# Tourniquets - What do you use and why?



## 104TN (Dec 23, 2016)

What tourniquet(s) do you use and why?

I've got several Rapid Application Tourniquets I keep in my home, range bag, and vehicles. 

While I didn't do much research before making my purchase, the short videos I watched prior to pulling the trigger made the RATS appear easy to apply, a retailer I frequent carries them which I took as an endorsement of sorts, and I got a good deal which allowed me to buy enough to have a bunch handy.


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## Muppet (Dec 24, 2016)

When I was in Division, in the 90's, TQ's were still considered "last resort". There were Ranger ratchet's floating around but not used much. Now, first as a SWAT medic, I have used SOFT-T and CAT's. As a street medic, I am issued SOFT-T for the first in jump bags / active shooter bags on each MICU we have in station. I went to SWAT medic school, ran around like a fucking maniac with both I mentioned, used both and liked the SOFT. Seems, that the velcro got nasty and did not like to work with blood and mud but again, I have used SOFT in real world issues, have not used CAT and have not been in shit holes where I needed to drag a brother over 100m of A-stan ground. Take that for what it's worth.

From some dudes I talk to, been GWOT, took a TCCC course from a group, traveled to P.A. from Canada called "Teir 1", some special dudes including a U.S. SEAL, they say, CAT'S used for arms, SOFT used for legs. I don't know. I don't trust TQ's that depend on pneumatic or wraps.

M.


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## policemedic (Dec 24, 2016)

I carry two SOFT-T Wides on my person when I'm working.  My bag has several more.  I prefer them over the CATs, although the CATs are a bit easier to self-apply to an arm (at least for me).  That said, I've carried and used both, and they both work.

We do also deploy the SWAT-Ts because they came with the bleeding control bags we bought from Z-Medica.  It would have cost us more to susbtitute real TQs, so it was a compromise.  The SWAT-Ts can be useful but I don't rely on them to act as a real TQ.

There are studies on the efficacy of specific TQs, and they are well worth reading.


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## Diamondback 2/2 (Dec 24, 2016)

I've used CAT, SOFT, and Ratchet's. I like the SOFT over the CAT, just better built. The ratchet style one seemed to work the best, but for the life of me I cannot remember the brand name (OD green with a red ratchet handle) I'd like to buy a few of them. I currently keep a SOFT in my truck bag, another in my IFAK, and I have a handful of CAT's floating around my other possibles bags.


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## Etype (Dec 24, 2016)

SOFT-T for durability and ease of use.

I've used the SWAT-Ts for wrapping sore muscles and joints, they are great for that if you have them laying around.


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## AKkeith (Dec 25, 2016)

I like the SOFTT Wide. I don't like the stupid screw on the original SOFTT. Its another step that people forget and its a very crucial. After teaching people on that tourniquet I feel like a broken record. The SOFTT Wide has the easy D ring to clip on and go. No velcro sticking to itself, no screw, comes apart easy to wrap around a limp if you need to.


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## x SF med (Dec 26, 2016)

Whatever gets the job done to save the patient.

Not being snide, just realistic.  I've used belts, CATs and SOF-T, torn uniforms and sticks...  whatever it takes, placement and width of the constricting band are the keys...  sometimes you even have to place a rock under the TQ at a pressure point to get the major arteries to close...

I currently have a few CATs in range bags and GFOD bags, gifts from friends.


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## Red Flag 1 (Dec 26, 2016)

x SF med said:


> Whatever gets the job done to save the patient.


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## Diamondback 2/2 (Dec 26, 2016)

x SF med said:


> Whatever gets the job done to save the patient.
> 
> Not being snide, just realistic.  I've used belts, CATs and SOF-T, torn uniforms and sticks...  whatever it takes, placement and width of the constricting band are the keys...  sometimes you even have to place a rock under the TQ at a pressure point to get the major arteries to close...
> 
> I currently have a few CATs in range bags and GFOD bags, gifts from friends.



