CoTCCC Devices and Adjuncts

[Ian]

There have been a few threads on hemostatic agents and other first aid interventions.  I personally go with and recommend the Committee on Tactical Combat Casualty Care’s (CoTCCC) recommendations.

This video gives some background on TCCC.  The link gives a list of CoTCCC Recommended Devices and Adjuncts.  For those interested in a purpose built tourniquet, I’ve used both SOFTT and CAT tourniquets.  The new buckle on the Gen 7 CAT tourniquet was a significant enough improvement in how it’s deployed to where it’s my preferred tourniquet these days.  I carry Combat Gauze as a hemostatic agent.

Rock on.

http://cotccc.com/wp-content/uploads/CoTCCC_Recommended_Devices_and_Adjuncts_01_DEC_2016.pdf

[Ian]

If you are going to buy a purpose built tourniquet, beware that there are counterfeits out there and only buy them from a reputable vendor.

https://www.jems.com/articles/2015/08/counterfeit-tourniquets-found-in-new-hampshire.html?c=1

 

[Ian]

A couple links as to how tourniquets have evolved from being the intervention of last resort, to the first when it comes to massive hemorrhage of an extremity.

https://www.jems.com/articles/2010/05/tourniquet-first.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660095/

 

[d k]

Wow…fake tourniquets.  On the moral level of adulterating baby formula with toxic compounds…

Interesting reads, thanks.

[Rex Sanders]

For people with various levels of first aid or EMS training – be careful not to exceed your training or scope of practice, for liability reasons.

I recently recertified as a WFR with WMI. Tourniquet-first and hemostatic agents were not part of the training. But they are not afraid of tourniquets any more.

Baby steps sometimes.

— Rex

[Jerry Adams]

yeah, interesting reads and video

tourniquet can be applied for 2 hours with minimum risk.  After 6 hours amputation is probably required.

[David Thomas]

When those clotting-dressings first came out, my MD wife got one for free prior to a GCNP raft trip – always a sign of high profit margins.  Now you can them not for $300 but for $11 at REI so my original cost-cutting idea is less applicable, but I purchase bentonite clay for far less than $1/pound, not $1000/pound.  It’s dirt!  Okay, a certain kind of dirt, with very high surface area, much of it mined in Wyoming, but still, it’s dirt!  So being ULers, if you hiked with a half ounce of bentonite clay in a film canister (I prefer glucose monitoring strip canisters) and, in time of need, smeared it on any fabric and then applied it, clay-side-inward, to a bad wound, you’d get much of the benefit for less weight and bulk for an item most of us will never use and will probably stop carrying the commercial version.

And the civilian versions?  3″x3″ or 5″x5″?  A wound you could hemorrhage to death from could be a lot bigger than that.  My smear-any-cloth-with-clay approach scales nicely to larger sizes, but of course, could never be marketed as such because it wouldn’t be sterile, etc.

[Ian]

DK,

There’s another story re counterfeit tourniquets out there where the patient died.  Upstate NY if memory serves.  I’ll try and find it later.

Rex,

Yeah staying in the scope of your training is never a bad idea, but unfortunately Red Cross and others including the WFR course I took are decades behind the military here.  Hopefully they review the evidence and catch up as these lessons were paid for in blood.

I’m perfectly comfortable packing a wound with plain ol’ compressed gauze, although there are some advantages to using a hemostatic agent.  Gauze is perfectly fine in this application and is much more affordable.

Nothing is ever settled and these treatment protocols are constantly under review and are (hopefully) modified as evidence is revealed.

Jerry,

A couple added thoughts that don’t disagree with what you said.

1. Better to lose a limb than it is to lose the limb and everything attached to it.
2. Agreed on two hours being the safe window but there are cases out there where the limb was saved after 12+ hours.
3. The TCCC model for applying a tourniquet is for a massive hemorrhage of an extremity (HOLY $#!+ THAT’S A LOT OF BLOOD!!!) and amputations where a tourniquet is a life saving measure.  For lessor injuries, dressings and pressure dressings should suffice and a tourniquet would be inappropriate.  Even working on an ambulance for a few years, I never treated an injury that met this criteria.  Some of my coworkers did so the chances aren’t zero, but in a non combat zone, they are rare.

All,

Consider not only how you would treat a stranger, but also a family member and yourself.  This in no way includes/precludes hemostatic agents but is a mental exercise to gauge what realistic threats you could encounter in the world you work/recreate in and available steps you can take to respond to them.

