The Shoot2hunt Podcast

[Dobermann]

This next one was the only “study” I could find reviewing the effectiveness of tourniquet use in the pre-hospital setting. Based on over 1100 limbs with tourniquets applied, the authors concluded that overwhelmingly tourniquet use was helpful and rarely led to permanent damage or amputation of the limb

Thanks for the great post.

As for published research, I think there's also a piece from late 2020 or very early 2021 - news of it came through to my advanced first aid / Stop the Bleed instructor (US Army TCCC trained) right in the middle of class in Jan 2021. He interrupted the class to share the good news.

 

[Drenalin]

I'm no professional, in fact CPR is really the only training I have. I could've swore that during the latest middle east combat tenure. They learned that tourniquets actually aren't as bad as originally thought to be. Which is why they're everywhere to buy for everyone. Also why law enforcement carries them (unsure about paramedics but I'm sure they do). Because of the use of tourniquets from the latest wars we were able to save what used to be considered lethal wounds, regardless if they were "truly" needed or not and found that you have a lot longer than originally anticipated length of time before serious damage occur?

Again, serious questions, just trying to understand. Especially with all the different sources of media available it isn't hard to become confused about certain things and or stuck in our ways?

Regardless, I'd like to think I'd rather lose a leg due to not needing a tq than to potentially die.

This is what I was told ~1 year ago when I went in for Wilderness 1st Aid cert. Basically, they were teaching then that "spurting" or uncontrolled bleeding on a limb, cut the bs and go to the TQ. 20+ years in Iraq and Afghanistan taught us that properly applied TQs presented low risk of other damage being done that might lead to the victim actually losing the limb or losing function due to the TQ. Some caveats in that sentence for sure. Direct pressure still has its place, but some of the mystique and fear around tourniquets has worn off.

 

[mtnwrunner]

Have you seen harm to a patient from the application of a tourniquet in the pre hospital setting?

I was hoping you would show up on this thread.

Randy

P.S. I don't carry a TQ, I just have pnwgator with me.......although he's tough to stuff in the lid.

 

[Reburn]

You can some serious damage with a tourniquet. Most folks grossly overestimate how much blood they’re losing. Tourniquet should be for life threatening bleeding, like accidentally shot your buddies leg off with your 7mag. I have a hard time imaging a field scenario when it would be truly needed except gunshot to an extremity. direct pressure is effective and safer, almost always.

Downside of tourniquet is causing someone to need an amputation when they would have been fine in the first place. A properly placed tourniquet can only be left on for a short time otherwise you are killing downstream tissue.

When someone shows up in my trauma bay with a tourniquet on, first thing I do is take the damn thing off unless the limb is obviously mangled. They are almost never needed in the first place.

Sorry I'm late back to the party. Went to bed early last night.

I kinda agree with you on gun hunting that the chances to need a TQ are very low.

However I also bow hunt too and a broadhead into your thigh can cut the femoral artery. I have already seriously cut myself with a broadhead once 1mm from penetrating the knee joint at home.

 

[menhaden_man]

Been enjoying the podcast @Ryan Avery - good balance between content and asshattery. Lots of hunting podcasts seem to be too far in either direction.

 

[Harvey_NW]

Israeli bandage and quick clot or combat gauze is a good addition to a kit for the more common and non arterial stuff.

 

[NSI]

Israeli bandage and quick clot or combat gauze is a good addition to a kit for the more common and non arterial stuff.

This is it.

The M in MARCH stands for .... don't eff around with massive hemorrhage.

Step 1: pack a quick clot bandage deep into that shit.
Step 2: Wrap it tight with an Israeli bandage.
Step 3: If it's still obviously ******, add a tourniquet above the wound, as high on the limb as possible.

Immediate tourniquet application is a combat technique not optimized for woods injuries.

-J

 

[fwafwow]

A couple have posted about placing the TQ as high as possible on the limb. That is what I was taught at Dark Angel some years ago. But I took a Stop the Bleed refresher a year or two ago and was told the TQ should be a few inches above the wound. I questioned it but later confirmed that the recommendation had changed - FWIW.

 

[Formidilosus]

There is a lot of old, beyond proven incorrect nonsense that is being repeated from the 60’s and 70’s about TQ’s in here. The longest war in American history where TQ usage was the very first thing that was applied any time penetrating trauma or anything beyond light bleeding was shown. “Put a TQ on immediately” is what TCCC and every advanced field care has taught since 2001 time frame. There have been exactly 0 confirmed limbs lost due to short term immediate use of TQ as of 2016’ish.

