CAT's eat RAT's: Tourniquet Comparisons

We have come a long way in trauma medicine since the days of "Use a tourniquet only as a last resort." We now know it can be on for hours before it even begin to damage the patient, and now tourniquets are often times your first intervention in tactical medicine

A Guide to avoid gimmicks in the world of Tactical and Austere Medicine:


Tourniquet+poster   We have come a long way in trauma medicine since the days of "Use a tourniquet only as a last resort." We now know it can be on for hours before it even begin to damage the patient, and now tourniquets are often times your first intervention in tactical medicine. It's now a rush to create the latest greatest equipment, especially tourniquets, to save lives both on the battlefield and here back home as referenced in their success in the Boston Bombing. Most often times these new medical innovations are not created by a scientist in some dark lab but the warriors who return from the battlefield and realize what we need. I applaud those who innovate in order to save lives and experienced Tactical Medics can make their own decisions about the newest medical interventions. Unfortunately, some products

come out seeming to be best thing since sliced bread and we here at Crisis Application Group are here to help you make an educated decision in what you choose to purchase because this purchase may be used to save somebody's life.  Every tourniquet has its Pro's and Con's that can and should be mitigated by rigorous training. When the human factor is eliminated as best it can through rigorous training, THEN we can talk about proper equipment.  It doesn't matter if you have the best tourniquet in the market if you can't use it properly.

 

 


R.A.T. Tourniquet:

CATSeatRATS   Cutting right to the chase: I'm not sold on the R.A.T. Tourniquet just yet. (Pictured:) it has "TCCC" approved on it, which is not the military's official "CoTCCC" which Crisis Application Group's CEO was formerly a member of. That could be misleading to many folks that think it has been approved for battlefield use. The RAT tourniquet is a flat bungee that works through wrapping the cord around the extremity to stop bleeding. While you could improvise many items to slow the bleeding, I expect total arterial occlusion from a commercial product. I have yet to see Doppler prove that it occluded arterial blood flow, studies on live tissue, or real CoTCCC approval. The RAT tourniquet page has video documenting it stopping the pulse through the use of a Pulse Oximeter, but that is not where the bar is set. I see the temptation with the lower cost and size, but in medicine you can't take the "idea" over proven effectiveness. In the game of saving a life, you may have to spend the extra dollar.

CAG Tier 1 Med Packs! Complete modular systems $99!

  There is also the argument about proper width, which is directly correlated to soft tissue damage and more importantly arterial occlusion. It states and is 1.5" when properly applied, which I will give them the benefit of the doubt. However, with items used in a high stress environment, you'll want a redundant product that is less likely to be messed up. For instance, if there is too much spacing between the wraps, or overlapping too much could require the Operator to re-do the intervention, releasing the tourniquets pressure. In addition, Some haFlatBungeeTourniquetve argued about the length of RAT tourniquet on a thigh, but after seeing a video demonstrates it's use on a 26" thigh properly, I have no complaints there.

  A large portion of the reviews say it's fast enough than taking an already 'looped' CAT from the foot of the patient and jostling it all the way up. I teach my TCCC students the option for a CAT to instead be applied through the friction adapter at the correct height of the limb. This requires less movement and going around the limb than the multiple loops of the RAT.   A tourniquet isn't just about putting one on, but keeping it on. I would like to see how it would hold up in casualty drags and carries, where rocks, debris and gear can cause a tourniquet to possible become loose and therefore less effective.   If we received one in the mail, we'd surely test it out further. Until then, we'll wait till we see more concrete proof.


SWAT-T Tourniquet:

[caption id="attachment_454" align="alignleft" width="372"]SWAT Tourniquet SWAT Tourniquet[/caption]

   This is the SWAT-Tourniquet. It's name is also how to use it: "Stretch, Wrap and Tuck." . It's an elastic wrap, I've used one in practice when I came across it. It was very strenuous to get working and after application to the legs and I put it on aggressive and tight. In addition, when finished wrapping, you have to find a place to tuck the tail into or it will unwrap itself, which was one of the largest issues I had. I would mention the pain, but that has no room in saving a life because "The Operator feels no pain (when doing medical interventions.)"  I would not recommend this product that is not CoTCCC approved and many units do not allow it. I wouldn't even use it as a pressure dressing to avoid compartment syndrome, and an ACE wrap is easier to see blood leaking through if your intervention fails.



