Improvised Tourniquets

[paracowboy]

with all the hoopla about one-handed, high-speed, tourniquets, I's a-wondrin': what do you fellas think about the old improvised jobbies we used (some still do) to carry? Like the ol' bungee cord I was shown by a USMC combat vet.
And if'n you guys's got no heartaches with 'em, what do you rek-komend?

(Yeah, I'm feeling down-homey, and folkish, today.)

 

[Chimo]

The US Army is taking this very seriously. They now issue torniquets to all going to OEF and OIF, Op Enduring Freedom and Operation  Iraqi Freedom. I know the arguement is that you may cause more harm then good.They see it like a reserve parachute, its a life saver, not a limb saver.

I will try to get some info on the type, manufacture, etc. 

 

[paracowboy]

that's great, and I knew about the Yanks issuing them, but we ain't ever gonna see that sort of expenditure here. Our gov't has more important things to worry about than the lives and limbs of it's soldiers. Y'know, like buying votes and stuff.
I'm curious about medic's viewpoint on improvised tourniquets. Stuff we can get our hands on and carry in our own personal first aid kits. I know some medics get all antsy when they hear about troops making their own kits, and I wonder how they feel about impro'd tourniquets, and for those who approve, what sorts of things they advise using.

 

[Big Red]

http://www.galls.com/style.html?assort=general_catalog&style=FA207

This is the closest thing being made to what I have. The model I have was made in Denmark but the guy who owns the company is operating in Iraq so it's not producing gear anymore.

I have a couple that I got from SF guys that you rock back and forth to tighten but don't work as well as the skiboot ratchet models.

London Bridge makes one that is like a 1" tiedown strap with ratchet but is about $40. You can find the same thing at a hardware store minus the little pad for the ratchet device which I'm sure can be added easily.

 

[Armymedic]

http://www.galls.com/style.html?assort=general_catalog&style=FA207
This is the closest thing being made to what I have. The model I have was made in Denmark but the guy who owns the company is operating in Iraq so it's not producing gear anymore.

I have a couple that I got from SF guys that you rock back and forth to tighten but don't work as well as the skiboot ratchet models.

Sounds and looks good, but that model shown was one which would come off too easily or break. The other baddie was the Tourni-qwik (blue strap with 2 hooks, pure garbage) which broke on use. The other

you rock back and forth to tighten

is the first one handed tourniquet. Good theory, but hard to make work effectively because you can't tighten it enough.

Tourniquets are where I draw that "line" between what everyone should know and do, and what medical pers should. Basically, you should know when and how to put them on, we know that as well as how and why to take them off.

I think everyone should learn and practice the improvised meathods using a triangular badage and rifle sling (spanish windlass method) before gettting all horny about buying a commercially made one. After all, chances are when you need one you won't be carrying a commercial one.

A good improvised tourniquet should be between 1-6 inches wide, cloth or belt like object that won't stretch or break after application.  A pad should be placed over the artery to assist in occluding it. Once applied tie it off securely. Once on it should stay on and never be taken off (by you...unless you have been specifically trained to know how and why)

Below I have included a letter from the US Army Surg Gen ref a study they did to find the most effective comercial tourniquets. Nice to note the "EMT" made by Defi Medical is a Canadian product (made in Vancouver). The CF is following that report and the EMT and CAT will be the issued tourniquets in the CF as well.

I have played with CAT and SOFTT and both are easy to use. I have yet to see one of the EMT models, but I imagine they will be out soon.

Tourniquet Recommendations from USAISR 28 July 2004

Nine battlefield tourniquets systems were offered for testing to the United States Army Institute of Surgical Research via a request for products. These included 7 commercially available systems and 2 prototype systems. Eighteen human subjects were used to test the effectiveness of each device in accordance with an IRB approved protocol. Success was based on ability to occlude arterial blood flow in the proximal thigh (elimination of Doppler pulse in the posterior tibial artery). Additionally, the subjects rated each tourniquet for pain using a visual analog pain scale.

Two tourniquets were rejected based on weight and/or faulty design. Of the remaining seven tourniquets, three were effective in 100% of the subjects. These included one pneumatic and two strap type tourniquets; the Emergency Medical Tourniquet (EMT) (Delfi Medical Innovations); the Combat Application Tourniquetâ„¢ (C-A-Tâ„¢) (NSN: 6515-01-521-7976) (Phil Durango, LLC); and the Special Operation Forces Tactical Tourniquet (SOFTT) (NSN: 6515-08-137-5357) (Tactical Medical Solutions LLC), respectively.

