Tactical tourniquet use – Part two
Ed Note: In part one of this two part series, which we suggest you read by clicking here, author Chuck Soltys explored self/buddy care, gear placement, basic hemorrhage control, as well as a few of the vital arteries and nerves in the leg. In part two below, Chuck looks at the types of tourniquets as well as the best practices for their use.
By Chuck Soltys
The tactical situation or the presence of an existing hostile threat may not allow the time and may prevent conventional methods of hemorrhage control such as direct pressure, elevation, and/or the use of a hemostatic agent. The recommended means to control extremity bleeding in a tactical environment while under fire is a rapidly and properly applied tourniquet.
If the casualty is shot in the head, neck, or torso, it is a load-and-go situation and medical care should be administered while enroute to a trauma hospital. If bullets or knives penetrate an arm or leg, these wounds are almost always survivable if a tourniquet is used immediately (delayed only by the officer first neutralizing the immediate threats). Once the bleeding is stopped, it is generally not a huge emergency. The officer can remain behind cover until the extraction route has been tactically cleared. Simply leave the tourniquet in place until arrival at the hospital.
In any typical domestic law enforcement situation, if arrival at a hospital cannot be accomplished within two hours, there was something drastically wrong with the plan. Wilderness operations and military operations may be an exception to this. Dr. John Wipfler, tactical and emergency physician, puts it thusly:
The use of tourniquets has long been discouraged by traditional EMS protocols. However, direct pressure is difficult to maintain during casualty extraction or transport under fire. As combat changes, so do our methods of treatment. In tactical medicine (TEMS), the training and use of tourniquets is not only accepted, it has become the standard intervention for life threatening bleeding injuries to extremities where time or situation are not conducive to the use of direct pressure methods. Tourniquet use is the most reasonable initial choice to stop extremity bleeding as you initiate care to yourself or someone else while under fire. Tourniquets should be immediately available to every officer on the street and should be part of the standard gear load-out for all SWAT operators.
Training in the proper use of a tourniquet is crucial. Generally speaking, a tourniquet will more likely be required for arterial bleeding rather than for venous bleeding. Arterial blood is oxygenated blood being pumped from the heart and is characterized by bright red blood spurting from the wound. Venous blood is deoxygenated blood that is returning to the heart and is characterized by a steady flow of dark red blood from the wound. The military cites several issues from the front lines regarding the use of tourniquets.
• Tourniquets are not being placed correctly
Types of Tourniquets
• Easy to use. Can be applied one-handed
The only tactical tourniquets currently approved for military issue are the Special Operations Forces Tactical Tourniquet (SOFTT) ™ (www.tacmedsolutions.com) and the Combat Application Tourniquet (CAT) ™ (www.combattourniquet.com).
2. Improvised: The windlass/cravat is an improvised tourniquet made by using a length of 1” or wider strap, webbing, or folded cravat and stick, tool, etc. to use as a windlass to apply sufficient tension. Using anything less than 1” wide for a tourniquet could substantially increase the risk of nerve damage to the victim and possibly result in permanent injury. However, life is more important than limb. If all that is available to use is something less than 1” wide and the blood flow is life-threatening; you must use what you have at your disposal. When improvising a tourniquet, you are only limited by your imagination. Items such as belts, rifle slings, or T-Shirts are just a couple of examples of items that most people would have with them and could be configured into an effective tourniquet. A tree branch, tool, or handcuffs are examples of items that could be used as a windlass. According to former operator and renowned trainer, Henk Iverson, who is currently training U.S. military troops, using the Israeli Battle Dressing as a "tourniquet" works well if applied properly. You may need to substitute a more durable object for the windlass in place of the plastic clip supplied with the bandage. It does take practice, especially if your hands are covered in blood. Training on making and applying an improvised tourniquet will be beneficial should you ever have to do it for real.
Facts about Tourniquets
Common Errors with Tourniquet Use
• Apply without delay for life-threatening bleeding
It is very important for all tactical operators and medics to practice repeatedly until the application of a tourniquet can be done confidently and rapidly within 30 seconds, with either hand (using only one hand) when applying a tourniquet on their own leg or arm.
Remember, if unable to control bleeding except with a tourniquet, it is better to sacrifice a limb than to lose a life to excessive bleeding.
If your employing agency does not or will not provide you with the necessary emergency medical training and equipment, you must obtain it on your own. Everyone owes a certain amount of their own time and money to their chosen profession. While you may be right that this is the responsibility of your employer, don’t be dead right!
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