Committee of TCCC (CoTCCC) Approved Tourniquets:

  The two tourniquets widely used in the the Special Operations community as well as experience in the staff here at C.A.G.,  but even more importantly have approval from the Committee on TCCC (CoTCCC) and Fort Sam Houston's Institute of Surgical Research are the Combat Application Tourniquet, version 3 -or- CAT3 and Special Operations Forces Tactical Tourniquet -or- SOFT-T/SOF-T. CATTrauma CAT-T   The CAT3 has been ol' faithful for quite some time. It does get a lot of hate, though, and as someone who has taught all different groups of people TCCC, I can see where it frustrates newcomers. Just like many other good pieces of equipment, a tourniquet is not a learn-once and done. The CAT3 needs some practice to get down smoothly, especially with the friction adapter. C.A.G. has a video you can watch to learn how to do it right and practice in order to stay under the goal time of 30 seconds.


** A CAT3 once used for training or any other purpose should not be used in trauma.

[youtube https://www.youtube.com/watch?v=BAF5LIxzOPo&w=420&h=315]

SOFT-T:   Special Operations Forces - Tourniquet is another tourniquet we recommend, but just as with the CAT, it will take practice to get it right. If you foresee you or others in your group having a hassle with the tightness of the screw or remembering it, the newest generation SOFT-T has a buckle that makes life easier. SOFT-TSOFT-TW (Wide version with Buckle instead of screw.) LEFT: SOFT-T RIGHT: Newer SOFT-TW Wide with Buckle in place of the screw.

 

 

 

Improvised Tourniquets: token1

  Improvised Tourniquets are as their name implies, using what you have available in an attempt to create a tourniquet effect. They are good to know how to make and have prepared for an austere or mass casualty incident where you do not have one, or do not have enough tourniquets. However, they do not work as well as commercially designed tourniquets, so prepare a few in case you run out and tuck it away in your intellectual equity toolbox. Our very own Crisis Application Group's Jay Paisley demonstrates just how simple it can be.

[youtube https://www.youtube.com/watch?v=0Q_ClfyM0Ls]



  What I hope you take away from this article is to be skeptical of new inventions proclaiming to be the next big thing, especially in the business of saving lives. I could go over every possible tourniquet on the market and write a book but I'm sure you got the point. When you come across one you're unsure about, do some research or even feel free to ask us about it. Inspect your tourniquets as you receive them, as some have cheap after-market knock offs made of cheaper, flimsy products or even an older generation of what's currently best. I also recommend you take your tourniquets out of the packaging and prepare them properly as fumbling around with that can cost a few extra seconds when the goal is preserving "fresh clean blood."

CAG Class: Intro to Austere Field Medicine, Conyers, GA!

  Once more, I applaud those out there creating these products to save lives on the battlefield, Law Enforcement Officers and even Civilians back home. I would love for a product that is smaller, faster and lighter than what we currently use, but more importantly I want one that can save more lives. It would be a safe bet to stand back and monitor a product you're interested in while it receives further testing and real world application to work out the kinks. Even the beloved Combat Gauze had criticism when it first came out and replaced Celox and Chitogauze awhile back, then in the new TCCC updates Celox/Chito are back in the game as alternate uses because they work intrinsic of the clotting cascade and may perform better for someone with poor clotting factors. It goes to show you that what you knew about medicine 6 months ago may not be correct, and what you knew a decade ago might not work as well as what is out today.   For now I recommend you stick with what you know and keep training. No matter which tourniquet you or your community purchase, buy at least two; One for training, one to keep when you need it. Mark/spray paint the training TQ to keep it separate and train on it often to stay fresh and keep your time under 30 seconds. The equipment doesn't live up to its full potential without proper, consistent training.   If you have any question on medical products, feel free to ask the medical subject matter experts here at Crisis Application Group about it. We have Special Operations, Special Forces, former CoTCCC members and other Medical Professionals that can give you a professional opinion. Trust the reviews of those who have used tourniquets on real life trauma casualties. [caption id="attachment_2" align="aligncenter" width="300"]Med training with Crisis Application Group Med training with Crisis Application Group[/caption]   Don't take our word for it, Check out these References and come to your own conclusion, or Google "TCCC" or "CoTCCC tourniquets" : JSOM TCCC References: https://www.jsomonline.org/TCCC.html TCCC PDF from U.S. Army Institute of Surgical Research updates, as of 02 June 2014: http://www.usaisr.amedd.army.mil/pdfs/TCCC_Guidelines_140602.pdf

