Wilderness Doc: Pre-Hospital Care in Mass Casualty Shootings

This article from Wilderness Doc discusses a key difference in civilian vs military shooting injuries and how, because of the difference, the first aid focus for civilians may be better served with blod clotting bandages than tourniquets — Pre-Hospital Care in Mass Casualty Shootings.

 

You will likely recognize the above picture as a CAT tourniquet. As programs such as Stop The Bleed and others have focused on the use of tourniquets in the field, these have become a popular item for most to carry in our kits. This is for good reason too. Studies and data coming from military experience in Afghanistan and Iraq have shown, these devices are no longer to be considered the “last ditch” efforts we once thought. That being said, what does the data show about efficacy or applicability of this data in civilian shootings as we have recently seen in El Paso and Dayton?

This very question was addressed in the May/June 2019 edition of the Air Medical Journal. Three studies by Smith, Butler and de Jager were used to discuss differences between the battlefield and civilian injuries. Interestingly, military injuries tend to be to extremities. This is due to several reasons. First, many soldiers are injured by high explosive devices and the fragments coming off of them. Secondly, the battlefield and the highly armed nature of the two sides on the battlefield, tends to separate the combatants much further than what is seen in the civil setting. This separation makes shots to vital areas such as the torso, head and neck less likely. Finally, soldiers tend to wear body armor that covers vital areas. While not fool proof, especially against higher caliber and more powerful rounds, it can protect against many rounds, especially if shot from a distance.

What does this difference mean for civilian first responders in such scenarios? It means that chest, back and head shots are much more likely. These areas are, obviously, not amenable to tourniquet placement. So, while still important, we need to adjust training and prepare our first responders for what they are more likely to see. In particular, the authors advise focusing on chest wounds. While there are many who have survived head shots, the chest can be far more survivable. Focusing on pressure and hemostatic impregnated gauze as well as chest seals and decompression may be the next line in pre-Hospital treatment. Also, ensuring such first responders are well versed in all forms of artificial airways can be lifesaving…

Click here to read the rest of the article at Wilderness Doc.

John Mosby: Tourniquets, Chest Seals, and Pressure Dressings

Following up on the recent post about newly approved by the CoTCCC tourniquets, John Mosby of Mountain Guerrilla has written a piece – Tourniquets, Chest Seals, and Pressure Dressings, Oh My!discussing med kit you should be carrying if you are carrying a firearm.

pocket med

 

Tourniquets get a lot of digital bandwidth in tactical and preparedness virtual circles. Rightfully so, since they’ve demonstrably saved a …ton of lives over the last two decades of combat. Unfortunately though, in the process of bludgeoning a deceased equine, in order to overcome decades of medical institutional inertia about the supposed hazards of tourniquet use, many people—myself included, unfortunately—have neglected to make it a point to discuss the surrounding issues.

Let’s start with this, just to get it out of the way:

If you carry a gun, and you’re not carrying a tourniquet or two, you’re either LARPing, or you’re a… idiot. The fact is, a “gunfight” implies bilateral ballistics, and the enemy gets a vote. If you assume your one box of ammo a month “practice” regimen means you’re automatically a far better marksman than the bad guy you are going to end up in a gunfight with, well, I’ve got an 8 ounce jar of fairy dust I’ll sell you cheap, and it’s guaranteed to make you stronger, faster, higher flying, and generally more attractive to members of your preferred sex.

Sure, you COULD try using your belt or handkerchief or what-the-…-ever to improvise a tourniquet, but experiential research and laboratory study both pretty clearly demonstrate they are a piss-poor substitute, and don’t work particularly well (which is not the same thing as saying they DON’T work, AT ALL. I know people who have saved lives with improvised tourniquets, and you may too. Both they, and their patients, probably would have appreciated a manufactured, quality, tourniquet).

That having been said, we’ve got to look at the circumstances surrounding battlefield wounds, versus our likely circumstances, to see if tourniquets are even MOST of the answer, let alone all of the answer.

Click here to read the entire article at Mountain Guerrilla.

Doom and Bloom: New Tourniquet Additions to TCCC Guidelines

The Altons at Doom and Bloom Medical have posted an article about some new tourniquets which have been approved by the Committee on Tactical Combat Casualty Care.

new tourniquet acceptable for military use
SAM-XT Tourniquet newly added to TCCC list

Tourniquets to control bleeding has been in use for centuries, sometimes praised and sometimes reviled as a tool of the devil. Painful lessons learned in Iraq and Afghanistan, however, lead us to believe that they save lives that would otherwise be lost to hemorrhage. In civilian life, the rapid and effective use of a tourniquet by those at the scene gives valuable time for emergency medical personnel to arrive. In survival settings, it doesn’t take a rocket scientist to know having tourniquets in your medical kit is not a bad idea.

For years, the Committee on Tactical Combat Casualty Care (CoTCCC) has approved a small number of commercially available tourniquets, which I’m sure many of you have in your medical kits: They include the combat application tourniquet or CAT and the special operation forces tourniquet SOF-T.

TCCC accepts Gen 6 and Gen 7 CAT tourniquets
Both Gen 6 and Gen 7 CAT Tourniquets are acceptable

These are the tourniquets you’ll find in our medical kits. We also add the non-TCCC SWAT tourniquet as a secondary tourniquet in many of them, mostly due to its versatility to also function as a pressure dressing and splint stabilizer.

Now, the TCCC committee has widened the range of options acceptable for the effective control of bleeding. One of their additions is the SAM-XT (pictured at top of page), produced by the venerable Dr. Sam Scheinberg of SAM medical. SAM is well-known for producing malleable splints useful for a number of orthopedic injuries, and now their tourniquet is considered acceptable for even military use…

Click here to read the rest of the article at Doom and Bloom.

May is National Stop the Bleed Month

The top cause of preventable death in trauma is bleeding. 20% of people who have died from traumatic injuries could have survived with quick bleeding control.

May is National Stop the Bleed Month, bringing Bleeding Control (B-CON) Instructors and students together for a month of training – free of charge in many places. Go to bleedingcontrol.org to find a class.

On Saturday May 11th, Dr. Jacobo Rivero will be teaching a free stop the bleed class in Prosser from 9:00 am to 11:00 am. The class will also be taught on June 8th and July 13th at the same location and hour.

Call 786-6601 to RSVP for Dr. Rivero’s classes. Space is limited.

Location: PMH Vineyard Conference Room
723 Memorial St, Prosser, WA

In Umatilla, the course will be taught on May 22nd at the Good Shepherd Medical Center conference room 2 from 8:00 am – 11:00 am. Call 541-667-3509 to register.

Related:
Prehospital tourniquets in civilian settings significantly decreased mortality