Bleed control - personal program

[fwafwow]

Another thread (linked below) caused me to want to reassess my readiness with respect to bleed control. If anyone can point me to a good resource, either for implementing a personal program, or on any of the topics below, that would be most appreciated.

Here are the broad steps of what I'm thinking:

1. Admin stuff - certain parts of this should be admin - like calendaring for:
   • updating gear that expires
   • checking for new info on equipment
   • refreshing training and practice, etc.
   • inventory of current items
2. Gear - can't have a rabbit hole without a gear component. I would value any authoritative sources
   • what's better/improved/best (for various use)?
   • what used to be good that isn't anymore - info on device failures/limitations (see https://rokslide.com/forums/threads/small-form-factor-tourniquet.348005/ for some discussion)
3. Method -
   • where do I place items - kitchen (not doing currently), cars, luggage,
   • how do I use - EDC (see thread above), in hunting and shooting bags
   • other?
4. Training -
   • how frequently for basic refresher vs more extensive?
   • who to use (is Dark Angel still well-regarded, alternatives, logistics)?
   • how frequently to practice?

 

[sbaker0029]

I feel like this is a great topic that doesn't get much attention.

1. Admin stuff- depends on how detailed you want to get and how much time and money you want to put into it.

This time of year is and the upcoming time change is always a good time to go through and check dates.
I started with the usual checking the smoke detector batteries the week of the time change and its grown into a spring cleaning/checking gear/restocking event. Probably should do it in the fall as well but fall is for other activities
If I find something about to expire I'll order a replacement and pull the old when it comes in but it's definitely a flawed system.

I've known people to go as far as spread sheets to keep track of everything.

2. Gear- I've always just went with the CAT and ordered straight from NAR.
The thread linked is definitely an eye opener on what else is out there.
Big rabbit hole to jump into.

3. Method- I struggle with this as well. Where's the best places to keep emergency kits and how to store them.

I've recently decided that the best location for my needs is going to be on the back side or behind the laundry/mud/utility room door.
It's a space that's pretty large and unused otherwise. Be great to make a shelf with emergency medical items readily available. It's central location for outside and inside the house seems best in my mind.

4. Training-
At work everyone gets cpr and basic first aid trained every other year. Plus I joined the emergency medical response team. So all my training and refreshers are through work, which I'm very thankful for.

On Youtube, PrepMedic and SkinnyMedic are the two that I've land on that seem to give the best info. The training instructor(retired fireman/EMT) at work also recommended those two channels.

I'd really like to find a good wilderness first aid course to attend. I'd be willing to travel if it was worth it.

Opening up and messing with the expired stuff is also a good way to get familiar with items.

 

[MuleyFever]

Stop the bleed is a good resource that I learned of from a fire department training.

STB Home Page

The American College of Surgeons Stop the Bleed program has prepared nearly 4 million people worldwide on how to stop bleeding in a severely injured person.

www.stopthebleed.org

 

[def90]

Stop the Bleed is what you want. Look up Tactical Combat Casualty Care (TCCC) classes in your area. These classes will teach you how to use tourniquets, pack wounds, use compression bandages and open airways. All stuff that you need to inow how to do in order to save a life until the emts areive.

 

[fwafwow]

Thanks guys. I am knee deep in the rabbit holes. I’m leaning towards updating expiring stuff, adding stuff, and switching to the ratchet TQs. My inventory was a bit eye opening. The only downside I see currently to the ratchet options is that others may not be trained on them. Leaning towards the RMT and TX2 and TX3 for add ons.

 

[northernalpine]

Two things worth considering as well:

1. Delineating between treatment/procedures and damage control/packaging for movement to a care provider. The majority of folks should focus on stabilizing themselves or others until they can get to better care and not operate under the assumption that with a weekend course or three they can perform tracheostomy procedures in the backcountry. The TCCC and STB routes are good ones to take, especially from a skill sustainment perspective.

2. Scaling the size/level of kit for use case. The med setup at the house is significant, the car has an aid bag+, range bag has a trauma-based iFAK, backcountry setup is compact but far more capable than most pre-mades out there plus an array of individually packaged meds that cover aches/pains/swelling/diarrhea/constipation/minor allergic reactions/etc…things that can prematurely end a hunt.

Edit: An awesome conversation to have @fwafwow - I have been in some hairy spots with “experts” who brought moleskin, 4 bandaids, a tube of neosporin, and an abundance of good intentions.

