Professional Soldiers ® - View Single Post - Tourniquets Lifesavers on the Battlefield

NousDefionsDoc · 10-13-2004, 10:15

So the next question should be, when do we remove the tourniquet? The rule of thumb should be to remove the tourniquet as soon as tactically and or medically feasible. Does the tactical situation now allow time for more conventional means to control the bleeding, such as direct pressure, pressure dressings, or pressure points? Has there been a lull in the firefight or has contact with the enemy been broken? Are there now medical personnel available who have more experience in controlling hemorrhage with additional supplies like hemostatic bandages or hemostatic powder? If so, they can be utilized and the tourniquet can be loosened, but make sure the tourniquet is still in place incase the other means of hemorrhage control doesn’t work. Also make sure that any resuscitation fluids are given BEFORE loosening the tourniquet.

This is a second myth we are busting. The myth that the tourniquet should never be removed once applied. Now, there may be certain times when the bleeding cannot be controlled by any other means, and the tourniquet will need to be left in place. In these instances it is better to risk potentially sacrificing the limb rather than to lose the casualty to fatal bleeding. If the soldier is in shock, do not remove the tourniquet. Finally, if the tourniquet has been on for 6 or more hours, don’t remove it.
So now we know that tourniquets are not the universal limb destroying devices we believed them to be in the past. How do we integrate their use into every soldier’s common tasks?
Unit leaders need to be accountable for this training, both in garrison and during their mission planning. They must insure that every soldier is trained on the application of a tourniquet. The equipment for tourniquets, or actual tourniquets that work, need to be issued to all soldiers in both combat arms and support units. Reinforced training needs to be placed on the training schedule and every soldier must demonstrate his skill in applying an effective tourniquet.
If we can integrate this task into our daily business we can save more soldiers’ lives on the battlefield. Statistically, up to 9 percent of soldiers killed in action (KIA), die from extremity bleeding. These are lives that we should be able to save.
Steps for improvised tourniquet application:
1. Place the tourniquet between the heart and the wound, leaving at least 2 inches of uninjured skin between the tourniquet and the wound.
2. Wrap the tourniquet around the extremity.
3. Tie a half- knot on the anterior surface of the extremity.
4. Place a stick or similar object on top of the half-knot, tie an additional full-knot on top of the stick and twist until the bleeding stops.
5. Secure the stick or windlass in place so it will not unwind.
6. Mark the casualty with a “T” on their forehead. Record the date and time the tourniquet was applied on a field medical card or anything that can be transported with the casualty.
7. If an amputation is present put a dressing on the stump, and try to preserve the amputated part.
8. Transport the casualty to a medical facility as quickly as possible. Do not cover the tourniquet while transporting the casualty.
We must put this plan into action. We must place a special emphasis on this training at the individual soldier level, especially now given the events in the world today. We must equip our soldiers with the supplies to save their own and their battle buddies’ lives. Remember that extremity hemorrhage is the leading cause of preventable death on the battlefield.
Recommendations:
The United States Army Institute for Surgical Research evaluated nine tourniquets, three were effective in 100% of the subjects. These included one pneumatic and two strap type tourniquets; the Emergency Medical Tourniquet (EMT) (Delfi Medical Innovations); the Combat Application Tourniquet System (CATS) (NSN: 6515-01-521-7976) (Phil Durango, LLC); and the Special Operation Forces Tactical Tourniquet (SOFTT) (NSN: 6515-08-137-5357) (Tactical Medical Solutions LLC), respectively.

The two strap tourniquets used a built in windlass as the mechanism for tightening. Of the two successful strap type tourniquets, the CATS was less painful, easier to use, smaller and lighter than the SOFTT (59 grams vs. 160 grams). The design of the SOFTT limited the ability of the windlass to tighten the tourniquet, i.e., it was limited to approximately 3 turns. This limitation can be overcome through training the user to pull the tourniquet snug before attempting to tighten with the windlass. The EMT pneumatic tourniquet was wider and thus significantly less painful than any device tested and is much less likely to induce nerve damage compared to either of the strap tourniquets. The EMT weighs 215 grams and when packaged is similar in size to the SOFTT.

Based on these facts it is recommended that the CATS be issued to each individual soldier, and the EMT pneumatic tourniquet be considered for issue to combat medics. Further, it is recommended that the EMT be issued for all medical evacuation vehicles and echelon I-III medical facilities.

Log into AKO (http://www.us.army.mil) and copy paste the below into the address window to access:

Read the complete USAISR findings: https://www.us.army.mil/suite/doc/1252084

View a picture of the CAT Tourniquet: https://www.us.army.mil/suite/doc/1252083

Note - if you have to ask what an AKO account is - you don't have one and can't access it.

