The topic of having tourniquets in SAKs has come up at various times in these forums. This article on NBCNews speaks to the use of makeshift ones in Boston on Monday. I'm not qualified to speak to the efficacy of their use but it seems that in this case their use helped.

I definitely noticed when the media mentioned tourniquets about the Boston bombing, too. I even saw mention of people using shoelaces!

Unlike 10-15 years ago, there were probably a number of police and EMS (and bystanders even) on scene at the finish line who are ex-military and who were actually trained to use tourniquets in the service within the last 10 years or so. Military medicine seems to have come around and now recognize tourniquets as a useful tool.

Then again, that's partly the history of a particular confict. Combine a conflict(s) where IED's and massive blast injuries are the weapon of choice, plus the evolution of more effective body armor where limbs are still relatively unprotected, and that seems to set up a scenario where severely mangled or even amputated limbs becomes a specific type of wound that medics and surgeons see a lot of.

Seems like amputations and near amputations would be a no-brainer for tourniquets. It's those other situations, like cutting an artery, where I can still see controversy. You'd hate to see someone lose a limb from tourniquet use when other measures could have stopped the bleeding and still saved the limb.

Boston does make me wonder, though--if someone decides to go to the trouble of packing a tourniquet, how many to pack? If gunshots are the primary risk envisioned, then one tourniquet is likely sufficient for a first aid or "blow out" kit. But if you're worrying about blast injuries, seems like having more than one might be prudent. The Army IFAK contains one tourniquet, but in actual use, I wonder how times a soldier ends up needing more than one?

Now you medical professionals weigh in on this. I once had surgery to remove shrapnel from a foot, and instead of anesthesia, the doctors placed a restricting band around the ankle that cut off all feeling after it was on for a while. I was given a sedative and the restricting band, and it was on for more than three hours. My foot is just fine. Is a tourniquet really that dangerous to the limb?

As for the military IFAK, each soldier has one, and most I knew carried extra tourniquets, especially when the roadside bombing campaigns really got started. That way there are plenty of them for use, as not everyone will need one, but everyone will have one. The normal procedure was to reduce the threat, slap on tourniquets, and get out of the kill zone. Then the medical personnel would sort it out, but people rarely bled to death.

I will always default on stopping the bleeding, and worry about other issues later.

Dr David Johnson of Wilderness Medical Associates has a nice blog post about the use of tourniquets. I think I posted this sometime back in another thread, but it seems appropriate to post it again.

In most situations severe bleeding should be controlled by direct pressure. Where this is not possible, a tourniquet is indicated. A Mass Casualty Incident like Boston is another case where they could be a lifesaver. One rescuer can't hold direct pressure on multiple victims at the same time. Being able to quickly apply a tourniquet to stop bleeding on one person, so that you can move on to care for others, could save many lives. Likewise, for the military, under fire it is crucial to be able stop bleeding fast, then do proper treatment of the wounded after the shooting stops.

Thanks for posting that article. His comments ring true, especially in light of recent events.

Montanero, that is an interesting question. Is a restricting band truly a tourniquet? That is pretty good that the pressure was maintained and the bleeding stopped, right. Perhaps the blood loss site and rate did not warrant a tissue-crushing, bone mashing tourniquet. Still, three hours is quite a long time.

I am not a medical professional and never have been. I've also never served in the military.

With that said, one of my instructors had been a combat medic and a civilian paramedic. He taught us that purpose-made tourniquets (like the SWAT-T or CAT) had to be on for quite a while before endangering the limb. Field-expedient tourniquets made with a wide belt were similarly unlikely to cause that sort of problem. Using cordage or other material that doesn't spread the pressure over a larger area can, however, cause nerve damage.

I have also used tourniquets as a holder for a pressure bandage, and for straps to hold on an improvised splint. They are useful.

