The Shoot2hunt Podcast

[willfrye027]

Your much more fragile than only needing a tq for a gsw. That was an extremely hyperbolic silly thing to say.
See post above yours re: arterial bleeds
Then think all the sharp things capable of creating that sort of bleed in hunting


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fingers and firm direct pressure over almost any artery you could conceivably puncture with a knife or broad head..

 

[willfrye027]

Arrow to an artery, like in your own arm or leg, could be a bleed that’s hard to stop with pressure.

I totally agree with the comments above about TQs should only be used when nothing else works. That goes with the primary suggestion - get trained.

Hard to stop but it will stop. Maybe your own femoral artery would be dicey. With a tourniquet you are cutting off all distal blood flow. Radial artery for instance you can occlude with finger pressure, and allow your ulnar to provide collateral flow to the rest of the hand.

 

[fwafwow]

I guess if I really had to use one I’d use a boot lace or paracord and a stick. But if you’re busting out a tourniquet, you should be thinking medevac and life or death

If you need a TQ and can’t get one applied, a medievac won’t help. You could be dead before the copter is even contacted.

Hard to stop but it will stop. Maybe your own femoral artery would be dicey. With a tourniquet you are cutting off all distal blood flow. Radial artery for instance you can occlude with finger pressure, and allow your ulnar to provide collateral flow to the rest of the hand.

Not saying it’s impossible but that seems to go against everything I’ve read or been told and cuts against the studies I’ve seen. Your recommendation of using a string or paracord to create a TQ makes me curious as to whether there is any support to the statement above. And I don’t doubt I can be wrong, it’s happened plenty of times before.

 

[Musky]

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.

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.

 

[amassi]

fingers and firm direct pressure over almost any artery you could conceivably puncture with a knife or broad head..

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[amassi]

If you need a TQ and can’t get one applied, a medievac won’t help. You could be dead before the copter is even contacted.

Not saying it’s impossible but that seems to go against everything I’ve read or been told and cuts against the studies I’ve seen. Your recommendation of using a string or paracord to create a TQ makes me curious as to whether there is any support to the statement above. And I don’t doubt I can be wrong, it’s happened plenty of times before.

There’s 4 really suspect opinions so far.
Have a feeling more to come


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[WiscoHoundsman]

To be clear I wasn’t saying carrying one isn’t important or that training isn’t important but I am trying to understand real scenarios where one would be warranted. My mind didn’t go to broadheads as I don’t archery hunt. Maybe a knife could go through pants or shirt otherwise falling on a sharp stick is possible and I think that would be worse if it hit your chest just right.

 

[BjornF16]

Will listen to Ep. 44 (Gear) on drive to NM for coues deer hunt…hopefully doesn’t put me to sleep

 

[swavescatter]

Just rub dirt on it you pansies.

 

[willfrye027]

I don’t intend to come off as a know it all here but bear with me.

My day job is an ER doc in one of the busiest trauma centers in CA. So I have some experience with bleeding wounds. A lot of experience with tourniquets that were applied in the field because of “arterial bleeding”. Very rarely were they needed, and in the cases that they were, patients had mangled extremities and needed emergent surgery. Not subtle in those cases. I think a lot of medics, cops, etc will slap on a tourniquet and high five that it worked and was cool, but the aftermath is that I immediately take them off and the patient is fine.

By all means carry a tourniquet if you want to. There’s just not many situations where it’s truly needed, and when it is, shit has hit the fan and you are going to be calling for a rescue. But yes you could save someone’s life with a tourniquet in that rare situation.

If you want to test your makeshift tourniquet skills…find your radial pulse, or a pedal pulse, slap on your tourniquet of choice a bit higher up the limb until your pulse goes away and then tighten some more beyond that. Should hurt pretty bad.

Ideal tourniquet is wider than 1”, but I am not personally going to carry a separate one for the one in a million worst case scenario when I could probably get by with paracord, belt, or shoelace.

 

[eamyrick]

I don’t intend to come off as a know it all here but bear with me.

My day job is an ER doc in one of the busiest trauma centers in CA. So I have some experience with bleeding wounds. A lot of experience with tourniquets that were applied in the field because of “arterial bleeding”. Very rarely were they needed, and in the cases that they were, patients had mangled extremities and needed emergent surgery. Not subtle in those cases. I think a lot of medics, cops, etc will slap on a tourniquet and high five that it worked and was cool, but the aftermath is that I immediately take them off and the patient is fine.

By all means carry a tourniquet if you want to. There’s just not many situations where it’s truly needed, and when it is, shit has hit the fan and you are going to be calling for a rescue. But yes you could save someone’s life with a tourniquet in that rare situation.

If you want to test your makeshift tourniquet skills…find your radial pulse, or a pedal pulse, slap on your tourniquet of choice a bit higher up the limb until your pulse goes away and then tighten some more beyond that. Should hurt pretty bad.

Ideal tourniquet is wider than 1”, but I am not personally going to carry a separate one for the one in a million worst case scenario when I could probably get by with paracord, belt, or shoelace.

I 100% respect your position and you have way more training in medicine than I will ever have. With that said I work at a large metro police agency with over 1500 cops who all carry TQ. I could fill a book with how many life threatening bleeds have been saved by CAT TQs which all cops carry here. There are weekends when there are multiple applications in the downtown district alone. I have had multiple friends who have been shot at work and the CAT TQ is directly credited for saving their life. Not sure how our experience is so different. Maybe there isn’t as robust a training program and distribution in your area.

