When Do We Apply the TQ "High and Tight?"

TQ Forearm      There is a lot of discussion on whether to place a tourniquet (TQ) "high and tight" on an arm or leg,  or place 2-3 inches above the wound, even if on the forearm or lower leg, sometimes called a  "double bone compartment. " There is also those who say a tourniquet can be on for 1 hour, or for 8+, so which is it? 

The short answer is, it depends on the wound, who you are, and where you are.

 "When do we do high-and-tight? "

High-and-tight is a "catch all" for most situations and non-medical professionals. It's easy to remember and unlikely to be placed distal (away from the injury, not between injury and heart) or be placed over a joint which would make it ineffective. High and tight also accounts for blast wounds where the wound may be more extensive or deeper than it appears, and when placing over clothes during "Care Under Fire" where the wound and location of bleeding may not be easily apparent.

For non-medics and Tactical Combat Casualty Care (TCCC) trained individuals, high-and-tight is for care-under-fire.

For those close to a hospital, within 1-2 hours, high-and-tight is also fine. We will discuss why if farther away from care you may want to consider other options.

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Improvised pelvic splint

https://www.youtube.com/watch?v=WtFBs_DXHwI&w=560&h=315

Austere medical tips for stabilizing a fractured pelvis with supplies you have in your aidbag. If you don't have a pelvis sling you can fashion a hasty sling out of a TQ and SAM splint. Take a look! www.CAGmain.com

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New medical tool

Adjustable Oral Airways

https://www.youtube.com/watch?v=-64dl3dqHeg&w=560&h=315

For years we have watched clinicians struggle with the traditional airways. Many have stopped utilizing them altogether. We, at NuZone Medical, following American Heart Association (AHA) recommendations, felt that it was time for a new airway. One you could actually work with! We observed the current airways to be difficult to size correctly and insert; thus, making them uncomfortable for the patient. Plus, they do not allow for an easy airway clearance. In addition, if the patient’s Level of Consciousness (LOC) improves, the traditional airways stimulate a gag reflex, which makes it necessary to remove the airway with a potential for reinsertion if a need arises. The Dual-Air® Adjustable Oral Airway provides solutions to many of the above mentioned situations. This adjustable airway is pretty awesome for the field medic. We will be doing some more testing this year but after seeing this at the conference i just wanted to share it with all of you. www.NUZONE.com Crisis Application Group Ready-Sure-Secure www.CAGmain.com #JedburghTargets
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Xstat- Intrinsic vs extrinsic pressure (Video)

[youtube https://www.youtube.com/watch?v=RgEO-sRwdAs&w=560&h=315]

Medical Concepts: Intrisic vs. extrinsic pressure. Click here to watch: https://goo.gl/noatbE Synopsis: In this video we show you the difference between the two concepts of pressure using a Gen 7 CAT tq, and the X stat trauma syringe....
‪#‎TjackSurvival‬ ‪#‎CrisisApplicationGroup‬ The Activity Group North American Rescue We will be giving away a free: CAG tier 1 IFAK with combat gauze to a lucky subscriber. watch the video for a chance to enter. Click here to learn more about the prize: https://goo.gl/I3Er8F Crisis Application Group Ready-Sure-Secure www.CAGmain.com ‪#‎Survival‬ ‪#‎AustereMedicine‬ ‪#‎IFAK‬ ‪#‎CombatProven‬ ‪#‎TheActivityGroup‬ ‪#‎RevMedX‬ ‪#‎NorthAmericanRescue

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LiveFire Care Under Fire (Video)

[youtube https://www.youtube.com/watch?v=gRmpnnmmZmo&w=960&h=720]