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How to do a trauma assessment for preppers (Graphic pics)

[caption id="attachment_200" align="alignright" width="300"]TCCC with CAG TCCC with CAG[/caption] Naturally before we begin it needs to be said: CALL 911. However since we are a page dedicated to prepping and crisis management, it stands to reason that in this venue there is no 911 or 911 isn't coming. Either way YOU need to act.... Why start with trauma? Trauma is universal to every major catastrophe that's hit the US since 1776. Of course we support learning how to shoot and the myriad of other skills required to stay ready, but trauma is statistically proven to be the most likely event you will 

encounter. Medical skills aren't sexy and tend to be put on the back burner in favor of more glamorous venues. A $2000 assault rifle ISNT going to stop bleeding or manage an airway is it? We get it, medical supplies are expensive and there is an army of "practitioners" who want to keep control over medicine, but that isn't going to cut it for a prepper. What medical program should look into? There are dozens of good programs out there and they all will be great additions to your tool box, but for a prepper nothing can hold a candle to Tactical Combat Casualty Care or TCCC. TCCC was intended to teach a NON TRAINED service members in the military basic life saving skills so you can rest assured your "allowed" to know this. It's also what all of the elite fighting forces use on their teams, this goes for Green Berets, SEALS, PJs, Rangers and so on. Its also designed for an austere venue where evacuation will be delayed or wont be coming at all, again another check in the prepper block. TCCC is backed with mountains of good data managed by Doctors and senior battlefield medics from across the DoD arsenal, this is a solid program for everyone to know. If we ignore the word combat and instead use the word austere, all of a sudden this program makes even more sense. Can you give blood? Can you manage a delicate airway? Can you offer definitive surgical repair? Can you manage a collapsed lung? If the answer is no, then your entire trauma strategy needs to change to reflect this reality. It doesn't matter if it's an enemy force denying you evac or an economic collapse, you're on your own... Where to begin? Start with the assessment. Look at it like the toolbox, and all of the treatments are the tools. Lets focus todays article on the toolbox. [caption id="attachment_340" align="alignleft" width="246"]TCCC trauma assessment TCCC trauma assessment[/caption] The TCCC trauma assessment is placed in order of statistic injury patterns that are ranked from the most lethal (short and long-term) to the least lethal. All the "science" you need to know is built into the sequence. When in doubt or you get overwhelmed or lost, just start the assessment sequence over and you'll do fine...