 

[JMasson]

Thanks guys. I am knee deep in the rabbit holes. I’m leaning towards updating expiring stuff, adding stuff, and switching to the ratchet TQs. My inventory was a bit eye opening. The only downside I see currently to the ratchet options is that others may not be trained on them. Leaning towards the RMT and TX2 and TX3 for add ons.

I’m sure the ratchet tourniquets work and have been tested but there’s a reason that the CAT is the gold standard. They’ve saved lives through 20 years of sustained combat and I tend to not trust life-saving interventions that have a mechanical feature. I carry three tourniquets on my combat gear. One CAT on my sub belt immediately to the right of my IFAK. One CAT on the left cummerbund of my plate carrier immediately to the left of a frag grenade pouch where it is easily seen and I can reach it and apply it to myself (they are no good if you cannot get to it and put it on yourself). The third is a SOF-T that is attached to the bottom of my dangler pouch on the front of my plate carrier. I see a lot of guys in my line of work carrying tourniquets in pockets. I’m not a fan of that set up for a couple reasons. One, because they’re harder to see if you are treating a casualty. In a situation where seconds can mean the difference between life and death, being able to apply a tourniquet quickly is of the utmost importance. Secondly, when that tourniquet is contained in a pocket, it takes added dexterity in order to get it out of the pocket. If the pocket has a flap, you can wrip it open but that’s a decision point (reference my concern above) and we’re talking about seconds here. I prefer them to attached in plain view with rubber bands that can be easily broken by pulling on the tourniquet.

I recommend having multiple tourniquets because if you ever have to use a tourniquet, you may find yourself wishing you had more than one. Simplicity is key, when it comes to life-saving interventions. You need to be able to quickly assess injuries and apply interventions when you are under duress. The simpler your equipment is, the easier it will be to use while you are stressed. Mind you, my experience is garnered from multiple deployments to some very kinetic areas of Afghanistan and Iraq so my experience and perspective will differ.

 

[Sadler]

I’ll echo a TCCC class. Learn MARCH and how to use everything in your IFAK. Listen to @JMasson, CAT TQs are what you want and need.

 

[QuackAttack]

On a side note, there are a lot of TQs on the market.

Go with one that approved by the committee on tactical combat casualty care.

Generally, that means a CAT of a SOFT-W. There are others, but those are the standard.

Within those, the SOFT is a much more durable and reliable product. The CAT is a good TQ, but it relies on Velcro that can be cont by mud, sand, blood. It uses plastic components. The SOFT uses a metal windless, metal buckle, and is re-usable.


I prefer the SOFT, but it’s also what I’m issued at work. YMMV.

 

[JMasson]

I’ll add that when buying CATs, be careful. There’s a plethora of Chinese knock-offs available (especially through Amazon) you can buy real CATs on Amazon though, just buy them through the N.A.R. store. I like SOF-Ts because of the metal windless but they are not good for applying to oneself, especially if you only have one good arm at the time and you do not have the ends clasped together. Tourniquets should be prepped when stored for rapid use. Out of the plastic with the free running and through the friction adapter. The prepping goes for everything. Anything sterile should only have one layer of plastic while stored. Many items come from the manufacturer in two layers of plastic (pressure bandages, compressed gauze, etc.) Get NPAs and learn how to use them. They’re extremely simple and an effective means to secure an airway but if you don’t know how to use them you’ll struggle in the moment. Learn how to treat and prevent shock. The two most preventable causes of death in the last 20 years of war were tension pneumothorax and shock. Shock is not hard to treat or prevent in most cases but it is a step that if not done can cause an otherwise preventable death. CPR is a massively beneficial skill that should be taught to every school aged child, in my opinion. TCCC classes would be mostly beneficial to everyone, it gives you knowledge of how to treat most life threatening injuries with a heavy emphasis on massive hemorrhaging. Remember who it is geared toward. Hopefully, most people will never have to treat massive hemorrhaging during a gun fight but there’s certainly a ton of knowledge that most anyone could garner from it. There is possibly some local EMTs/ FDs or PDs that invest their time back into their communities and teach something very similar to TCCC, likely minus the “no medicine in a gun fight” mantra.

 

[JMasson]

On a side note, there are a lot of TQs on the market.

Go with one that approved by the committee on tactical combat casualty care.