The two strap tourniquets used a built in windlass as the mechanism for tightening. Of the two successful strap type tourniquets, the C-A-Tâ„¢ was less painful, easier to use, smaller and lighter than the SOFTT (59 grams vs. 160 grams). The design of the SOFTT limited the ability of the windlass to tighten the tourniquet, i.e., it was limited to approximately 3 turns. This limitation can be overcome through training the user to pull the tourniquet snug before attempting to tighten with the windlass. The EMT pneumatic tourniquet was wider and thus significantly less painful than any device tested and is much less likely to induce nerve damage compared to either of the strap tourniquets. The EMT weighs 215 grams and when packaged is similar in size to the SOFTT.

Based on these facts it is recommended that the C-A-Tâ„¢ be issued to each individual soldier, and the EMT pneumatic tourniquet be considered for issue to combat medics. Further, it is recommended that the EMT be issued for all medical evacuation vehicles and echelon I-III medical facilities.

John B. Holcomb, MD, FACS
COL, MC, US Army
Chief, Trauma Division
Trauma Consultant for The Surgeon General
Commander, US Army Institute of Surgical Research
3400 Rawley E. Chambers Avenue
Fort Sam Houston, TX 78234-6315
Off: 210-916-2720
Fax: 210-916-1851
DSN: 429
Secure 210-916-9254

 

[Big Red]

"Tourniquets are where I draw that "line" between what everyone should know and do, and what medical pers should. Basically, you should know when and how to put them on, we know that as well as how and why to take them off."

I'm putting one on if I have a limb that is bleeding excessively and getting back in the fight.

"Next we need to address when it is appropriate to use a tourniquet. In a combat situation if a soldier is wounded and still under effective hostile fire, a tourniquet is the most appropriate means to control bleeding. Why? When a soldier is wounded by enemy fire, using direct pressure to stop bleeding may take several minutes, and while holding direct pressure on the wound, the soldier or medic is unable to do anything else. If a soldier is able to apply a tourniquet to himself, he may then be able to continue to return fire. The best medicine on the battlefield is fire superiority. It may be essential to the mission to have as many weapons trained upon the enemy as possible. In addition, it is difficult to maintain direct pressure on a wound while transporting a casualty under fire. To further emphasize this point, it is imperative for every soldier who may be involved in combat to have an appropriate tourniquet readily available at a standard location on their battle gear. This allows every soldier to be equipped and trained to stop bleeding on themselves or their battle buddy immediately. "

Tourniquets
Lifesavers on the Battlefield
By Donald L. Parsons, PA-C, LTC (RET), Thomas J. Walters, Ph.D


"After all, chances are when you need one you won't be carrying a commercial one."

Your personal first aid kit should be on your vest, so that isn't an issue. Guys that carry them here have them easily accessable, either in a pouch, rubber banded on the PALS, or already on their legs. 

 

[R711]

TQ's should be applied by the first responder.This also includes the use of Quickclot and all the other variatitions of these product, most have no need in prehopsital settings in Canada due to rapid transport system avalible in the civilian setting. However, unlike in a civilain treatment settings, the military medic is not a quick phone call away. It's you or your fire team partner. Research coming back from OIF and OEF are pointing out that most applications need at least a two men (one to apply pressure and the other to do interventions espec in an artirial bleed). Fire power is the best medicine, not immediate tx of the patient (under TCCCS treatment protcols the patient treats himself with the most immediate and life saving tx and cont with the fire fight). Thus that means everyone must know how to use them.
We as a service are to heavliy influenced by the civilian side of practice. ie "the paltinum ten and the golden hour". These sayings have a use, in a certain context. However in and under battlefield conditions these rules are being thrown out the window. Recent examples include the Battle of Falujah(sp), where tx of pt were greater than 24 hrs before getting to a tx station.
-edited-
R711 OUT

 

[Old Ranger]

Your personal first aid kit should be on your vest, so that isn't an issue. Guys that carry them here have them easily accessable, either in a pouch, rubber banded on the PALS, or already on their legs.  

So, what your asking is "Where would the Medic like me to keep my TQ, so they can apply it to me if I have not been properly trained in it's use."