Thanks Java

10-13-2004, 10:15	#2
NousDefionsDoc Quiet Professional Join Date: Jan 2004 Location: LA Posts: 1,653	So the next question should be, when do we remove the tourniquet? The rule of thumb should be to remove the tourniquet as soon as tactically and or medically feasible. Does the tactical situation now allow time for more conventional means to control the bleeding, such as direct pressure, pressure dressings, or pressure points? Has there been a lull in the firefight or has contact with the enemy been broken? Are there now medical personnel available who have more experience in controlling hemorrhage with additional supplies like hemostatic bandages or hemostatic powder? If so, they can be utilized and the tourniquet can be loosened, but make sure the tourniquet is still in place incase the other means of hemorrhage control doesn’t work. Also make sure that any resuscitation fluids are given BEFORE loosening the tourniquet. This is a second myth we are busting. The myth that the tourniquet should never be removed once applied. Now, there may be certain times when the bleeding cannot be controlled by any other means, and the tourniquet will need to be left in place. In these instances it is better to risk potentially sacrificing the limb rather than to lose the casualty to fatal bleeding. If the soldier is in shock, do not remove the tourniquet. Finally, if the tourniquet has been on for 6 or more hours, don’t remove it. So now we know that tourniquets are not the universal limb destroying devices we believed them to be in the past. How do we integrate their use into every soldier’s common tasks? Unit leaders need to be accountable for this training, both in garrison and during their mission planning. They must insure that every soldier is trained on the application of a tourniquet. The equipment for tourniquets, or actual tourniquets that work, need to be issued to all soldiers in both combat arms and support units. Reinforced training needs to be placed on the training schedule and every soldier must demonstrate his skill in applying an effective tourniquet. If we can integrate this task into our daily business we can save more soldiers’ lives on the battlefield. Statistically, up to 9 percent of soldiers killed in action (KIA), die from extremity bleeding. These are lives that we should be able to save. Steps for improvised tourniquet application: 1. Place the tourniquet between the heart and the wound, leaving at least 2 inches of uninjured skin between the tourniquet and the wound. 2. Wrap the tourniquet around the extremity. 3. Tie a half- knot on the anterior surface of the extremity. 4. Place a stick or similar object on top of the half-knot, tie an additional full-knot on top of the stick and twist until the bleeding stops. 5. Secure the stick or windlass in place so it will not unwind. 6. Mark the casualty with a “T” on their forehead. Record the date and time the tourniquet was applied on a field medical card or anything that can be transported with the casualty. 7. If an amputation is present put a dressing on the stump, and try to preserve the amputated part. 8. Transport the casualty to a medical facility as quickly as possible. Do not cover the tourniquet while transporting the casualty. We must put this plan into action. We must place a special emphasis on this training at the individual soldier level, especially now given the events in the world today. We must equip our soldiers with the supplies to save their own and their battle buddies’ lives. Remember that extremity hemorrhage is the leading cause of preventable death on the battlefield. Recommendations: The United States Army Institute for Surgical Research evaluated nine tourniquets, three were effective in 100% of the subjects. These included one pneumatic and two strap type tourniquets; the Emergency Medical Tourniquet (EMT) (Delfi Medical Innovations); the Combat Application Tourniquet System (CATS) (NSN: 6515-01-521-7976) (Phil Durango, LLC); and the Special Operation Forces Tactical Tourniquet (SOFTT) (NSN: 6515-08-137-5357) (Tactical Medical Solutions LLC), respectively. The two strap tourniquets used a built in windlass as the mechanism for tightening. Of the two successful strap type tourniquets, the CATS was less painful, easier to use, smaller and lighter than the SOFTT (59 grams vs. 160 grams). The design of the SOFTT limited the ability of the windlass to tighten the tourniquet, i.e., it was limited to approximately 3 turns. This limitation can be overcome through training the user to pull the tourniquet snug before attempting to tighten with the windlass. The EMT pneumatic tourniquet was wider and thus significantly less painful than any device tested and is much less likely to induce nerve damage compared to either of the strap tourniquets. The EMT weighs 215 grams and when packaged is similar in size to the SOFTT. Based on these facts it is recommended that the CATS be issued to each individual soldier, and the EMT pneumatic tourniquet be considered for issue to combat medics. Further, it is recommended that the EMT be issued for all medical evacuation vehicles and echelon I-III medical facilities. Log into AKO (http://www.us.army.mil) and copy paste the below into the address window to access: Read the complete USAISR findings: https://www.us.army.mil/suite/doc/1252084 View a picture of the CAT Tourniquet: https://www.us.army.mil/suite/doc/1252083 Note - if you have to ask what an AKO account is - you don't have one and can't access it. Thanks Java __________________ Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home. He knows only The Cause. Still want to quit?
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