Generally, that means a CAT of a SOFT-W. There are others, but those are the standard.

Within those, the SOFT is a much more durable and reliable product. The CAT is a good TQ, but it relies on Velcro that can be cont by mud, sand, blood. It uses plastic components. The SOFT uses a metal windless, metal buckle, and is re-usable.


I prefer the SOFT, but it’s also what I’m issued at work. YMMV.

SOF-Ts are great tools, if they’re prepped properly. I always have one on my kit and two CATs. The CAT only relies solely on Velcro if you do not pass it through the friction adapter through both openings. If that is done, then the Velcro is essentially just to secure the excess in the running end. It does have plastic components and I’m sure they could break but I’ve applied several, both during training and combat, and I’ve never seen one break.

 

[Wellsdw]

20 years FF/EMT and I run A LOT of gsw and stabbing due to my assignments. One thing that gets lost on tourniquets is when you use them. I’ve taken off more than I’ve put on (which if they have only been on briefly I can). PD loves them! They usually aren’t needed, not tight enough, and improperly placed. Another key is making sure you you can put one on one handed. I would argue that a Stick anywhere bandage is just as if not more important. But I agree Train train train

 

[def90]

Thanks guys. I am knee deep in the rabbit holes. I’m leaning towards updating expiring stuff, adding stuff, and switching to the ratchet TQs. My inventory was a bit eye opening. The only downside I see currently to the ratchet options is that others may not be trained on them. Leaning towards the RMT and TX2 and TX3 for add ons.

The CAT tourniquet is pretty much what every organization recommends to use. Do not buy discounted ones off of Amazon as they are most likely fakes and will break on you. There are a couple sites out there that show the differences between the real ones and the fake ones.

 

[QuackAttack]

SOF-Ts are great tools, if they’re prepped properly. I always have one on my kit and two CATs. The CAT only relies solely on Velcro if you do not pass it through the friction adapter through both openings. If that is done, then the Velcro is essentially just to secure the excess in the running end. It does have plastic components and I’m sure they could break but I’ve applied several, both during training and combat, and I’ve never seen one break.

The current Gen CAT (grey) eliminated the second opening. It’s 100% Velcro now.

 

[JMasson]

The current Gen CAT (grey) eliminated the second opening. It’s 100% Velcro now.

I only have the black CATs. Come to think of it, I don’t think we have any that are grey…at least not that I’ve seen issued. I don’t think I’d be ok with solely relying on the velcro to hold them in place, especially on a femoral bleed. Good to know cause that’s something I have to keep an eyes out for now.

 

[QuackAttack]

I only have the black CATs. Come to think of it, I don’t think we have any that are grey…at least not that I’ve seen issued. I don’t think I’d be ok with solely relying on the velcro to hold them in place, especially on a femoral bleed. Good to know cause that’s something I have to keep an eyes out for now.

They upgraded it significantly. From the white Velcro to the grey Velcro, they beefed up the windless, made it slightly wider, deleted the second routing through the buckle, and upgraded the Velcro.

I have full confidence in the CAT. I think it is a great TQ. That said, it was designed around being low cost and something that gets swapped out when it’s been exposed to the elements. I see a lot of them that are in bad shape after having been worn on a police duty belt for a year or more. The CAT just isn’t made to be long term durable when worn exposed.

If it’s carried in a protective case, it lasts longer.

Either way, they all work if the user knows how to apply it.

 

[JMasson]

They upgraded it significantly. From the white Velcro to the grey Velcro, they beefed up the windless, made it slightly wider, deleted the second routing through the buckle, and upgraded the Velcro.

I have full confidence in the CAT. I think it is a great TQ. That said, it was designed around being low cost and something that gets swapped out when it’s been exposed to the elements. I see a lot of them that are in bad shape after having been worn on a police duty belt for a year or more. The CAT just isn’t made to be long term durable when worn exposed.

If it’s carried in a protective case, it lasts longer.

Either way, they all work if the user knows how to apply it.

I’ll have to look around. The CATs I’m issued are black with black velcro. They do have a beefy plastic windless that doesn’t flex like the older versions used to (definitely an upgrade from the first CATs I was issued 15 years ago). They have two holes in the buckle. I don’t know who manufactured them, I’ve honestly never looked.

 

[fwafwow]

Thanks again for all of the feedback. I spent quite a few hours yesterday going through my current gear and doing updated research.