Had an old school SF medic teach me to take gatoraid bottle cap seal rings and thread a cravat through them. When you cranked down your stick or whatever, instead of tying it down with the ends of the cravat, you slide the seal rings over the stick on each side. Works damn good and it doesn't come loose.

He was a firm believer in use whatever the hell you have available and use it smartly. Your mentioning of the rock to pinch off an artery reminded me of him, as he had stated the same as well.

 MSGT Salazar, I believe he was a team daddy out of 20th SFG 2005-06'ish.


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## Gunz (Dec 26, 2016)

I used a sling and twisted the rifle around because I didn't know what else to use. This was an ARVN who hit a pressure device that pretty much took off his right foot. I wrapped the sling below his knee and just started twisting the rifle and the sling tightened up. Our corpsman was with our Alpha unit about a klick away, but en route. It seemed the most expedient thing to do. It worked but I had to keep holding the rifle so it stayed tight. When Doc got there he put his own on so the rifle didn't get medevaced with the patient.


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## Etype (Dec 26, 2016)

Ocoka One said:


> I used a sling and twisted the rifle around because I didn't know what else to use. This was an ARVN guy who hit a pressure device that pretty much took off his right foot. I wrapped the sling below his knee and just started twisting the rifle and the sling tightened up. Our corpsman was with our Alpha unit about a klick away. It seemed the most expedient thing to do...and thankfully, it was the only time I had to do it.


Unfortunately, quite a few of those 58,000+ Americans would still be with us today if they had commercially produced tourniquets.

Luckily, we learned from the lesson.


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## Gunz (Dec 27, 2016)

I got a lesson in tourniquets after that...I couldn't claim to be the sharpest tool in the shed at 19. I suppose I could have come up with 5 or 6  better ways to do it if I'd had time to think about it, just from my boy scout days.


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## Etype (Dec 27, 2016)

Ocoka One said:


> I got a lesson in tourniquets after that...I couldn't claim to be the sharpest tool in the shed at 19. I suppose I could have come up with 5 or 6  better ways to do it if I'd had time to think about it, just from my boy scout days.


What we are taught these days, is that tourniquets weren't the norm in the Vietnam era. Just out of curiosity, what did they teach for extremity bleeding?

When I first came in the Army, they still taught pressure dressings and elevation. Within a year the first treatment of choice switched to tourniquets and it's remained the same for the last 12 years.


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## Gunz (Dec 27, 2016)

Etype said:


> What we are taught these days, is that tourniquets weren't the norm in the Vietnam era. Just out of curiosity, what did they teach for extremity bleeding?
> 
> When I first came in the Army, they still taught pressure dressings and elevation. Within a year the first treatment of choice switched to tourniquets and it's remained the same for the last 12 years.



Our first aid training was basic at best.  I don't think we had more than 4-hours of classes in total during infantry training. I remember being taught about sucking chest wounds; shock; tourniquets for amputations or wounds in the legs and arms where a major artery was involved; how to get an IV needle in for plasma; and the rest was "wrap a battle dressing around it and keep fighting."

Luckily we had proactive Corpsmen in our Combined Action company who made sure we had more than the basics.


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## Etype (Dec 27, 2016)

Ocoka One said:


> Luckily we had proactive Corpsmen in our Combined Action company who made sure we had more than the basics.


It's about the same these days.

When I was in the 82nd, the Combat Lifesaver Course is taught by medics with the POI set by the batallion PA.

On ODAs, it's up to the medics to teach whatever they feel is necessary.

Luckily, most medics realize it will be the guys they teach who will be responsible for saving their lives should they get hurt.


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## x SF med (Dec 27, 2016)

Etype said:


> Luckily, most medics realize it will be the guys they teach who will be responsible for saving their lives should they get hurt.



^^^TRUTH!!!^^^


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## Gunz (Dec 27, 2016)

Etype said:


> Luckily, most medics realize it will be the guys they teach who will be responsible for saving their lives should they get hurt.




It's so important, especially in small units that operate independently for extended periods.


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## amlove21 (Dec 28, 2016)

I carry 2 CATs (one on my chest, one in the bottom pocket of my pants) and 2 SOFTW's (same configuration). 