LiveFire CareunderFire www.CAGmain.com In this video one of our students runs the Live Fire Care under Fire drill here at CAGmain. Its a chance for them to apply both basics courses (TCCC and Intro to Pistol) under timed pressure in a controlled environment. This past week end we ran 7 students total, and only 1 passed in time. This clip runs just over the 5 minute pass mark, but he will get another chance to try in Jan. Each student must have (Mandatory): Passed Intro to pistol and safety Intro to TCCC 2 safetys per student Eye and hearing protection The Drill: -The patient is located behind simulated cover -The student medic must engage targets and move to the patient behind cover. -If the medic breaks the cover box they must shoot a penalty -Timed shots and initiated at 30 seconds then every 60 seconds after -The student MUST engage immediately when the horn blasts, even if mid treatment. In orderTo pass: -The student must hit both steel targets twice per shot sequence (20 yards) -Identify all injuries in sequnce (MARCH) -Treat all injuries -Verbalize for hypothermia blanket and reassess every 15m In this video the student medic was using: The warrior assault systems recon Mk1 (Courtesy of www.ArizonaDefense.com) http://arizonadefensesupply.com/store/#!/WARRIOR-ASSAULT-SYSTEMS-Recon-Shooters-Cut/p/56347282/category=15066506 The CAG Tier 1 IFAK:http://cagmain.com/shop-cag/#!/CAG-Trauma-Packs/c/13147503/offset=0&sort=normal Which uses combat proven products from www.NARescue.com) 1x Gen7 CATTQ: http://cagmain.com/shop-cag/#!/Combat-Application-Tourniquet-C-A-T-Tactical-Black/p/50856842/category=13227550 1x NPA 1 Hyfin chest seal twin pack: http://cagmain.com/shop-cag/#!/Hyfin-Vent-Chest-Seal-Twin-Pack/p/50869901/category=13227552 2x Compressed Gauze 2x 4" ETD dressing:http://cagmain.com/shop-cag/#!/EmergencyTrauma-Dressing-ETD-4-in/p/50856860/category=13227550 This video was made possible by: Arizona Defense Supply www.ArizonaDefenseSupply.com and North American Rescue www.NARescue.com

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IFAK Chest seals (Video)

https://youtu.be/VI4nycwiqnY Its more important now than ever that we have the right people with the right gear. Getting ready for an emergency is everyone's personal responsibility with in the boundaries of their capabilities. We have tested multiple chest seals here at CAGmain and I have of course experience while on active duty. The reigning champ so far is the Hyfin vented twin pack. There are other good products but for the cost and durability we use the Hyfin. Available at SHOPCAG $14.99 More on the Hyfins: http://cagmain.com/shop-cag/#!/Hyfin-Vent-Chest-Seal-Twin-Pack/p/50869901/category=13227552 They can also be found in the CAG tier 1 IFAK: http://cagmain.com/shop-cag/#!/CAG-Tier-1-Med-Pack/p/50478734/category=13147503 Here's a link to the new compact version that we haven't tested yet: http://www.narescue.com/portal.aspx?CN=6A6CFEAD5E58 Product specs from the manufacturer: North American Rescue The new HyFin Vent Chest Seal Twin Pack from North American Rescue sets the standard for the treatment of penetrating injuries to the chest. Providing two vented chest seals in one unique package for treatment of both entry/exit or multiple penetrating injuries to the chest. The new HyFin Vent Chest Seal design provides 3-vented channels that prevent airflow into the chest cavity during inspiration while allowing air to escape through the vent channels during exhalation. The 3-vent channels allow blood to escape and also provide a backup fail-safe system, as even if two of the three channels become obstructed, the vent will remain fully operational. Advanced adhesive technology provides superior adhesion in the most adverse conditions, including sweaty or hairy casualties. Packaged in a rugged, easy-to-open foil pouch, the perforated packaging allows rescuers to open only one dressing at a time as needed. Each chest seal also includes a gauze pad to wipe the wound surface prior to application. Each HyFin Vent Chest Seal has a large, Red-Tip ™ pull tab for single-step peel-and-apply application and allows for the burping of the wound if necessary. The clear, transparent backing allows for easy placement over the wound area and conformability to the patient’s chest. Meets or exceeds the current EMS Standard of Care and TCCC & TECC Guidelines for treatment of penetrating injuries to the chest, the new HyFin Vent Chest Seal Twin Pack is the superior prehospital chest seal. Special Features: Patented, new design with 3-channel pressure relief vents Two Chest Seals for the treatment of both entry/exit or multiple penetrating injuries Advanced adhesive technology for a superior seal in the most adverse conditions, including sweaty or hairy casualties 3-vent channels that prevent airflow into the chest cavity during inspiration while allowing air to escape through the vent channels during exhalation Vent channels allow blood to escape and provides a backup fail-safe system as even if two of the three channels become obstructed, the vent will remain fully operational Easy-to-grip, large Red-Tip™ tab for single step, peel-and-apply application that allows for the burping of the wound if necessary Rugged, easy-to-open foil package featuring signature Red-Tip Technology™ tear notches with perforated packaging allowing rescuers to open only one dressing at a time as needed Weights and Dimensions: Packaged: Folded: H7.5 in. x W4.5 in. x D0.25 in. Unfolded: L7.5 in. x W9 in. x D 0.13 in. Chest Seal Size When Deployed: H 6 in. x W 6 in. Weight: 2.5 oz. US Patent 7,504,549 & Patent(s) Pending