The sequence: Its easy, just remember MARCHE and treat as you go! [caption id="attachment_344" align="alignright" width="253"]Identify life threats Bleeding was controlled with a ratchet strap![/caption] M-Massive Bleeding. Here you are looking for pooling blood or fast bleeding you can see. We don't care if its bright red or not, those days are gone. You can die from losing venous blood also...If its NOT bleeding, skip it we will come back to it later. Ugly wounds are distracting but if they aren't losing blood (for now at least) they aren't a priority during your initial survey. We need to save as many blood cells and clotting factors as possible and most arteries bleed fast enough to kill you in minutes. This is where TCCC tends to deviate from traditional EMS medicine. EMS hinges on the nearby hospital to manage the internal medicine issues that come with bleeding out like losing the ability to clot and acidosis. Saving as much "clean" blood as possible early on the event will give your patient the best chance at long-term survival when evac may not be coming... Use tourniquets and pack wounds, this is for time so hurry up! [caption id="attachment_347" align="alignright" width="268"]Simple NPA Simple NPA[/caption] A-Airway. Concept: Is the air hole open? It doesn't do us any good to make a patient respire if there is no hole to pass air. While we prefer to teach a modified jaw thrust, we don't have a problem with the head tilt/chin lift technique from your CPR training days. In effect, we are temporarily opening their mouth and we asses "how open" it is by LISTENING for them to breathe. Remember, an airway blockage may not visible from a visual inspection, you still have to look listen and feel for air passage. During this initial survey, consider temporary adjuncts like a nasal trumpet (NPA) or a J-tube (OPA), we like using positional airways, aka the "drunk don't puke roll to the side" technique... [caption id="attachment_349" align="alignright" width="300"]NAR Chest seals NAR Chest seals[/caption] R-Respirations. This gets confusing with new providers. When we say respirations we intend to examine the mechanical structures that are required to breathe. Namely the chest. For TCCC purposes the chest is front to BACK, Adams apple to navel. Here you will apply seals as needed and check for any broken ribs that could haunt you down the road. IF a patient has a collapsed lung, you wont really notice any one thing jump out at you, things like deviated tracheas and one sided rise and fall of the chest are late and grave signs, don't wait for those... It will be a combined series of symptoms that we use to direct treatment in the field, but that's another lesson in itself. [caption id="attachment_351" align="alignright" width="300"]NAR saline lock NAR saline lock[/caption] C-Circulation. Here we will check pulses and other signs of perfusion/circulation, also we will wrap up any other "meat" wounds we skipped over during our initial blood sweep. IF you have the skills and feel the patient could benefit, now's the time to gain IV access, but that's a clinical decision based on your over all patient presentation and skill. Clean up all the boo boos we skipped and anything else we missed. H-Hypothermia/Head injury. Not much you can do for a head injury other that take note of their level of consciousness. This early on information and the progression of symptoms form this baseline will be invaluable to any Docs that see them later. [caption id="attachment_354" align="alignright" width="150"]Inexpensive options are out there Inexpensive options are out there[/caption] Always treat for hypothermia. In trauma we aren't as concerned about heart attacks rather its effect on clotting. If you have a patient with internal injuries we want clots, and cold patients don't clot! Even in the summer put a blanket on them. Dead people are cold to the touch, even in summer... Don't look at it like it's a weather issue, look at it like their internal over has been turned off... E-Evacuation. This is obviously your biggest issue as a prepper, or a commando. If we had this we wouldn't be having this discussion! In all seriousness evacuation may be only be delayed. Don't look at SHTF as the only event you need to worry about. Ice storms and tornadoes could delay your 911 evacuation and TCCC will carry the day until they get here. Most of the lives saved during the global war on terror are from non trained medical providers using simple adjuncts early on in the patients injury/evac cycle. What I mean is that untrained providers are proving this system works....Numbers don't lie. CAG also offers a no non sense trauma pack, inventoried by Special Forces medics, with high quality name brand tools to ensure that you have everything you need to your TCCC venue. Clearly labeling in modular cells its designed for the TCCC MARCHE complete with emergency blanket. In addition to the Tier 1 Med Pack we offer the TCCC training to go along with it!

CHECK OUT THE CAG TIER 1 MED PACK

Naturally we recommend taking a class on the subject. Please don't read something online and think you've check the block for medical training. Online programs are great for refresher and developing new strategy, but they simply don't replace the value of hands on skill training with experienced educators. We can recommend a few good online references if you're just interested in getting to know TCCC. As always thank you and follow us on Facebook@ Crisis Application Group! Helpful links:

  • http://www.naemt.org/education/TCCC/tccc.aspx
  • http://www.usaisr.amedd.army.mil/
  • http://www.havokjournal.com/national-security/inside-the-special-operations-combat-medic-course/
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Simple BugOut Bag (BOB) packing list

Consider a bag for each member of your family, plan on up to 72 hours and tailor them to your needs. Don't include equipment you don't know how to use and keep it light. Don't forget seasonal extras, like gloves and knit caps.Try to keep it under 25% of your body weight and then train with it.
  • Food: 1500 calories a day, fishing kit with bait, rat trap or snares, cups/plates, coffee
  • Water: Minimum 2 liters, plus water purification system
  • Shelter: Tent or tarp, dry clothing, fire starters, stove and sleeping bag
  • Cordage: 50' of 550 cord (paracord), 100' Kevlar fishing line
  • Signal and communication: Signal kit and strobe, two way radio, spare batteries and maybe a spare cell phone
  • First aid: NAR IFAK, over the counter medications, personal meds and feminine hygiene
  • Weapons support (optional): Spare parts, ammo and cleaning kit
  • Utility: Spare knife/multi-tool, folding shovel (E-tool), hatchet and pry bar or bolt cutter
  • Documents: Maps, cash, back up ID, insurance cards, emergency contact info, compass and/or GPS Optional: Solar charging, pen flares, hand saws, escape kits, lock picking sets, CBRN and bio masks, tyvek suit
Keep in mind this bag is to get you home, not to make you comfortable. It should be comfortable to wear and hike, but you can lighten your bug out load by using caches along your route home (which we always advocate). Learn local food and water sources for resupply. If you have any questions about this list, lets discuss it on Facebook at: Crisis Application Group...

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