Why do you need medical skills and tools?

[cmailliard]

Yeah it's graphic.

Why do you need to train with them and not just have them? You think muscle memory might be important at a time like this? How much time do you have?
Students in class on Saturday found out how important the location of the tear tabs are on the Pressure Dressing and Gauze. When opening S-Rolled Gauze from North American Rescue how do you open the inner pack? Muscle memory is not just for your gun, you need to practice these medical skills. They are more likely to save a life than your 5000 rounds of 5.56.

Stay Safe


http://youtu.be/7e8gGXZDRY0

[hunterhawk]

That just makes me angry... WTF! And your post is not really accurate.. It's not like he is just going to be carrying that on him and patch himself up.. And even if he did have it on him.... I doubt they would have let him...

[DingleBerns]

That just makes me angry... WTF! And your post is not really accurate.. It's not like he is just going to be carrying that on him and patch himself up.. And even if he did have it on him.... I doubt they would have let him...

i don't think the post is about whether the guy should of had medical stuff on him. My guess is the OP is trying to help people see how fast you can bleed out and die if nothing is done.

[cmailliard]

Yeah I am not talking about the guy in the video, as Dingle said, it is to demonstrate how quickly you can die, more importantly how quickly you can no longer help yourself due to lack of oxygen secondary to massive blood loss. It does not matter how it happens the wound pattern from a 5.56, .308, or 9mm is the same in Pakistan, Afghanistan, India, or Colorado. Stay Safe.

[rbeau30]

This is why my EDC is clearly marked on the blow out pocket with a large red cross. Like cmaillard said, you can quickly become unable to help yourself.

[hunterhawk]

Ah well yes that makes more sense... But man this video pisses me off I can't even say what I want to and I don't even know why he was shot...

[Sawin]

Ah well yes that makes more sense... But man this video pisses me off I can't even say what I want to and I don't even know why he was shot...

agreed

[cofi]

Yeah I am not talking about the guy in the video, as Dingle said, it is to demonstrate how quickly you can die, more importantly how quickly you can no longer help yourself due to lack of oxygen secondary to massive blood loss. It does not matter how it happens the wound pattern from a 5.56, .308, or 9mm is the same in Pakistan, Afghanistan, India, or Colorado. Stay Safe.

so would a quickly applied tourniqite saved that guy or was that going to be fatal no matter what?

[cmailliard]

so would a quickly applied tourniqite saved that guy or was that going to be fatal no matter what?

Hard to tell but with two shots fired and bleeding from the arm and leg with the fatal wound most likely being the leg, yes a quickly applied TQ most likely would have saved a life. When we look at the three leading causes of Preventable Deaths on Battlefield, Extremity Hemorrhage is #1, this is the reason why. This is why the 180 degree shift in thinking about tourniquets, that $30 piece of velcro and plastic is saving more lives on the battlefield than almost anything else. It does not have to be a GSW though, it can be a knife or other form of penetrating trauma that cuts the artery.

[Sawin]

The other thing to consider is the location of and medical resources near the incident. In the case of the man in the video, may he rest in peace, a tourniquet might have simply lengthened his suffering. Do you think there was a capable doctor and donor blood in his general vicinity, 15 minutes away [Dunno]?

[Mick-Boy]

FWIW, Our SOP is; A TQ goes on if there is any high pressure or high volume bleeding from a wound (it doesn't have to be both) on a limb. You should be able to put it on any of your limbs yourself. This means being able to do it with one hand.

As with any skill - You're only as good as your training. So seek good training.

[Wulf202]

The other thing to consider is the location of and medical resources near the incident. In the case of the man in the video, may he rest in peace, a tourniquet might have simply lengthened his suffering. Do you think there was a capable doctor and donor blood in his general vicinity, 15 minutes away [Dunno]?

If the tq stopped the bleeding he'd have up to 6 hrs.

Case or med evacs are around. Its highly likely he was savable

[ChunkyMonkey]

The other thing to consider is the location of and medical resources near the incident. In the case of the man in the video, may he rest in peace, a tourniquet might have simply lengthened his suffering. Do you think there was a capable doctor and donor blood in his general vicinity, 15 minutes away [Dunno]?

In that particular event, yes. They were in the army base. A mob accused that young man of stealing and turned him in to the army. These assholes simply executed him.

Based on those uniforms, they are Pakistani rangers/ mountain troops.

I hope libtards watch that vid. It's their wet dream to have unarmed civilian society and have fellow citizens turn in others to the authority.