Would that statement be agreable to all?

Ben

 

[Old Ranger]

TQ's should be applied by the first responder.This also includes the use of Quickclot and all the other variations of these product, most have no need in prehopsital settings in Canada due to rapid transport system avalible in the civilian setting. However, unlike in a civilain treatment settings, the military medic is not a quick phone call away. R711 OUT

Quikclot, there is some very good information in this Medical forum you might want to read first...

Civi settings, you of course are only referring to Urban areas with an adequate Hospital, right..

Phone call/ Radio Call, what's the difference?

Ben

 

[JANES]

Hopefully you still check this thread paracowboy.  I'll add my two cents here.  WRT improvised tourniquets; when the ISR did the testing that "Army Medic" posted the results in this thread, they did a test to see how long it took a trained medic to apply an improvised tourniquet.  It ended up being 4.5 minutes.  If you are shot or receive a shrapnel wound in your thigh that disects you femoral artery and or vein (you dont have armor for there), how long do you think it will take you to bleed out?  If you guessed under 5 minutes, like 2 to 3, then you were right.  So do the math.  Are you happy with an improvised tourniquet.  The sound of a bungee one scares me a little too.  A tourniquet isn't something that should be taken lightly.  If you apply one that is inadequate - like most of the ones tested in the ISR study, then you risk doing more harm than good by applying to little pressure stopping veinous return but not stopping arterial flow out.  The best improvised tourniquets are: a triangle bandage and a cleaning rod or surgical tubing wrapped continuously and tightly.  Thats from a Canadian Army study done a couple years ago. 

The best thing you can do is lobby your c of c to buy you one, or two for that matter.  Two on a big drum stick is better than one.

 

[kj_gully]

Not too many answers here to the original question, though. Most CQ's have 1" tubular nylon, I think, and that, with a sturdy piece of dowelling, and a metal ring (like a grenade pin, you decide what to do with the grenade ) to hold the dowel in place once tight, will make a reasonable facsimile of the commercially available TQs. A keener would get together with his unit's medics, and come up with a good version, and have the troops all make their own B4 deploying. Who knows, a cleverly worded article about "Canadian Ingenuity" in the Maple Leaf, and they might rush procuring the real thing!

 

[JANES]

If everybody starts making their own, then for sure they won't buy the real thing.  Why should they, everyone has one.  I cannot say if the bungee is as effective, I dont know how you are employing it.  The best improvised tourniquet is surgical tubing, officially Canadian military tested.  Not a penrose drain, but surgical tubing wrapped continuously and very tightly, then tuck the running end under one of the tight wraps.  It takes two hands, but so does a triangle bandage and a cleaning rod.  I would highly discourage the use of 1 inch tubular nylon.  Its to narrow especially when it gets twisted in the windlass system.  A triangular bandage is much broader which means less pressure to stop the arterial flow which means less pain which means less nerve damage which means better.  The grenade pin ring is a good idea.  You can use a loop of paracord too.

 

[Armymedic]

A triangular bandage is much broader which means less pressure to stop the arterial flow which means less pain which means less nerve damage which means better.

exactly, 1 inch wide good, 2 inches wide better. Nothing beats the spanish windlass for tightening.

JANES, where did you get the time it took to get the improvised TK applied? I ask because 4.5 mins seems like a terribly long time.

 

[JANES]

This is quoted from the US Army Institute of Surgical Research presentation on Laboratory Evaluation of Battlefield Tourniquets, Thomas J. Walters, Ph.D., SFC Dominique Greydanus, Joseph C. Wenke, Ph.D.  July-Aug 2004

"Average blood volume:
5 liters

Hemorrhage from femoral artery:
1  liter per minute*

Average time to apply improvised tourniquet (trained medic)
4.4 minutes**

Do the Math

*Wenke JC, Walters TJ, Greydanus DJ, Pusateri A, and Covertino VA.
Physiological Evaluation of the One-Handed Tourniquet. Mil Med, In Press.
**Mabry, RL Use of a hemorrhage simulator to train military medics. Mil Med, In Press."

 

[Armymedic]

No arguing the math.

Must preach practice and availibilty of materials for improvised touriquets while teaching how to do the triangular bandage as tourniquet  next two weeks.

I want to quote the numbers and reference for the class. Thanks.

 

[JANES]

"Do the Math" was the quote in the presentation