Get to a legit training course, TQ immediately with penetrating trauma to a limb, or major bleeding. Once blood loss has been controlled, revaluate and potentially switch to hemostatic dressing. The reason you don’t use a TQ “after everything else has failed”, is because by the time something has failed, if you needed a TQ you are already done.

Worse than that it’s “don’t put a TQ on it, use a shoe lace”. I’ve seen a lot of TQ’s applied, I’ve applied them on myself. I give about zero credence what US based DR’s in an ER with the best lifesaving equipment on the planet and a full staff has to say about their use. That context has zero relevance with someone being miles from a vehicle and stopping major bleeding.
Because of those exact DR’s and their opinions, TQ use was the “last ditch effort” for every war before 2001 and costs the lives of tens of thousands of people.

 

[willfrye027]

There is a lot of old, beyond proven incorrect nonsense that is being repeated from the 60’s and 70’s about TQ’s in here. The longest war in American history where TQ usage was the very first thing that was applied any time penetrating trauma or anything beyond light bleeding was shown. “Put a TQ on immediately” is what TCCC and every advanced field care has taught since 2001 time frame. There have been exactly 0 confirmed limbs lost due to short term immediate use of TQ as of 2016’ish.

Get to a legit training course, TQ immediately with penetrating trauma to a limb, or major bleeding. Once blood loss has been controlled, revaluate and potentially switch to hemostatic dressing. The reason you don’t use a TQ “after everything else has failed”, is because by the time something has failed, if you needed a TQ you are already done.

Worse than that it’s “don’t put a TQ on it, use a shoe lace”. I’ve seen a lot of TQ’s applied, I’ve applied them on myself. I give about zero credence what US based DR’s in an ER with the best lifesaving equipment on the planet and a full staff has to say about their use. That context has zero relevance with someone being miles from a vehicle and stopping major bleeding.
Because of those exact DR’s and their opinions, TQ use was the “last ditch effort” for every war before 2001 and costs the lives of tens of thousands of people.

Fair enough. So you carry one in the backcountry? Battlefield and police where a GSW is a real possibility, absolutely. I would never argue that tourniquets are not life saving and effective. Hunting, when you might realistically slice yourself with a knife..it’s just not necessary in my opinion. Very interested to hear what wound you had that required one, unless you’d rather not share.

I can think of two cases in the last year where the tourniquet was absolutely needed. It wasn’t subtle and I think they both ended up dying later. I cannot count how many tourniquets were applied, fully “indicated” at the time they were put on based on protocol, but not really needed. In a research study they would probably be considered a “win”. Because the bleeding stopped and the patient survived. Almost impossible to “research” whether or not the tourniquet was needed. Too heterogeneous of a disease process, and too subjective on the indications and outcomes, in my opinion.

Yes we have some advanced equipment and operating rooms with trauma surgeons, but the vast majority of time direct pressure on the bleeders will slow things down enough for the bodies natural coagulation pathway to work. Especially on a healthy person with an isolated injury. Smaller GSWs, knife wounds, chainsaw accidents. Rarely was a TQ truly needed. Rarely did I do something special to get bleeding to stop. Blood can squirt from someone’s scalp 3 feet across the room onto the wall…it’ll stop with firm pressure from one or two fingers. And with some patience and a pressure dressing it’ll be hemostatic. Sometimes I do need to put a stitch or two into a smaller artery or arteriole..but that is after I’ve let a pressure dressing or whatever sit on there for a while. Nobody is bleeding out from that, and the pressure dressing is doing the real work of slowing bleeding enough for coagulation.

Someone could argue that we’re hunting with centerfire rifles and a major GSW is possible. That’s totally fine. I am more of a minimalist at heart and just can’t stomach carrying one for the what if worst case scenario stuff. But if you’re going to carry one, get some training for sure. But the far more useful part of any stop the bleed training is learning how to effectively apply pressure on a wound.

 

[wesfromky]

Hunting, when you might realistically slice yourself with a knife..it’s just not necessary in my opinion.

Probably an edge case, but if he was carrying (and knew how to self deploy, etc) a TQ, he might still be alive.

Man dies after being accidentally stabbed with hunting knife, officials say

A 37-year-old man has died after accidentally stabbing himself in the leg with a hunting knife.

www.wsaz.com

 

[Formidilosus]

Fair enough. So you carry one in the backcountry?