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Austere Medicine: Weekend roll up

The week end November 14th and 15th was a trauma heavy training blow out here at CAGmain! We had 2 full crews of 4 students a day and burned thru multiple high threat TACMED scenarios. [caption id="attachment_2451" align="aligncenter" width="660"]Intro to Austere Medicine Intro to Austere Medicine[/caption] Medical emergencies are statistically the most likely event you will encounter in a disaster. Take a look at the headlines, its easy to see why civilian trauma skills can and will pay off if the right person with the right skills is ready to take action..... Here's a quick breakdown of a few take home points for the students as a whole (both groups):

  • Remember to do the "Meat Check" following pulses
  • PRACTICE taking vital signs. Pulses can be hard to find.......
  • If the supplies are available, dress wounds that have been treated by a tourniquet for infection control.
  • If you have limited medical supplies, focus on untreated limbs before the tourniquet limb.
  • Do the chest exam the same way every time and learn what normal feels like. This way when a patient presents an injury it sets off your red flag during a high stress event.
  • Commit to one role or the other. At this phases of your medical career its important to decide definitively to either perform the medical procedure or to address the threat to you and your patient. Don't try and apply a tourniquet AND shoot bad guy. As we saw this week end, its a recipe for an ineffective treatment.
  • Know your gear. If you're using a new IFAK or someone else's gear, take a second to make sure you know EXACTLY what your using. GEN6 and GEN7 CAT TQs are out there and in some cases apply differently. The 2 seconds you take to confirm the gear prevents the two minutes of redoing a treatment that was applied incorrectly.
  •  Super glue creates a super mess...... Be deliberate when opening your chest seals.
  • The emergency blankets in the CAG Tier 1 IFAKs work. Every student had a chance to be the patient and was exposed to the cold floor, then insulated with the blanket. Use them....
  • Watch the membership videos to rehearse your assessment sequence.

ADMIN NOTES:

  • Make sure students come class with clothes they are willing to get stained and dirty! There will be blood!

The total for this weekend: 8 students and they all earned their Austere Medicine tabs! As you would expect, CAG members show up ready to learn and ready to work. Both classes worked hard and were able to get full training effect and value as civilians learning austere/TCCC medicine. We had variety of students that participated in training this week end. Young and old, hurt and healthy, male and female.

Great job to the students, ya'll kicked ass!

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Review: NEW Gen 7 CAT Tourniquet (Video)

The Combat Application Tourniquet was initially fielded by USSOCOM in 2004 then fast followed by conventional forces in 2005. In the early years of the Global War on Terrorism (GWOT) and prior to the implementation of modern prefabricated tourniquets, the death rate from extremity exsanguination was 23.3 deaths annually. After full implementation, this number was reduced to 3.5 deaths per year, an 85% decrease in mortality. In 2005 the Combat Application Tourniquet was selected as one of the Army’s top 10 greatest inventions and is recognized as one of the foremost advancements in pre-hospital care during the GWOT with an estimated 1,850 lives saved.