Typically the SOFT's work a little better on legs than the CAT's do, but I'll echo what everyone else here has already said- use what you need to, it's the technique and theory, not the specific brand of equipment.


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## 104TN (Dec 28, 2016)

Thanks guys. For those of you that have used CATs, any concern over them breaking? In reading some of the COTCCC minutes it "seems" like the CAT is the defacto standard, but it was noted something like 1/10 broke when applied...which seems high.

Aside from my own post (which I'll discount because I admittedly didn't make an informed decision), I only see two references to elastic-type TQs and neither suggested them for use as a primary tourniquet. Is it safe to say you guys feel that elastic TQs like the SWAT-T and RAT are less effective than more traditional windlass-based options, or am I reading between the lines too much here?


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## Diamondback 2/2 (Dec 28, 2016)

rick said:


> Thanks guys. For those of you that have used CATs, any concern over them breaking? In reading some of the COTCCC minutes it "seems" like the CAT is the defacto standard, but it was noted something like 1/10 broke when applied...which seems high.
> 
> Aside from my own post (which I'll discount because I admittedly didn't make an informed decision), I only see two references to elastic-type TQs and neither suggested them for use as a primary tourniquet. Is it safe to say you guys feel that elastic TQs like the SWAT-T and RAT are less effective than more traditional windlass-based options, or am I reading between the lines too much here?



The CAT's that were breaking were old ones that had been weathered on peoples gear. The plastic handles were snapping when cranked down on. It was being discussed back around 07-08 about the time the new ones came out.


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## policemedic (Dec 28, 2016)

The newer CATs, especially the Gen7s are GTG.


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## x SF med (Dec 29, 2016)

@rick - like any other piece of equipment, it needs to be maintained and inspected on a regular basis.  It is a collection of parts - nylon, elastic, plastic, etc. - weather and wear from carry will do it harm, if it looks worn, weathered, or wobbly, replace it.


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## Etype (Dec 29, 2016)

To echo what @Diamondback 2/2 said, we had windlasses and also had the little plastic retainer ears break.

We would throw one or two turns of 100 MPH tape or electrical tape around it after cranking it down. That way if it broke while transporting the patient, it would stay in place.


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## Devildoc (Dec 29, 2016)

I have a CAT and a SOFT-T.  I carry one in my backpack I wear to work.  I park about a mile from work and walk it, twice a day.  It is along a busy road which sees a couple pedestrians seriously injured a year who attempt to cross at the wrong areas, and I am far likelier to use it on one of those poor saps than on anyone else.


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## CDG (Dec 29, 2016)

AKkeith said:


> I like the SOFTT Wide. I don't like the stupid screw on the original SOFTT. Its another step that people forget and its a very crucial. After teaching people on that tourniquet I feel like a broken record. The SOFTT Wide has the easy D ring to clip on and go. No velcro sticking to itself, no screw, comes apart* easy to wrap around a limp if you need to*.



Seems a bit extreme, but I'm not a medic.


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## Viper1 (Jan 7, 2017)

CAT tourniquets are what we were issued and trained with, so that's what I've got.


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## Ooh-Rah (Apr 10, 2018)

- Interesting to see where the officer keeps his tourniquet
- Not as easy to apply as they make it look in the old Westerns
- Look at the amount of blood "pumping" out of the bad guy.
- Another example of the risks cops take everyday.  No time to put on fancy gloves and eyewear
- Mentioned in the comments.  2:18 is the best muzzle awareness ever caught on film.

*NSFW* due to real world language and and metric shit-ton of blood


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## Stretcher Jockey (Apr 10, 2018)

When ths officer is attempting to place the first TQ, if you look at his foot near the guys knee, you can see a large steady stream of blood coming out. Ive used this specific video multiple times in "Stop The Bleed" classes as a true example to students how quick that blood comes out. Plus its an excellent example of the officers doing solid work in a stressful situation.


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## Devildoc (Apr 10, 2018)

Great video for a bunch of reasons. The tactical reload? Textbook. The muzzle awareness? Textbook. After the shooting stopped, putting on the tourniquet he had for real adrenaline dump his hands were shaking like leaves on a tree, but he got it done.