Tourniquets are being "re-introduced" in the Seattle/King County EMS system. Very few places in this area are far from trauma hospitals but the Drs that decide what we do have decided that we need to bring tourniquets back into our daily tool kit. That must mean something eh?

Our local Police carry tourniquets as well. That's the only medical supply they carry on their person! I just spent a week doing drills with them and that's what they had. No pressure dressings just tourniquets.

I personally carry a 4" and a 6" Israeli Battle Dressing in my IFAK and a 6" in my EDC bag. Both can be used as regular pressure dressings and as tourniquets.

Wilderness First Aid began providing basic instruction in applying tourniquets a few years back, and as Dr. Johnson's blog shows there is still some debate about their efficacy in remote or wilderness settings. My WFA instructor's view was although he had never applied a tourniquet in the wilderness, for an uncontrolled bleed you might as well apply it. On 3 day trips into the wild (24 hrs from trail head) I will often carry the tourniquet with my wilderness FAK. There's no expiration on them unlike other blood stopper options, so why not.

Based on WFA I began to carry a SOF-T tourniquet in my car FAK which I nickname the Blood Stopper 3000. Its in the back of my car and intended for breaking out if I encounter a serious bleed, and contains several options to bring bleeding under control, including ABD pads, kerlix, 4x4 gauze, and the SOF-T. This isn't a WFA setup, its meant if medics are called and responding within minutes. I will stop for MVAs if its safe. Call 911, assess scene for safety, glove up, stabilize the patient, apply pressure, and await the cavalry which should arrive directly. If I'm busy applying a tourniquet by the time the medics arrive I may be rushing that decision in an urban setting. But I have stabilized an accident victim's neck for 25 minutes before and after medics arrived (the PD arrived 10 minutes earlier but engaged in traffic control). When you're way out there rapid response isn't always possible, for me its comforting to have a tourniquet in the bag (and the basic training to apply it).

Troops use a tourniquet to stop arterial bleeds quickly while they get the victim out of the immediate danger zone to a safe area where he can be worked on. Usually the TK isn't on that long a period of time, but hey, if the choice is bleed out or use a TK... no brainer.

When I was deployed in 2011, we were required to have a TQ on us at all times, in our upper RT shoulder pocket, red tab facing out. The division surgeon also tried to make us carry quick-clot in a leg pocket, but I think that the battalion and brigade surgeons managed to talk her out of it.

It was fairly common to see the red tab with ALL US troops. So, when you figure each soldier outside the wire has his/her IFAK and another TQ on the shoulder ... I'd say nearly everyone had 2 of them. Most of the medics I had only had a few in their bag, figuring that everyone couldn't need one at the same time. If there was a triple or quad amputee, they could pilfer TQ's from his buddies.

I didn't get much response to the "DIY petroleum gauze"... so I'd like to pose the question... what are others use for a penetrating chest wound where air is entering the pleural cavity?... multiple thoracic penetrations from shrapnel could be a serious problem... world class trauma centers were minutes away in Boston... probably not so close for most of us

My range kit -- my most complete and capable kit -- is designed for a single patient. Because my most-likely treatment scenario is an accidental gunshot victim waiting on an ambulance, I've tailored my kit appropriately. If I do have multiple victims I'll have compression bandages and Combat Gauze, field-expedient TKs and hopefully the other RSOs will come running with their kits.

A chest seal, such as the HALO. It's what I carry. I do have a decompression needle but I've been told very sternly that its beyond my scope of practice.

Chaos... my range kit, and kit I carry with my pistol is for single care, though I too think I could improvise a bit... a good friend is a contractor for SOCOM, and just finished an upgrade project to the Casualty Care program for SOF... their medics reported that from a military view, sweating from body armor, and blood made the chest seals less viable than plain old petroleum gauze... the petroleum gauze is cheap to make, and packs pretty small...I've always carried some for that reason, and just wanted to upgrade the amount...I carry an nasal pharangeal tube in my range kit,...better for you to have the needle than not ... my last motorcycle accident, I had a delayed tension pneumothorax... when the tube went in it sure was nice to breathe easily again... pic of my carry kit which fits in a small outer pocket of a JanSport bag



CAT tourniquet, 4" Israeli dressing, Kerlix gauze, 4' of duct tape, 2 commercial petroleum gauze, Quick Clot, irrigation syringe.. protective pack

"A chest seal, such as the HALO. It's what I carry."