[Wulf202]

https://docs.google.com/file/d/1KC1H_br2LDtDgdX6Svlrjmvxvnun9dVdka2ScLyoYJj32r3kO 4YeDP72f8Yz/edit
and the airsoft companies are now making CAT knock offs.

[rbeau30]

https://docs.google.com/file/d/1KC1H_br2LDtDgdX6Svlrjmvxvnun9dVdka2ScLyoYJj32r3kO 4YeDP72f8Yz/edit
and the airsoft Chinese companies are now making CAT knock offs.


Are you flipping KIDDING me? I know Airsoft is a fun hobby, but really? I also fixed it for ya.



I hope libtards watch that vid. It's their wet dream to have unarmed civilian society and have fellow citizens turn in others to the authority.

They will just argue that "our troops are above that and would never fire upon our own citizens". well then the government will just recruit people who will, and get rid of the people who won't. It is arrogant to think Americans are ANY different from any of the other countries with HUMANS in it, that have government sanctioned armies that do this.

[DingleBerns]

We just had a medical class for work where we trained with tourniquets (applying them) with live fire.

The "Golden hour" is the key to survival. One hour after being shot and tourniquet is applied you should be in surgery to increase chances of survival. Beyond that, it's not a good day...

[Brian]

https://docs.google.com/file/d/1KC1H_br2LDtDgdX6Svlrjmvxvnun9dVdka2ScLyoYJj32r3kO 4YeDP72f8Yz/edit
and the airsoft companies are now making CAT knock offs.

I'm curious why this. Is it just like any other knockoff (make/sell something cheap), or is a simulated medic something that's become popular with the airsoft guys?

[Mick-Boy]

Because a legit CAT is around $30 and people are cheap. [facepalm]

These have been floating around since about 2009. Buy your life saving gear from a reliable source. Buying body armor or medical gear from ebay is asking for trouble that you won't know about until it's too late....

[cmailliard]

I have not seen fake CAT's that are Gen V or Gen VI. Gen V and VI have the RedTip and Fatter Windless. All the fakes I have seen have been pervious generations. Go to North American Rescue or Rescue Essentials to get your CAT's.

Mick boiled it down to very simple things, if it's high pressure or high volume you get a TQ. Better to error on the side of caution here and throw on a TQ.

[Mick-Boy]

Mick boiled it down to very simple things, if it's high pressure or high volume you get a TQ. Better to error on the side of caution here and throw on a TQ.

This is especially true when you have easy access to a higher level of care. If there is an injury to a limb and the thought "wow that's bleeding a lot" pops into your head, put a TQ on it. The Docs can take it off later. They can't bring someone back from the dead.

[275RLTW]

We just had a medical class for work where we trained with tourniquets (applying them) with live fire.

The "Golden hour" is the key to survival. One hour after being shot and tourniquet is applied you should be in surgery to increase chances of survival. Beyond that, it's not a good day...
No such thing anymore. Survivability is more dependent on where the wound is, severity of the wound(s), amount of blood lost, etc... Nowhere in trauma medicine is there a "1 hr" survivability time line for extremities. Obviously the quicker you can get to definitive medical care the better the probable outcome, and getting shot anywhere is already not a good day.

[Mick-Boy]

Coloccw - Do you have a source for that? I was just browsing through the latest TCCC bulletin to try and find something on how long TQs can/should be left on. I didn't see any hard and fast timelines.

[275RLTW]

There is no time limit anymore for how long you can leave TQs in place. Removing a TQ is not a current TCCC task (Just checked the DoD courseware). I've seen permanent damage after only a few hours in one individual and an extremity completely recover after 24+ hours of TQ placement. We finally realized there are too many other factors in medicine than a watch. Good wound care (bleeding and infectious control), medics who know their shit, and lots of replacement fluids/blood cells/meds are what's saving extremities now. Good pre-hospital care is key.

[Mick-Boy]

Rgr. I've been taught both to leave them in place until you reach a higher level of care and to try reducing them after 30min. Since I'm a fan of simplicity, I ere on the side of "let someone better trained take it off".

For those of you (us) who get their geek on reading about this stuff. Here's the link. (http://www.health.mil/Education_And_Training/TCCC.aspx)

[Mick-Boy]

OK. So looking at this PPT (http://www.health.mil/Libraries/120917_TCCC_Course_Materials/0203PP03-Tactical-Field-Care-120917.pptx) on tactical field care (specifically slides 71-78) it appears that the TQ should NOT be reduced if

- There is a traumatic amputation

- Casualty is in shock

- TQ has been on more than 6hrs

- Higher care will be reached with two hrs of applying

- Other considerations make reducing the TQ a bad idea.

