’ where I can’t carry. I have one on each car kit. I have one in my carryon bag for flying, which is my EDC bag when I’m on vacation with family. It has a ‘blow out kit’ and a TQ and snivel gear.
I found an old Bucket Boss cell phone holder with a nice clip that fits one, and that is the one I move to my belt when I’m out and about.
I’m going to put one with the chainsaw. That was an excellent idea.
nick
(they can be used to put pressure on a wound to, you don’t have to just use it as a TQ. Oh, and if you have kids, get a soft one that fits their little limbs. There are a few different ones. Put that in your daddy bag.)
A word of caution… Yes, the paramedics used a tourniquet, but (a) they are trained professionals with a much higher skill set in this area. And (b), they were only minutes away from advanced care at a hospital.
The next time you are at your doctor’s office for whatever, ask your doctor to explain the side effects of using tourniquets.
Next time your at your doctor’s office, ask how long it would take you to bleed out from an arterial bleed? Answer: before the 911 call is dispatched to the responding EMS.
Are there risk in using a tourniquet improperly, absolutely! However the risk from bleeding out and dying will nullify all other risks.
The use a tourniquet is not advance care, it’s considered basic training now. The U.S. military provided this training to all soldiers going through basic training.
I second this. Every reputable medical org is recommending TQ to control bleeding now. We’ve got decades of experience in the .mil in their use and efficacy.
Use a manufactured TQ and live. Use a piece of bailing wire or some 550 cord and you will have the issues that used to make TQ use contraindicated.
Take a class and see. The stop the bleed .org classes are free and widely available. The national ‘I shot someone’ lawyer services often sponsor classes. I took one sponsored by Texas Law Shield and it was great. Thorough, with training tourniquets and hands on instruction. Didn’t take long, but was long enough to cover the material. Seriously, bleeding control should be as commonly available as fire extinguishers.
Google “immediate responders” to see how the doctrine is changing to reflect actual, real world considerations- lessons hard taught by the Las Vegas shootings and other events. TLDR- the EMS community is finally realizing that they can’t and shouldn’t be the “only ones” and are adjusting to the way people actually respond to emergencies and mass casualty events.
You can read it for yourself. Google the AAR from the ER doc in Vegas. And the actual official AAR for that event. Same for the Pulse nightclub murders. Read the recommendations. TLDR- they’re starting to push training down to the level of the man on the street, officially, because not all people suck and a surprising number of them will step up and ACT when called upon. And from the EMS point of view, they won’t be setting up triage areas according the three ring binder developed by the interagency working group, they’ll be commandeering vehicles and self evacuating to the nearest medical facility, ready or not, so they need access to the training and tools to make that effort more effective.
Hell, even my grocery store has a “bleeding control station” by the checkout lines. NOT a first aid kit, it only has TQ, pressure bandages, clotting agent, and gloves and is clearly marked “BLEEDING CONTROL”.
Get the gear, get the training, pray you never need it.
nick
Nick,
Good read! Did the same class through Texas Law Shield. Also completed the TCCC course instructed by a active duty Sergeant Major Medic with a lot of experience in the sand box and rock pile..
A lot of people don’t know that during the Pulse night club shooting, the fire station across the street went into lock-down because of an active shooter. They were not letting anyone in or responding to medical emergencies just across the street until law enforcement arrived. Most people that reach the hospital, which by the way was only about 4 blocks away self-evacuated or with the assistance of a non-first responder. The bottom line is you’re the first responder, police, ems and fire are second responders!!!
In the last year I’ve seen tourniquets taught at my 1st responder (emergency medical responder, technically) re-certification course alongside a local volunteer fire department (who have used them many times).
TQs were also taught to general population (shocking, I know) at the most recent CERT class that was run in my area (my whole family are members of CERT).
Yes, a paramedic or other trained medical professional can do some of this stuff better. That doesn’t mean it’s limited to them.
Now that said, are you in the USA or in some other area which may have different regulations on this?
Steelheart
Wrong.
The Army has been teaching GED dropouts how to apply one in about 5 minutes, for most of the last 20 years.
Stop The Bleed classes are given to anyone with a pulse rate.
There are YouTube videos available that are explained at a 6th grade level, and cover the TQ material in about 3 minutes.
https://www.youtube.com/watch?v=LxwjHzTpXV4
This ain’t rocket surgery.
And the next time you ask your doctor about tourniquets, ask him also what year he graduated medical school, and the last time he did anything trauma-related.
If either answer results in a number prior to 2003, he’s a dinosaur, and he knows as much about tourniquets as he knows about quantum physics or Chinese calculus, unless he’s made a herculean effort to stay up on medical literature far afield from his regular practice. (Odds of that 2000:1 against, rough guesstimate).
We routinely use modern tourniquets in the trauma ER 24/7/365, and have for 10-15 years.
And current trauma literature with a few thousand cases in OIF/OEF puts the time a tourniquet properly applied can be left on with negligible risk of damage is 6 hours, not ” only minutes.”
6 hours was the average time to hospital in WWI and WWII, FFS.
If you don’t know this stuff cold, please read and listen to people who do; don’t spout FUD from 1970 or 1940.
Mike: Yeah, your local EMS folks are professionals. And, as is common sense in the gun world, “When seconds count, (EMS) is minutes away!”
3rd Man is correct.
In line with Aesop’s comments, please remember that orthopedic surgeons, spending a couple of hours pounding in a new knee, or hip joint, require a blood free field to see what they are pounding on, and where. They commonly have tourniquet times in the coupla hours range, in OR. So, the “ask your doctor what the side effects of using a tourniquet”bit, leads me to respond, (a) the likelihood is very high that your Mark 1, Mod Zero GP/Family Practice doc/NP/PA is not up to speed on emergency medicine. (Hell, I try to keep kinda sorta up to speed, working in an urgent care, and I learn new stuff, daily. Often, from Aesop!)
(b) concern about “side effects” is reasonable. However, just as with the CPR breaks ribs issue, contemplate the recovery time/success rate of however horribly broken ribs, vs an extended period (like, the rest of your life, however many minutes that may be…) without breathing and circulation. Myself, I’ll visit you in ICU while your ribs heal, and you are on a vent, and accept your thanks.
Similarly with a tourniquet. “At least, he did not require an amputation!”
“Yep. He looked just like he was asleep….”
(3) what is the likely side effect of NOT applying a tourniquet in the setting of failed direct pressure, and enthusiastic bleeding? And, how would YOU treat that side effect? (hint: Death. Holy water, and one last Perfect act of Contrition).
It is important to recognize that EVERYTHING we do in medicine has adverse consequences. If I prescribe freaking Tylenol to enough people, SOMEBODY is going to have an adverse outcome, maybe liver failure. The trick is attempting to select out those folks at higher than usual risk, and doing something else for them. Liver disease folks get Motrin. Really, really bleeding folks, get a TQ. If direct pressure (etc) hasn’t controlled the bleeding, either they will risk losing the limb, or they will not care. About anything. Ever.
And, in closing, PROPS! (again) to Aesop. The “So, which of your limbs/children are you willing to sacrifice?” perspective, once again, illuminate something for me.
LA police gear is a direct vendor for NARP CAT tourniquet. I carry them in all my blow out kits, as well as my get home bags. We use them at work as well. I wait until LAPG runs one of their 20 percent off sales then I buy several. As a 23 year paramedic, and a TCCC instructor, I can’t recommend the NARP CAT tourniquet enough.