https://youtu.be/_1dvKdyHWec Brief History (North American Rescue) The Combat Application Tourniquet was initially fielded by USSOCOM in 2004 then fast followed by conventional forces in 2005. In the early years of the Global War on Terrorism (GWOT) and prior to the implementation of modern prefabricated tourniquets, the death rate from extremity exsanguination was 23.3 deaths annually. After full implementation, this number was reduced to 3.5 deaths per year, an 85% decrease in mortality. In 2005 the Combat Application Tourniquet was selected as one of the Army’s top 10 greatest inventions and is recognized as one of the foremost advancements in pre-hospital care during the GWOT with an estimated 1,850 lives saved. Relentless comprehensive analysis of all deaths from extremity hemorrhage has resulted in evidence-based tourniquet improvements. This approach has yielded critical device improvements to include five refinements in the design of the Combat Application Tourniquet over the last decade. These enhancements were focused on maximizing the effectiveness of the device while minimizing morbidity. Continuous interface with end-users and researchers, literature review and tourniquet applications in both real world and simulated high stress tactical environments have made it clear, that despite tremendous success, tourniquet knowledge gaps exist in the following areas (1) single verses double routing of the band (2) Importance of slack removal prior to engaging the windlass.  Closing these gaps will be accomplished through device enhancements, knowledge products and focused training.   The Combat Application Tourniquet Generation 7 When we began work on the CAT GEN 7 we considered every element that defines a tourniquet designed for combat use. We challenged ourselves to find the best, most forward-looking way possible to enhance performance and maximize application success. But we didn’t do this alone. Leveraging input from after action reviews, researchers, material scientists and you, the end-user, we were able to create the most advanced CAT to date. Every component of the CAT GEN 7 is optimized performance and reliability.  The CAT GEN 7 has a single routing buckle system that  (1) allows for extremely fast application and effective slack removal (2) unifies training standards and eliminates confusion by having a single protocol/directions for all applications.

The Combat Application Tourniquet Generation 7 Requirements Driven Enhancements 

Single Routing Buckle C-A-T® Gen 7 performs better and is easier to use than previous generations, resulting in less blood loss Unified training standards with single protocol/directions for all applications. Windlass Rod Increased diameter for enhanced strength Aggressive ribbing for improved grip Windlass Clip Bilateral beveled entry for rapid windlass lock Bilateral buttress for added strength Windlass Strap Sonic welded to clip for constant contact Color changed to Gray for tactical considerations Stabilization Bar Reinforced, beveled contact bar maintains the plate's integrity and decreases skin pinching  General Studies for the CAT TQ: 001. Tourniquet Problems in War Injuries - 1945 002. Battlefield tourniquet systems.2000 003. Tourniquet Controversy - 2003 004. Tourniquets for hemorrhage control on the battlefield - 2003 005. Tourn Issues MilMed.2004 007. Issues Related to the Use of Tourniquets on the Battlefield - 2005 008. Research on Tourniquet Related Injury for Combat Casualty Care - 2004 009. Surgical Tourniquet Technology Adapted for Military and Prehospital Use - 2004 010. Labortory Evaluation of Battlefield Tourniquets in Human Volunteers - 2005 014. Tourniquet_Evaluation_AUG05 015. A Balanced Approach to Tourniquet Use - 2006 016. Tourniquet 2007 017. Extended Tourniquet Application After Combat Wounds - 2007 018. Practical Tourniquet Use - 2008 018.1 TCCC Doyle Tourniquets PEC 2008 020. Tourniquet Technology on Today's Battlefield 2008 021. Tourniquet Use in Combat Trauma UK Experience - 2008 022. Battle Casualty Survival with Emergency Tourniquet Use to Stop Bleeding - 2009 023. Survival with Emergency Tourniquet Use - 2009 023.1 TK CALL AAR_Jul-09 rebuttal to Johnson 024. Final_tourniquet_working_group_minutes_march_2010 026. The Military Emergency Tourniquet Program's lessons Learned with Devices and Designs - 2011 027. Tourniquets - 2011 028. History of Tourniquet Use 2011 029. Re-Evaluating the Field Tourniquet for the Canadian Forces 030. CAT_Single-Routing_ 031. Tourniquet_Slack_Issue 032. Israeli NSW Feedback_to _the_Field_(FT2F) #11 FT2F #12 - TQ Use in OEF OIF and OND - 16Jul12 [caption id="attachment_2463" align="aligncenter" width="660"]QUALITY RETAIL QUALITY RETAIL[/caption]

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