I give classes where we improvise tourniquets.  When we throw out ideas, we find that many of the suggestions don’t work.  Belts are almost always suggested but very few of them will actually restrict blood flow to a point that will kill a distal pulse.  If anyone’s plan is to use a belt as a tourniquet, try it at home one handed on an arm and then try it again on your leg.  If you didn’t stop your distal pulse, you need to come up with another plan.

I know my leather belt doesn’t work but my long sleeved nylon shirts do.  I can apply it as a tourniquet on my leg easy enough.  I’d struggle to apply it one handed to a mangled arm.

What do you carry that would work as a windlass?

[Ian]

Here’s a link regarding some of Quick Clot’s hemostatic agents and what they evolved to.

https://en.wikipedia.org/wiki/QuikClot

Combat Gauze is z fold gauze.  It was recommended by one of my instructors who had deployed four tours as an 18D, which was more than enough to convince me.

I won’t link the video as the thumbnail will upset some, but a quick search in YouTube of “Combat Gauze with Disclaimer” which was posted by CoTCCC demonstrates how it is applied.

 

[Ian]

“In the U.S., however, where many trauma fatalities are also the direct result of exsanguination, there has been little change in hemorrhage control protocols that most often include only direct pressure and standard dressings. The success of these new hemostatic dressings on the battlefield should prompt all EMS agencies to consider their use in civilian practice.„”

https://www.jems.com/articles/print/volume-33/issue-3/training/use-hemostatic-dressings-civil.html?c=1

[Jerry Adams]

maybe a tent stake or pole as a windlass?

I took first aid and life saving as Boy Scout and Red Cross, but they only go into so much detail.  That was a long time ago, I should get a refresher.

[Ian]

Both great windlass ideas Jerry.  I don’t carry trekking poles all that often these days but they would work and can be used as a traction splint for those who’ve been trained on how to deploy them.

A cheap option that can serve a number of uses including as a tourniquet is compressed gauze.  I’ve used something similar to the one in the link below with success.  The trick is to wrap it around the limb a couple/few times to give the constriction more surface area and to lessen the chances of it causing a laceration.  If anyone were to try going this route, I’d recommend buying an extra one and sacrifice it for training use at home to ensure the product you purchased is up to the task.  The ones we used in training were and killed the distal pulse, but there’s always the possibility of a cheaper one failing/ripping as the windlass is tightened.

[Gordon Bedford]

In WW2 my dad’s officer had his arm completely severed above the elbow by a bomb explosion. They saved his life with a leather belt as a tourniquet. This was in the Syrian desert and a couple of days in the back of a truck to the nearest hospital. They must have had the right type of leather belt! Then again it might not work on a thigh.

[Ian]

I’m glad the officer made it.

Part of the issue we were encountering was that this was a class for LEOs.  Regardless if they are nylon or leather, our belts tend to be thicker and less flexible so they can support the weight of our gear or a larger gun belt.  While these characteristics make for a great LEO belt, they do not make great tourniquets.

I’ve seen some lightweight belts at REI that may do the trick, but I don’t own one to experiment with on my own.

At any rate, whatever anyone imagines their solution would be, it’s probably wise to try a dress rehearsal at home first to ensure it works as well as we imagine it would.

[W I S N E R !]

When I worked as an EMT long ago tourniquets were very much considered “battlefield medicine” and not encouraged, to say the least.  We were taught how to apply them and then essentially told to never do it lest we be sued.  Sounds like times have changed.

Funny you mention bentonite David, it’s a staple in the ceramics studio.  Though for bad cuts (on myself, not students!), I’ve always used dry (powdered) fire clay to stop bleeding.  Pack that sucker and you’re good to go.  I’ll give bentonite a try.  It is indeed very fine and absorbent, it makes sense.

 

[Rex Sanders]

Department of Homeland Security has a “Stop the Bleed” national awareness campaign encouraging tourniquet use if direct pressure doesn’t work:

https://www.dhs.gov/stopthebleed

— Rex

[Ian]

There’s a difference between a hemorrhage and a massive hemmorage.   I’ve had some decent lacerations but have never cut an artery.  The TCCC tourniquet first is only for a massive hemmorage eg cut femoral artery, not for capillary bleeding.

Do what works for you and what you feel comfortable with.   Nothing in this thread is a substitute for training and experience.

The TCCC model is based on the experiences and evidence learned from thousands of injured soldiers.   When I was in the Army, pre 911, tourniquet was taught to be used as a last resort.   They changed that protocol in Iraq and Afghanistan for a reason.

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