Added tourniquet to my thigh pocket

[HBVetera n2312]

Well, I was trying to be serious, not condescending. That was not my intent. Apologies for not conveying effectively.

I will say this as I would to anyone face to face. Teaching pressure bandages for arterial bleeds is foolish. It will not work. Anything else is BS. And for those military instructors, well I can assure you that is not what is taught in the military. It is harmful to the readers of this board to emphasize or propagate the myth that pressure bandages fix arterial bleeds. Dude, you are a DM. You are supposed to know this stuff. It's in Rescue Diver, Master Diver, AND DM. I'm not sure what Home Guard exercises are, but if those people are teaching and evaluating pressure bandages for arterial bleeds, it's BS.

For everyone else reading, these interventions are meant to extend the Golden Hour of acute trauma treatment by First Responders. Safe movement to direct physician medical care is the end goal.

Storker, I am not being condescending, now I'm just calling out BS when I read it.

 

[Storker]

Teaching pressure bandages for arterial bleeds is foolish. It will not work. Anything else is BS

I just checked¹ to see how bad all my first aid training has been, and what you are saying is not rhyming with what they still are saying out there. In fact, it's my training which seems to be fairly well aligned with what they're saying out there.

First hit:

Arterial bleeding is characterized by brighter red blood that may pulsate or spurt. Apply direct pressure with a dressing. If blood leaks through, apply more dressing on top. Never remove a dressing. If there are no bone fractures or spinal cord injuries, elevate the wound above the heart. Once bleeding is under control, use roller gauze to secure the dressing, beginning at the distal end and working towards the heart. You can twist the gauze to apply more pressure. Check to make sure blood is not leaking through, and that the bandage is not having a tourniquet effect. Elevate the wound, and call EMS or take the patient to the nearest hospital.

Arterial Bleeding Video - Bleeding Control Videos by ProCPR

Second hit:

Arterial blood is bright red and spurts out of a wound in time with the patient's pulse; in contrast, venous blood is darker and while it does not spurt, blood loss can be heavy. Severe, life-threatening bleeding, while extremely rare in a wilderness setting, must be controlled quickly as death from exsanguination can occur within minutes. The primary tools are well-aimed direct pressure, pressure bandages, commercial tourniquets, and hemostatic dressings; pressure points and elevation are ineffective.
Well-aimed direct pressure is first step in controlling severe bleeding and, if successful, often followed by the application of a pressure bandage.

Guidelines for Applying Direct Pressure

1. Open a dressing and wipe away any excess blood to expose the wound site.
2. Place the dressing directly over the wound and apply manual pressure. If you are over the wound and apply enough pressure, most bleeding will stop immediately. If possible, use a trauma dressing to distribute the pressure.
3. Maintain the pressure until the bleeding has stopped. Normal clotting requires 10-20 minutes. Continue to maintain pressure; consider using an elastic bandage to anchor the dressing in place and maintain pressure.

Guidelines for Applying a Pressure Bandage

1. A wide elastic bandage makes an excellent pressure bandage. Apply the bandage with enough force to stop the bleeding.
2. Note the time that the bandage was first applied. Monitor the patient’s CSM below the bandage; remove or loosen the bandage within thirty minutes of application as necessary to ensure the patient’s distal CSM remains intact.

[...]

The successful use of commercial extremity tourniquets by the military over the past decade has saved countless lives. With the proper training, commercial tourniquets—CAT, SOF-TT, SOF-TT wide, and SAM XT—are effective and safe to use in a wilderness environment.
[...]

It’s important to note that improvised tourniquets have been shown to be generally ineffective due to the time it takes to locate the necessary supplies and apply it, and the skill required to engineer it.

Field management fo severe arterial bleeding
Emphasis mine. What they don't mention here is what i was taught: the use of a small, hard object between the pad and the bandage to apply extra pressure directly to the wound from the pressure bandage.

Third hit (from Harvard Medical School, no less):

Emergencies and First Aid - Direct Pressure to Stop Bleeding
Direct Pressure to Stop Bleeding
Updated: February 3, 2017 Published: September, 2005
A wound that is deep, bleeding heavily, or has blood spurting from it (caused by bleeding from an artery), may not clot and may not stop bleeding.

Immediate care
Call out for someone to get help, or call 911 yourself. Elevate the wound and apply direct pressure.