Gear. I am "long" on TQs (3 CAT-7s - including a blue trainer, a Snakestaff and SWAT-T, plus two RMTs on order), but short on gauze and packing materials (some of which is out of date), especially in my kitchen. I'm still very interested in the TX2 and TX3, and realize that like with many things, there are tradeoffs for each of the types of TQs.

Deployment. I can improve this. A couple of my TQs are in holsters that may make it harder for me to get to them out of quickly. I should also have better visibility carriers. And the bigger set of gear in my car has been in my trunk - not ideal for a quick grab.

Training. I've taken the Dark Angel 2 day class, but it's been years. I took the online STB class and will be taking the STB/trauma class again at my gun club. I started to look into what it would take to become an instructor, but hit a technical roadblock in accessing the instructor manual and course guidelines. (If anyone has access, let me know.)

Resources. The STB and Deployed Medicine sites are helpful.

I feel like this is a great topic that doesn't get much attention.

1. Admin stuff- depends on how detailed you want to get and how much time and money you want to put into it.

I've known people to go as far as spread sheets to keep track of everything.

I'm already working on a multi-sheet spreadsheet. It's a problem.

2. Gear- I've always just went with the CAT and ordered straight from NAR.
The thread linked is definitely an eye opener on what else is out there.
Big rabbit hole to jump into.

Yeah, I went deep on it yesterday. Confirmed all of my TQs are in good working order, but I also had not been aware of some concerns about the way windlass TQs are used, the velcro issue, etc. I'm not going to get rid of any of the TQs I have, but I may add to them with some of the ratchet versions that have been approved by CoTCCC.

3. Method- I struggle with this as well. Where's the best places to keep emergency kits and how to store them.

I've recently decided that the best location for my needs is going to be on the back side or behind the laundry/mud/utility room door.
It's a space that's pretty large and unused otherwise. Be great to make a shelf with emergency medical items readily available. It's central location for outside and inside the house seems best in my mind.

Good suggestions.

4. Training-
At work everyone gets cpr and basic first aid trained every other year. Plus I joined the emergency medical response team. So all my training and refreshers are through work, which I'm very thankful for.

On Youtube, PrepMedic and SkinnyMedic are the two that I've land on that seem to give the best info. The training instructor(retired fireman/EMT) at work also recommended those two channels.

I'd really like to find a good wilderness first aid course to attend. I'd be willing to travel if it was worth it.

Opening up and messing with the expired stuff is also a good way to get familiar with items.

Thanks for all of the above. The PrepMedic and SkinnyMedic were very helpful. This video was on point in comparing the TQs -

. I also like that I can train with the ratchet TQs without needing to buy a separate trainer.

I carry three tourniquets on my combat gear. One CAT on my sub belt immediately to the right of my IFAK. One CAT on the left cummerbund of my plate carrier immediately to the left of a frag grenade pouch where it is easily seen and I can reach it and apply it to myself (they are no good if you cannot get to it and put it on yourself). The third is a SOF-T that is attached to the bottom of my dangler pouch on the front of my plate carrier. I see a lot of guys in my line of work carrying tourniquets in pockets. I’m not a fan of that set up for a couple reasons. One, because they’re harder to see if you are treating a casualty. In a situation where seconds can mean the difference between life and death, being able to apply a tourniquet quickly is of the utmost importance. Secondly, when that tourniquet is contained in a pocket, it takes added dexterity in order to get it out of the pocket. If the pocket has a flap, you can wrip it open but that’s a decision point (reference my concern above) and we’re talking about seconds here. I prefer them to attached in plain view with rubber bands that can be easily broken by pulling on the tourniquet.

I recommend having multiple tourniquets because if you ever have to use a tourniquet, you may find yourself wishing you had more than one. Simplicity is key, when it comes to life-saving interventions. You need to be able to quickly assess injuries and apply interventions when you are under duress. The simpler your equipment is, the easier it will be to use while you are stressed. Mind you, my experience is garnered from multiple deployments to some very kinetic areas of Afghanistan and Iraq so my experience and perspective will differ.

I'm not in combat but all of the above recommendations are helpful. I should have more than one TQ in hunting and range situations, and probably in the car. Also a good reminder that I need my buddies to start carrying some better gear - and to always let them know what I'm carrying.