Yes sir. I am a minimalist as well. Basically I treat it as the MARCH algorithm in TCCC. Stop major hemorrhaging, establish an airway, respiratory, circulation, and hypothermia. A TQ, quickclot or the like, and a needle. I always have an emergency blanket. A surgical Trach is easy enough. After that it’s just a couple bandaids, a small burn cream, and some IB. The whole thing weighs 5-6oz.

 

[willfrye027]

Probably an edge case, but if he was carrying (and knew how to self deploy, etc) a TQ, he might still be alive.

Man dies after being accidentally stabbed with hunting knife, officials say

A 37-year-old man has died after accidentally stabbing himself in the leg with a hunting knife.

www.wsaz.com

Well shit, that sucks. Maybe he could have saved himself? Hard to say. The deer I shot in its femoral artery with archery equipment died in about 90 seconds (or was unconscious at least). Wound would have to be down far enough on the leg to get a tourniquet above it, fast.

My opinion overall with wilderness medicine is that some shit, you are just gonna die from, and there’s not much anyone can do. But it’s definitely a philosophical issue more than anything, I’ve got colleagues with massive med kits and they would argue with me vehemently. I have my opinions and you will get 5 different opinions from 3 docs in a room.

 

[willfrye027]

Yes sir. I am a minimalist as well. Basically I treat it as the MARCH algorithm in TCCC. Stop major hemorrhaging, establish an airway, respiratory, circulation, and hypothermia. A TQ, quickclot or the like, and a needle. I always have an emergency blanket. A surgical Trach is easy enough. After that it’s just a couple bandaids, a small burn cream, and some IB. The whole thing weighs 5-6oz.

Sounds like I’ve got some things to learn from you. How are you gonna ventilate your emergent airway in the field? Quickclot is a good idea. I do have a needle scalpel and some other odds and ends but usually don’t have it in my pack with me. I’ve seen a couple codes from tension pneumothorax but they were old and sick without much reserve. Medical not so much trauma. The trauma patients we are just doing finger thoracostomy for the most part and then chest tube, can’t say I’ve seen it be THE life saving intervention. If they’re getting chest tubes they’re probably bleeding out somewhere else and dying from that. But it certainly is textbook to code from tension pneumothorax, just rare. But I’m sure others have have seen it.

The one thing I need to be carrying but don’t is an epipen. Probably one of the few medical emergencies where something simple could save a persons life in the backcountry.

 

[atmat]

Probably an edge case, but if he was carrying (and knew how to self deploy, etc) a TQ, he might still be alive.

Man dies after being accidentally stabbed with hunting knife, officials say

A 37-year-old man has died after accidentally stabbing himself in the leg with a hunting knife.

www.wsaz.com

Seemingly, the guy was walking up to a deer with his knife unsheathed. I’m skeptical he would’ve known how to use a TQ.

 

[Ryan Avery]

I took an advanced firstaid class in the Army from a crusty old former Marine. He said “For some people the best use for a TQ is around their neck”

 

[amassi]

That line was still popular in 2004.


Sent from my iPhone using Tapatalk

 

[fwafwow]

So small.

I have a different TQ in my car, and carry this (or CAT-5) in my pocket if I’m at the range or in the field. If I’m with a buddy who was in the service, we tell each other where our trauma kit (often only a TQ, but sometimes with more) is on our person so the other can give aid. Maybe we are Chicken Little. But it doesn’t take much time, effort, space or weight - for me.

But I also have a gear problem.

EDIT - “a buddy who was in the service” is descriptive of him. I am a civilian.

 

[mtnwrunner]

So small.

I have a different TQ in my car, and carry this (or CAT-5) in my pocket if I’m at the range or in the field. If I’m with a buddy who was in the service, we tell each other where our trauma kit (often only a TQ, but sometimes with more) is on our person so the other can give aid. Maybe we are Chicken Little. But it doesn’t take much time, effort, space or weight - for me.

But I also have a gear problem. View attachment 628167

Aint nothing wrong with a gear problem.
Just sayin.........

Randy

 

[atmat]

So small.

I have a different TQ in my car, and carry this (or CAT-5) in my pocket if I’m at the range or in the field. If I’m with a buddy who was in the service, we tell each other where our trauma kit (often only a TQ, but sometimes with more) is on our person so the other can give aid. Maybe we are Chicken Little. But it doesn’t take much time, effort, space or weight - for me.

But I also have a gear problem.

EDIT - “a buddy who was in the service” is descriptive of him. I am a civilian.
View attachment 628167

I feel like I could draw a perfect rendition of your house because I see so many pictures of it in the background of photos.