Like @Paramagician I also teach the stop the bleed class, and I will definitely use this video in my instruction.


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## Muppet (Apr 10, 2018)

As an experienced paramedic, all that nonsense, I am now mandated to wear a ballistic vest, sign of the times I suppose. I decided to mount a SOFTT wide, center line on the vest through the molle webbing with the black bands it came with. Some rookies and experienced cats asked me why and I explained the concept of both arms reaching, they all now copy it. I recall years ago when the T.Q. thing first became a thing here, I was still an active SWAT medic with my military experience. The L.E.O.'s were given the T.Q.'s for patrol but no advice on how to deploy, many of those cops are personal friends. We sat in the station one night, a few of us, discusing how to deploy them, figured, as center line on their gun belts was the first plan and it worked out. SWAT guys I served with did same on the heavy vests.  I am also a bleed trainer, TECC/TCCC instructor. In addition, now, the county received grants for active killer bags for the trucks. Each MICU has a large bag with a skedco type litter and a bunch of TQ's/dressings that we can deploy in an event, plus we are now outfitted with entry vests and MICHs. Fucking sucks that some folks are still resistant to this subject, saying, "I am not paid to play SWAT medic".

M.


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## Hillclimb (Apr 11, 2018)

Ooh-Rah said:


> - Interesting to see where the officer keeps his tourniquet



Thanks for the badass vid. I sent it to my medic incase he wants to use it for a class in the future.

Interesting on the ankle TQ. Couldn't catch how he had it secured; I imagine just strapped around. Team SOP for us is to try to keep a TQ per limb on us(usually one in each shoulder pocket, and two in the Fanny pack IFAK). I just roll with all of the above, then one in each of my pants ankle pockets since I havent found another use for them yet. 



Muppet said:


> Fucking sucks that some folks are still resistant to this subject, saying, "I am not paid to play SWAT medic".
> 
> M.



Resistant to TCCC or learning how to use a TQ?


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## Devildoc (Apr 11, 2018)

@Hillclimb , my experience is non Tactical Medics and some law enforcement officers are slow to adopt it because they see it as high-speed SWAT stuff.  A TCCC/tacmed thing, not necessarily a tourniquet thing.


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## Etype (Apr 11, 2018)

Is this really that great of work? I'm surprised to see no one mentioning that he should have used a knee to apply some pressure while he fumbled with the tournoquet.

I'm surpirsed the guy made it, if he did, after seeing how much blood he lost.


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## Devildoc (Apr 11, 2018)

Etype said:


> Is this really that great of work? I'm surprised to see no one mentioning that he should have used a knee to apply some pressure while he fumbled with the tournoquet.
> 
> I'm surpirsed the guy made it, if he did, after seeing how much blood he lost.



For the officer's (presumably) first time?*  I think it's pretty good.  If it's his 10th, I'd see it differently.  I agree re: knee, but who knows if he was taught that.  You are right, the booger eater lost a metric shit-ton of blood.

*I don't know they are trained.  Some of my local cops, all the training they get is "here's the tourniquet, here's how you put it on.  Now store it where you can get to it."


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## Ooh-Rah (Apr 11, 2018)

Etype said:


> I'm surpirsed the guy made it, if he did, after seeing how much blood he lost.


He made it. More on the story...

2 people shot in police-involved shooting in North Las Vegas


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## Muppet (Apr 11, 2018)

Devildoc said:


> @Hillclimb , my experience is non Tactical Medics and some law enforcement officers are slow to adopt it because they see it as high-speed SWAT stuff.  A TCCC/tacmed thing, not necessarily a tourniquet thing.



This...

M.


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## policemedic (Apr 11, 2018)

Devildoc said:


> @Hillclimb , my experience is non Tactical Medics and some law enforcement officers are slow to adopt it because they see it as high-speed SWAT stuff.  A TCCC/tacmed thing, not necessarily a tourniquet thing.



Disagree slightly.