20 years FF/EMT and I run A LOT of gsw and stabbing due to my assignments. One thing that gets lost on tourniquets is when you use them. I’ve taken off more than I’ve put on (which if they have only been on briefly I can). PD loves them! They usually aren’t needed, not tight enough, and improperly placed. Another key is making sure you you can put one on one handed. I would argue that a Stick anywhere bandage is just as if not more important. But I agree Train train train

Is the Stick anywhere bandage just self-adhesive bandage wrap?

 

[JMasson]

Thanks again for all of the feedback. I spent quite a few hours yesterday going through my current gear and doing updated research.

Gear. I am "long" on TQs (3 CAT-7s - including a blue trainer, a Snakestaff and SWAT-T, plus two RMTs on order), but short on gauze and packing materials (some of which is out of date), especially in my kitchen. I'm still very interested in the TX2 and TX3, and realize that like with many things, there are tradeoffs for each of the types of TQs.

Deployment. I can improve this. A couple of my TQs are in holsters that may make it harder for me to get to them out of quickly. I should also have better visibility carriers. And the bigger set of gear in my car has been in my trunk - not ideal for a quick grab.

Training. I've taken the Dark Angel 2 day class, but it's been years. I took the online STB class and will be taking the STB/trauma class again at my gun club. I started to look into what it would take to become an instructor, but hit a technical roadblock in accessing the instructor manual and course guidelines. (If anyone has access, let me know.)

Resources. The STB and Deployed Medicine sites are helpful.

I'm already working on a multi-sheet spreadsheet. It's a problem.

Yeah, I went deep on it yesterday. Confirmed all of my TQs are in good working order, but I also had not been aware of some concerns about the way windlass TQs are used, the velcro issue, etc. I'm not going to get rid of any of the TQs I have, but I may add to them with some of the ratchet versions that have been approved by CoTCCC.

Good suggestions.

Thanks for all of the above. The PrepMedic and SkinnyMedic were very helpful. This video was on point in comparing the TQs -

. I also like that I can train with the ratchet TQs without needing to buy a separate trainer.




I'm not in combat but all of the above recommendations are helpful. I should have more than one TQ in hunting and range situations, and probably in the car. Also a good reminder that I need my buddies to start carrying some better gear - and to always let them know what I'm carrying.


Is the Stick anywhere bandage just self-adhesive bandage wrap?

Like I said, my opinions and experience are skewed by my profession. My wife thinks my aid kits are ridiculous but she also has sting relief pads…which are truly ridiculous.

As far as the “stick anywhere bandage”, I believe he is referring to a hydrocolloid bandage. You are think of “coban” self-adhering wrap. Coban is good for securing improvised dressings, especially if you don’t have a pressure bandage or elastic wrap on hand. It is something I keep in my aid kits.

 

[fwafwow]

Update for me in case anyone is following along. I decided to come up with two types of IFAK kits, for 6 total.

1. Full (3)- one to be in each car, and if I can pack one tightly enough, with me at the range or hunting. Each will contain the following items (largely taken from the PrepMedic DIY kit, plus some items):
   • TQ
   • Packing gauze
   • Flat emergency trauma dressing
   • Mini Sharpie
   • Gloves
   • Space blanket
   • Chest seals
   • Trauma shears
   • Glow stick(s)
   • All in a ziploc with orange duct tape around it and a list of items, with expiry dates
2. Mini (3) - to be in the kitchen, in the field with me when the "Full" kit is too cumbersome, and maybe in my luggage when I travel for work. Each of these would include the bold items above.

TQs. And yes - I did pull the trigger and order both the TX2 and TX3 TQs (bringing me to 8 total, not counting the CAT-7 trainer). I will work to figure out how to allocate the TQs I have, and have ordered, among the above packs. I will probably also plan to have multiple TQs either in the "Full" kits, or at least on me, when I'm around guns, knives or broadheads.

Does anyone have access to the Journal of Special Operations Medicine? There are two articles (below) that are behind a paywall there that sound interesting. Maybe @Marbles?

• "Tourniquets USA: A Review of the Current Literature for Commercially Available Alternative Tourniquets for Use in the Prehospital Civilian Environment" by James Martinson, Habeeba Park, Frank K Butler Jr, Rick Hammesfahr, Joseph J DuBose, Thomas M Scalea
• "Effects of Tourniquet Features on Application Processes" by Piper Lynn Wall, Charisse M Buising, JaNiese Jensen, Alex White, Justin Davis, Catherine Hackett Renner