Direct Pressure for Bleeding

1. Elevate the wound above the heart and apply firm pressure with a clean compress (such as a clean, heavy gauze pad, washcloth, T-shirt, or sock) directly on the wound. Call out for someone to get help, or call 911 yourself. Do not remove a pad that is soaked through with blood; you will disturb any blood clots that have started to form to help stop the bleeding. If blood soaks through, place another pad on top of the soaked one and continue applying direct pressure.
   
2. When the bleeding slows or stops, tie the pad firmly in place with gauze strips, a necktie, strips of sheet, or a shoelace. Do not tie so tightly that blood flow to the rest of the limb is cut off. Stay with the person and keep the wound elevated until medical help arrives.

Emergencies and First Aid - Direct Pressure to Stop Bleeding - Harvard Health

Fifth hit (Mayo clinic):

For severe bleeding, take these first-aid steps and reassure the injured person.

1. Remove any clothing or debris on the wound. Don't remove large or deeply embedded objects. Don't probe the wound or attempt to clean it yet. Your first job is to stop the bleeding. Wear disposable protective gloves if available.
2. Stop the bleeding. Place a sterile bandage or clean cloth on the wound. Press the bandage firmly with your palm to control bleeding. Apply constant pressure until the bleeding stops. Maintain pressure by binding the wound with a thick bandage or a piece of clean cloth. Don't put direct pressure on an eye injury or embedded object.
   
   
   Secure the bandage with adhesive tape or continue to maintain pressure with your hands. If possible, raise an injured limb above the level of the heart.
   
   
3. Help the injured person lie down. If possible, place the person on a rug or blanket to prevent loss of body heat. Calmly reassure the injured person.
4. Don't remove the gauze or bandage. If the bleeding seeps through the gauze or other cloth on the wound, add another bandage on top of it. And keep pressing firmly on the area.
5. Tourniquets: A tourniquet is effective in controlling life-threatening bleeding from a limb. Apply a tourniquet if you're trained in how to do so. When emergency help arrives, explain how long the tourniquet has been in place.
6. Immobilize the injured body part as much as possible.Leave the bandages in place and get the injured person to an emergency room as soon as possible.

Call 911 or emergency medical help for severe bleeding that you can't control.

Severe bleeding: First aid

Given that a quick search pretty much confirms that what I was taught still seem to be current, I'm going to trust my training more that I'll trust an anonymous dude on an Internet forum.

I'm giving first aid to someone who has lost a limb, I'd probably try to apply a torniquet, but 1. That's a highly unlikely scenario in any activity I engage in, and 2. I'm not trained in applying a torniquet (but have been trained in applying a proper pressure bandage), so unless contraindicated, I'll stick to what I was taught.

I'm not sure what Home Guard exercises are

I can help you with that. It's rather easy to educate oneself these days.


¹ I know. Google University. But I don't have my learning materials available right now.

 

[Basheroffroad]

My recommendation (but do what you feel best) would be to keep a tourniquet with a med kit that stays on the boat or such instead of with you on the dive.

I agree on some points but strongly disagree on others. You being a paramedic would you trust your life to the tourniquet the OP linked to? I can honestly tell you I wouldn't. I have no idea what's going to be in the first aid kit on the boat until I need to dig into it. At least if I have a tourniquet in my pocket I know it's going to be a real tourniquet and it's going to do its job when I need it to.

 

[JohnnyC]

Nobody has learned more about rapid exsanguination in the last 20 years as the US military. There is a reason why tourniquets are such an important part of the TCCC. Pressure dressings suck, and realistically the lay person with only basic first aid training is gonna watch their friend bleed out in front of them while trying to keep pressure on an arterial bleed.

Civilian trauma training is really poor at teaching actual severe trauma intervention. There are studies upon studies demonstrating the efficacy of prudent tourniquet application.

There’s absolutely zero reason why civilian first aid courses shouldn’t be teaching tourniquet use as a first response to severe arterial bleeding, and other than the old pearl clutching idea that a tourniquet means instant peg leg, it’s mind boggling that they still refuse to accept the mountain of literature on the subject.

Now the real boon of a tourniquet is that it allows you to continue to render aid. As soon as you’re locked into applying direct pressure to an arterial bleed you are effectively useless for anything else. Great job, you’re squeezin’ that artery good! Too bad the poor sod drowned on his own blood because the busted nose was leaking down his throat and you were busy focusing on his leg because you can’t do more than one thing other than hold tight.