Medics don't mind the TQs, some just don't want to put on armor and sally forth into a hot or warm zone.  It's not what they signed up for (same reason many paramedics balk at fire-based EMS systems).  They're perfectly fine with applying a limb TQ in a safe area like the back of their ambulance.

Cops, on the other hand, tend to be reticent to engage in medical care at all--especially those with time on the job.  Again, it's not what they signed up to do.  There is a cultural shift happening that is changing that, but the problem does currently exist.  We're starting to see more TQs placed by cops (anecdotal at this point), but most think of TQs as being for their use instead of for use on citizens.


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## policemedic (Apr 11, 2018)

Etype said:


> Is this really that great of work? I'm surprised to see no one mentioning that he should have used a knee to apply some pressure while he fumbled with the tournoquet.
> 
> I'm surpirsed the guy made it, if he did, after seeing how much blood he lost.



It wasn't the most professional job.  But given the TQ was applied by the rookie, to a person he'd just shot, while he is on field training...I'll give him a pass.  

I'm unaware of what kind of medical training LVMPD gets, or what their medical sustainment program looks like.

I'm not a big fan of ankle carry for the TQ unless one is in plain clothes.  We teach our guys to place it centerline on the gun belt or centerline on their exterior vests.


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## Devildoc (Apr 11, 2018)

@policemedic , thanks for your perspective.  Again, my experience.  I will add it's been a hot year since I have been in the field, in the back of the bus or in the stack, and I know culture on these things change over time.


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## 256 (Apr 11, 2018)

Nothing should be limited to one group or another, especially life-saving measures which includes shooting, moving, and communication. If the attitude of personnel is "that's for SWAT" we need to change the culture of our profession. I don't want to go into a room at 4am with a dude that's never fired a single round in a dark house/building because "that's SWAT stuff." We don't rise to our expectations we fall to our lowest level of experience or training. Our Officers haven't used a single TQ in SWAT operations but have used them for car crashes and industrial accidents. Change the attitude/culture of personnel so we can save more lives. Our Chief is a big pusher of Below 100; it's a really great program. It can be applied to all MIL/LEO/First Responders.



Etype said:


> To echo what @Diamondback 2/2 said, we had windlasses and also had the little plastic retainer ears break.



@Etype Was that a common occurrence? I've never experienced that, thank you for sharing. *Throws small roll of duct tape in med kit.


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## 256 (Apr 11, 2018)

policemedic said:


> Disagree slightly.
> 
> Medics don't mind the TQs, some just don't want to put on armor and sally forth into a hot or warm zone.  It's not what they signed up for (same reason many paramedics balk at fire-based EMS systems).  They're perfectly fine with applying a limb TQ in a safe area like the back of their ambulance.
> 
> Cops, on the other hand, tend to be reticent to engage in medical care at all--especially those with time on the job.  Again, it's not what they signed up to do.  There is a cultural shift happening that is changing that, but the problem does currently exist.  We're starting to see more TQs placed by cops (anecdotal at this point), but most think of TQs as being for their use instead of for use on citizens.



I wouldn't have responded had I seen your post.


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## policemedic (Apr 11, 2018)

256 said:


> I wouldn't have responded had I seen your post.


 
No worries. Jump on in!


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## medicchick (Apr 11, 2018)

Etype said:


> Is this really that great of work? I'm surprised to see no one mentioning that he should have used a knee to apply some pressure while he fumbled with the tournoquet.
> 
> I'm surpirsed the guy made it, if he did, after seeing how much blood he lost.


Dude took 19 shots and lived.

Suspect hit 19 times in shootout with officers, Las Vegas police say


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## amlove21 (Apr 11, 2018)

Daaaaaaaamn that officer was in the fight for sure. 

Not a huge fan of dropping a knee on any heavy bleeding patient- if something was violent enough to damage a large vessel (and usually the bone next to it), I can't often guarantee that me putting 205lbs of pressure on that injured area won't do more, irreparable damage. 