I'll look it up. But if you can elaborate that would be handy. I don't have one.

Pete2

I am speaking outside my expertise or training, but I am told an Asherman chest seal may be more appropriate to the random tension pneumothoraxes you would encounter, say, outside battlefield conditions. A US domestic major bleed may be sweaty, but not body armor in 110 degree heat sweaty. There is no petroleum gel, its sterile, and it won't expire in your bag.

I have an Asherman in my kit but no training on treatment of tension pneumothorax, so only a vague idea of when to apply it. I was told my a local EMT that that's okay, their first step would probably be to evaluate the patient and tear it off, and apply their own treatments. Its a little edgy to apply - and I can rely only on 10 minutes voluntary instruction by a friendly, licensed EMT, but unlike other alternatives and treatments, you can't actually harm the patient by slapping an Asherman on their chest.

Anyone who wants to treat me with decompression needles to my lungs better have the license and certification to do so, that's all I'll say about carrying those.

There are two ways I know about to treat tension pneumothorax in the field. One is to use either a purpose-made or a field-expedient chest seal. Some have a valve-like function to allow trapped air to escape, others just keep more air from entering the thorax.

The other way is to use a decompression needle to remove the trapped air. The first way is something people can be trained on quickly and it would take special talent to make someone worse with one. The decompression needle can easily do significant harm if used incorrectly.

Reading over this thread, it occurs to me that the environment in which the injury occurs makes a big difference. I have mostly deal with blunt force trauma in a wilderness, or at least outdoors, setting, typically the result of falls. I have never encountered a penetrating chest wound, and only one limb amputation, in something like 200 or so cases. But if I were in a combat,range, or other firearms intensive environment, the PCW would be a lot more common. Tailor your kit to fit your circumstances. The injury profile associated with a bombing or combat will be very different from what you will see out in the woods. Study up on improvisation - there are always exceptions to every trend.

My instructors (plural now) and MDinana have said to avoid the Asherman. See http://forums.equipped.org/ubbthreads.php?ubb=showflat&Number=211911&page=3 .



Tension pneumothorax usually implies penetrating chest trauma, which in turn implies bleeding. A chest seal that doesn't seal isn't nearly as useful.



I'd advise you to get training. If you want to PM me with a locale, I could look to see if there was training I could recommend.



I wouldn't use one unless that person was going to die without it. I'm much, much more likely to use a purpose-made or field-expedient chest seal, especially if I can expect an ambulance to arrive soon.

As I've heard about this article, it is also in support for the Marquees that are available with a lot of variety in the market having graphics on them. They can use for emergency purposes and to avoid the hardness of weather.

Good advice Chaosmagnet. Again, I don't pack an Asherman anywhere except in my bloodstopper bag which is predicated on better help arriving pronto, and lots of folks have pointed to the practical issues with this bandage. I don't intend my bag as a blowout or gun shot bag of any kind. Its 4x4s, tape, TQ etc. Stuff I know now to apply, including the Asherman. Pressure. I think Alan's comments on Asherman seals was very practical, and I'll switch to his recommendation of prepackaged 4x4s, tape and a plastic bag instead of the Asherman.

FWIW, I've just gone through TQ training as part of my Emergency Medical Responder (Oregon) continuing training. We used the CAT branded TQ's. Extremely easy to use.

Our instructor mentioned a soldier in Iraq had one on for 9hrs with no long lasting effects.

For bigger guys like me, the instructor indicated you may need two for a femoral artery wound.