 

[Bowers]

I agree on some points but strongly disagree on others. You being a paramedic would you trust your life to the tourniquet the OP linked to? I can honestly tell you I wouldn't. I have no idea what's going to be in the first aid kit on the boat until I need to dig into it. At least if I have a tourniquet in my pocket I know it's going to be a real tourniquet and it's going to do its job when I need it to.

i did not look at the link, but you make a strong point. perhaps a good solution would be to have your own med kit in your dive bag? I beleive that if you take everything on your person that you MIGHT need in the case of an emergency, you would have so much clutter that A)you would be a diving christmas tree B)you would be less able to grab what you need in a timely fashion without dropping a bunch of other stuff.

 

[HBVetera n2312]

Storker

I don’t see how those are “hits” but whatever makes you feel smarter. Stick with it bud.

This whole friggen thread was started when a guy says hey, I’m carrying a TK now. Well I can say from personal, real life combat experience and training in the United States Army, that’s a good move. My suggestion is that you should find a legitimate person to show you how to use it. In fact if anyone is in the Denver area I will give you a free, yes free 4 hour first aid course that is applicable not only during diving operations but everyday life. And I can show you all my credentials and give references to verify me. Then we can go blow bubbles in the lake.

For me it’s about giving back, not googling crap and arguing with a screen and keyboard. I know what works and I will show you.

Even you Storker. Or you can stick with your websites and google-fu.

That’s meant to be a joke. I’m pretty sure you’re a good dude that means well, being a DM and all.

Stay safe brother

 

[HBVetera n2312]

Everyone else, you guys are on track. Take your own stuff to use on yourself. I’ve seen some of the aid bags on these dive boats and they are complete shite.

A surgeon once told me he’s only a surgeon in the OR. Outside, he’s a first responder like everyone else. It’s the resources that allow you to perform these medical interventions.

 

[Storker]

whatever makes you feel smarter.

I see that you aren't interested in a serious discussion where your arguments are based in more than your own bragging, but rather being snarky and condescending.

If that's what floats your boat, have at it. I'm out of here.

 

[Schwob]

Storker

I don’t see how those are “hits” but whatever makes you feel smarter. Stick with it bud.

This whole friggen thread was started when a guy says hey, I’m carrying a TK now. Well I can say from personal, real life combat experience and training in the United States Army, that’s a good move. My suggestion is that you should find a legitimate person to show you how to use it. In fact if anyone is in the Denver area I will give you a free, yes free 4 hour first aid course that is applicable not only during diving operations but everyday life. And I can show you all my credentials and give references to verify me. Then we can go blow bubbles in the lake.

For me it’s about giving back, not googling crap and arguing with a screen and keyboard. I know what works and I will show you.

Even you Storker. Or you can stick with your websites and google-fu.

That’s meant to be a joke. I’m pretty sure you’re a good dude that means well, being a DM and all.

Stay safe brother

Kudos to your stance and offer!
(If I was closer, I'd get in line...)

 

[HBVetera n2312]

The treatment protocols I have been discussing are specific to arterial bleeding on the extremities. The US Army, at first, then DoD, initiated this protocol after bleeding fatalities on the battlefield in Afghanistan. The use of an adjustable, single handed tourniquet was implemented and and CAT TK was born. The rules for it, or indications, where for occlusion of arterial bleeding on the extremities within 1 minute. The TK was to be incrementally loosened by a physician or authorized field medic for replacement by a pressure bandage if the bleed was found to NOT be arterial. If the bleed WAS arterial, a vascular surgeon performed a repair at a CASH. The other critical measure was to be able to access the tourniquet quickly. The meant it was supposed to be carried somewhere on your person.

And that is where this thread starts. Having a TK in your thigh pocket is correct. Anywhere else and it won't do you any good for the injury it is indicated for. All of the other treatment protocols mentioned here are just that. A plan. It is always better to have a risk mitigation plan than none at all. This risk mitigation plan is discussed from Rescue Diver level on up.

There are many others who served in the US military Post 9/11 who are reading this and have been trained in this manner, and it is for one reason only; it works. Many good people died to create a "Lessons Learned" regarding bleeding control, and although it is not as prevalent an injury in recreational SCUBA, as is DCI, it is absolutely 100% fatal if not treated properly. DCI is not nearly as fatal statistically. So good divers should be training in medical as much as you train in emergency procedures, pre-dive planning, risk mitigation, pre-dive checks, out of air emergencies, etc.

Sir, good on you for having a tourniquet.