There is an AAR floating around from an SMU that detailed a shattered pelvis from a knee (attempting to use pressure to stop a femoral bleed), and that ended with the patient dead. I am sure it's worked at one time or another, but as a practice, there are better ways.


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## Kraut783 (Apr 11, 2018)

policemedic said:


> Disagree slightly.
> 
> Medics don't mind the TQs, some just don't want to put on armor and sally forth into a hot or warm zone.  It's not what they signed up for (same reason many paramedics balk at fire-based EMS systems).  They're perfectly fine with applying a limb TQ in a safe area like the back of their ambulance.
> 
> Cops, on the other hand, tend to be reticent to engage in medical care at all--especially those with time on the job.  Again, it's not what they signed up to do.  There is a cultural shift happening that is changing that, but the problem does currently exist.  We're starting to see more TQs placed by cops (anecdotal at this point), but most think of TQs as being for their use instead of for use on citizens.



Probably the past 5 years have been a drastic change for our department, all patrol officer are issued TQ for carry on duty, we have a much closer relationship with our Fire Paramedics and PD*.  The first recorded incident where a patrol officer used a issued TQ was on a traffic accident where part of an arm was torn off and the officer applied the TQ, kinda opened our admins eyes. Good changes and better training for us.

*The new Fire Chief was one of our first SWAT medics, so the bonds are there.


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## Devildoc (Apr 12, 2018)

Kraut783 said:


> Probably the past 5 years have been a drastic change for our department, all patrol officer are issued TQ for carry on duty, we have a much closer relationship with our Fire Paramedics and PD*.  *The first recorded incident where a patrol officer used a issued TQ was on a traffic accident where part of an arm was torn off and the officer applied the TQ, kinda opened our admins eyes.* Good changes and better training for us.
> 
> *The new Fire Chief was one of our first SWAT medics, so the bonds are there.



When I was a RN in the ED, I argued for tourniquets for a very long time, to no avail.  The answer was "we're a level 1 tertiary care trauma center, why would we need tourniquets?"

We received a patient from a motorcycle MVC, right leg near amputation from colliding with a guardrail.  The man was bleeding to death, I kept calling for a TQ (homemade, of course) or clamping the femoral, the docs were trying packing and pressure and the MTP (massive transfusion protocol).  The guy bled to death before he hit the OR.  

Afterward I was asked to come up with and protocol for TQs (I was the only one in the ED at that time with any experience).  Even then, the protocol read MD-only application; the rationale being, we can't trust non-MDs to possess the knowledge and skill to know when and how to apply it.  It was shortly after this I made an exit strategy from that ED and never looked back.


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## Ooh-Rah (Apr 12, 2018)

Devildoc said:


> We received a patient from a motorcycle MVC, right leg near amputation from colliding with a guardrail. The man was bleeding to death, I kept calling for a TQ (homemade, of course) or clamping the femoral, the docs were trying packing and pressure and the MTP (massive transfusion protocol). The guy bled to death before he hit the OR.


Try as I might, I cannot even begin to imagine the emotional roller coaster you must have been on....from start to finish.


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## RustyShackleford (Apr 12, 2018)

Some of us need to sit down one of these days and discuss our agency/hospital protocols. I bet some solid ideas could come out of that. 

Regarding the officer and the ankle TQ-we issue the ankle med kit to guys in certain jobs, all low vis, mostly oconus stuff. Our guys working the street are running TQs centerline, accessible with either hand (at least that is what we are teaching).


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## FisherAD1 (Apr 13, 2018)

Follow the evidence. Nonwindlass TQs have a high failure rate. CAT and SOFTT have demonstrated effective. Elastic TQs are inferior. Belts have up to 50% failure rate, improvised TQs fail 32% of the time. There is at least one TQ out there that will probably make the new CoTCCC recommended list. Every piece of medical equipment has an acceptable failure rate. Most CAT failures are due to user error-keeping it exposed to the environment, not recognizing when a second TQ should be applied, or not getting he strap cinched right before twisting the windlass. SOFTTs have failures too, no one TQ is without failure. Ratcheting TQs have historically performed poorly, still waiting on new data on the updated versions.


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