Reduce only if

- Bleeding can be controlled by other means (slowly loosen and observe for renewed bleeding)

- You're a medic/doc

[275RLTW]

For those of you reading along and not familiar with TCCC/NREMT stuff I'll expand briefly: In the field, we cannot TREAT traumatic injuries (EMT-Ps excluded), only try to prevent further harm and package them up for transport to a Doc. This applies CONUS as well as OCONUS. If bullets are flying it doesn't matter if you are here or there: it is combat and combat proven protocols should be used. Stopping the bleeding, however you can, should be the main priority. If you think that pressure and elevation will work, then go at it. However, if it doesn't work then you just wasted all that time for nothing. Properly placing a TQ takes 10 seconds and works almost every time. Now you can take all the time you need to make a nice pretty pressure dressing and have the patient remain calm, etc... Taking off a TQ is not part of preventing further injury; it is treatment. A licensed Doc (CONUS) is needed to legally treat traumatic injuries. Whether a bystander on the range or an EMT-B, we cannot treat traumatic injuries. Basically, we can only stop bleeding, use basic methods to maintain an open airway, control hypothermia/shock, check and record vitals, and keep the patient calm. Get proficient at those basic skills and you can do a lot of good after an incident. Think of those as medical fundamentals: if your pre-hospital care or fundamentals are good, then the outcome should be better. Shitty fundamentals= shitty results.

[275RLTW]

OK. So looking at this PPT (http://www.health.mil/Libraries/120917_TCCC_Course_Materials/0203PP03-Tactical-Field-Care-120917.pptx) on tactical field care (specifically slides 71-78) it appears that the TQ should NOT be reduced if

- There is a traumatic amputation

- Casualty is in shock

- TQ has been on more than 6hrs

- Higher care will be reached with two hrs of applying

- Other considerations make reducing the TQ a bad idea.

Reduce only if

- Bleeding can be controlled by other means (slowly loosen and observe for renewed bleeding)

- You're a medic/doc
Pretty much sums it up. Loss of blood volume or pressure is shock, hence the reason for a TQ. Let the smart guys who pay lots of insurance handle reductions.

[Mick-Boy]

I'm a big fan of keeping treatment simple at my level (expired EMT-B with occasional follow on trauma training). Injuries to the extremities get TQs. Pelvic and shoulder girdles will likely get hemostatic agents. Anything from navel to the clavicle gets a chest seal. Head trauma's get disarmed unless they're clearly still with us. I let the brains worry about the details.

[cmailliard]

Thanks Mick and coloccw - good stuff [Beer]

[rbeau30]

I need to spend some money and get some real training. The Red Cross First Aid is not enough.

[dan512]

Talk to cmailliard, his classes are great for learning the basics and super affordable. Mick thanks for dumbing stuff down for us.

[cmailliard]

For those of you reading along and not familiar with TCCC/NREMT stuff I'll expand briefly: In the field, we cannot TREAT traumatic injuries (EMT-Ps excluded), only try to prevent further harm and package them up for transport to a Doc. This applies CONUS as well as OCONUS. If bullets are flying it doesn't matter if you are here or there: it is combat and combat proven protocols should be used. Stopping the bleeding, however you can, should be the main priority. If you think that pressure and elevation will work, then go at it. However, if it doesn't work then you just wasted all that time for nothing. Properly placing a TQ takes 10 seconds and works almost every time. Now you can take all the time you need to make a nice pretty pressure dressing and have the patient remain calm, etc... Taking off a TQ is not part of preventing further injury; it is treatment. A licensed Doc (CONUS) is needed to legally treat traumatic injuries. Whether a bystander on the range or an EMT-B, we cannot treat traumatic injuries. Basically, we can only stop bleeding, use basic methods to maintain an open airway, control hypothermia/shock, check and record vitals, and keep the patient calm. Get proficient at those basic skills and you can do a lot of good after an incident. Think of those as medical fundamentals: if your pre-hospital care or fundamentals are good, then the outcome should be better. Shitty fundamentals= shitty results.

This is about as good as can be said - Especially the last four words

Sorry been away most the day teaching - again Mick and coloccw, nice job on breaking things down. As Coloccw said EMS can fix very few things, trauma is not one of them, so it is stabilize and get to a trauma center. The more time that is lost immediately after the injury the less likely chance of survival, we need to keep that blood in the body moving oxygen. Which brings us back to the video to graphically demonstrate this process. With tourniquets it is The Golden Two Minutes, get that thing on, leave it on, get EMS on the way, get to a trauma center.

Stay Safe

[cmailliard]

There is a thread over at AR-15.com in the survival forum where some have gone full retard on this subject. One dude even said paracord and a stick is better than a CAT because the CAT is wider and will not stop the bleeding.[fail]

[jerrymrc]

There is a thread over at AR-15.com in the survival forum where some have gone full retard on this subject. One dude even said paracord and a stick is better than a CAT because the CAT is wider and will not stop the bleeding.[fail]

Sounds like he was trying for an amputation over a TQ.[Flower]

[Wulf202]

Saw it, some are just not worth reasoning with.

[rbeau30]

Saw it, some are just not worth reasoning with.

Yeah, that is why I carry the real stuff with me and hope that if I ever need help that the only person around is not that guy.

[Mick-Boy]

Talk to cmailliard, his classes are great for learning the basics and super affordable. Mick thanks for dumbing stuff down for us.

I can (have) plug holes if I have to. But no one ever hired me for my wealth of medical knowledge. I like to keep things simple so that I can spend my time worrying about the important stuff, like looking cool and making sure I have the right mix playing on my Ipod. [Coffee]


While we're geeking out on the medical stuff, this just popped up on a website I was browsing. A real bleed in a descending aorta is pretty much game over unless you've got a crazy switched on Doc who's not afraid to go invasive. Looks like someone is trying to simplify all that. Could be very cool.

http://www.popsci.com/technology/article/2013-06/amazing-tourniquet-invention-saves-two-lives

[rbeau30]

Bittersweet that war spawns such technology that will eventually save so many lives. Another thing to be thankful for our men and women in uniform for being human guinea pigs so-to-speak.

[cmailliard]

Mick that Abd. TQ is not to shabby. I saw it a while back, I have not got hands on one yet nor done much research into it, but if it works it is awesome. I had 60 y/o Male who was about to completely dissect a AAA, emergent to T10 at St. Anthony's, BP of 80/40 when we got him on the table, died about 10 minutes later as they were opening him up.

rbeau - That is one of the core reasons why we have TCCC. Soldiers have been dying the same way since the Civil War and why did we never put much effort into trying to stop it. Ft. Sam Houston and the United States Army Institute of Surgical Research are outstanding and doing true lifesaving work. Boston is a prime example of how it is paying off off of the battlefield. Time and Tourniquets are huge reasons why only 3 were killed in the bombings. This is a direct result of the research done at USAISR and on the battlefield.

[Batteriesnare]

I need to spend some money and get some real training. The Red Cross First Aid is not enough.

If you have the time, I recently took South Metro's EMT-B class and got the national registry. I have no intent of making EMS my career (though volunteering with a local FD is on my short list) but the skills I learned were awesome, especially as a shooter and CCW holder. Definitely worth the $690 for the class, and it was fun!

If you can't dedicate to that, definitely go to Cmalliard's CC&R class. Great stuff!

[cmailliard]

New study out on the routing of CAT's. Not real important for this conversation except for the minor result of this study and shows learning influenced the outcome of the study. Basically when you look at the curve bleeding was controlled faster as the study went on. Good info on CAT's.

HERE (http://www.asymresponse.com/news.html) is a link to the study on my site.

[Mick-Boy]

Army analysis of recovered TQs during OEF/OND (http://publications.amsus.org/doi/full/10.7205/MILMED-D-12-00491).

BLUF (my takeaways at least): Lots of TQs carried but unapplied. Some applied TQs applied incorrectly. No identified TQ failures based on windlass deformation (but deformation witnessed).

Carry them, train to use them (correctly) and, though it's not indicated in the study, don't carry a training TQ (one that has been applied multiple times) operationally.

I'm sure cmailliard could offer more.

[cofi]

Army analysis of recovered TQs during OEF/OND (http://publications.amsus.org/doi/full/10.7205/MILMED-D-12-00491).

BLUF (my takeaways at least): Lots of TQs carried but unapplied.
Is this because of a fault in army training?

[Mick-Boy]

The reasons weren't addressed. The study was conducted at mortuary affairs in Dover. It's just a look at what kind of TQs were being used and how they were applied.