 

[atmat]

I 100% respect your position and you have way more training in medicine than I will ever have. With that said I work at a large metro police agency with over 1500 cops who all carry TQ. I could fill a book with how many life threatening bleeds have been saved by CAT TQs which all cops carry here. There are weekends when there are multiple applications in the downtown district alone. I have had multiple friends who have been shot at work and the CAT TQ is directly credited for saving their life. Not sure how our experience is so different. Maybe there isn’t as robust a training program and distribution in your area.

I don’t think @willfrye027 is saying TQ’s don’t work. He’s saying that there are few situations that truly require them. And he’s correct, most bleeds can be stopped without a TQ. That doesn’t mean aren’t benefits of TQ’s, even when not absolutely necessary — some situations and locations make applying constant pressure difficult.

But even with TQ use, a significant percentage of the time they’re incorrect applied. It’s not rocket science, but it’s also not idiot proof

If you’re dealing with gunshot wounds frequently, that’s a situation where a TQ has a higher rate of being beneficial than most situations. It wouldn’t be surprising that you have a higher opinion of them in that situation.

 

[gabenzeke]

I'm definitely not a doctor, but I know for sure there have been several podcasts in the last couple years that I've listened to with medical professionals talking about tourniquets and how they DON'T cause you to lose your limb. And they've also mentioned how shoelaces or Paracord and the like isn't wide enough to be effective as a TQ. Add to that, how are you supposed to get out if you're using finger pressure to stop a bleed? I'm not trying to argue or say anybody is wrong, just pointing out that I think other medical professionals are broadcasting an almost entirely contradictory message.

Edit to add: maybe shoot2hunt could do yet another podcast with a medical pro on to talk about medical stuff in the outdoors

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[amassi]

If your worried about losing a limb a shoelace or para cord are your worst possible choice.
A tq weighs nothing and fits in a pocket real easy
Probably never need it but be happy if you do.
The good dr above speaks of end of line experience- ie his quote about ripping them off.
Front of line users who are putting them on know that dexterity and brain processing are greatly diminished
Big bleeders go into shock really fast, add to that the special circumstances of our sport- weather, altitude and proximity of emergency services carrying a TQ is a no brainer.
RE: the possibility of losing a limb, certainly exists but there’s also a multitude (hundreds maybe thousands)of gwot veterans alive today and fully limbed thanks to the use of tourniquets.
Look at the increased survival rate between Vietnam and the gulf war(s) travel time from injury to shock trauma we’re about the same, wounding mechanisms about the same. Gulf war had better tourniquets compared to the Vietnam style of belt, surgical tubing et el. And predictably better outcomes both in mortality and limb retention.


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[willfrye027]

For sure, there are some situations where a tourniquet could be life saving and absolutely the right tool. But I think you’re more likely to die of lightning strike than a GSW in the backcountry, statistically. And I’m not carrying an AED just in case, even though that would be the life saving tool.

I just can’t bring myself to carry a tourniquet when the odds seem so slim that it would come in handy. I think they are very overused in the prehospital setting and maybe the risks of doing harm with them are overblown, but there is a reason we write the exact time it was placed on the tourniquet.

Super interesting topic…worst case scenarios, realistic injuries, and what is actually worth it to carry. I’m sure other medical professionals would disagree or have totally different ideas than me

 

[willfrye027]

I 100% respect your position and you have way more training in medicine than I will ever have. With that said I work at a large metro police agency with over 1500 cops who all carry TQ. I could fill a book with how many life threatening bleeds have been saved by CAT TQs which all cops carry here. There are weekends when there are multiple applications in the downtown district alone. I have had multiple friends who have been shot at work and the CAT TQ is directly credited for saving their life. Not sure how our experience is so different. Maybe there isn’t as robust a training program and distribution in your area.

For sure they are an awesome tool. I just think the odds are too low in the backcountry to justify me bringing one. And I can tell you that sooo many of the extremity GSWs we see are pretty minor, usually handguns and nothing major gets hit. Most go home the same day/night. But send a TMK through someone’s femur…..

 

[PNWGATOR]

For sure, there are some situations where a tourniquet could be life saving and absolutely the right tool. But I think you’re more likely to die of lightning strike than a GSW in the backcountry, statistically. And I’m not carrying an AED just in case, even though that would be the life saving tool.

I just can’t bring myself to carry a tourniquet when the odds seem so slim that it would come in handy. I think they are very overused in the prehospital setting and maybe the risks of doing harm with them are overblown, but there is a reason we write the exact time it was placed on the tourniquet.

Super interesting topic…worst case scenarios, realistic injuries, and what is actually worth it to carry. I’m sure other medical professionals would disagree or have totally different ideas than me

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

 

[willfrye027]

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

No, but transport times are usually short. They get removed quickly on arrival, bleeding is stopped by other methods if it’s an issue, or they go to the OR to get the limb amputated. I imagine you could do some damage putting one on in the backcountry and leaving it on when it didn’t really need to be there to begin with. The risk of harm is really low if a medic puts one on someone down the street from the hospital. Put one on yourself 8 hours from the hospital, and I think there is a risk especially if it didn’t need to be there in the first place.

 

[ztc92]

Lots of varying thoughts and opinions on tourniquet use from a variety of people with different backgrounds. I initially planned to quote and reply to some of these thoughts but it became too much so I’ll just make one large reply. My experience is as a recently trained family medicine physician who now works in a rural hospital that includes shifts in the ER. I also have additional training and certification in wilderness medicine as well.

To the point of what injuries tourniquets help, most have it right - they are specifically for arterial bleeds that are life threatening and/or cannot be stopped adequately with less invasive methods. While we do have lots of great tools in the ER to stop bleeding (including our surgical colleagues), which make tourniquets less necessary in that setting, when talking wilderness or civilian medicine it’s mostly just wound packing, direct pressure and if you’re lucky, perhaps some Quick-Clot or a similar clot forming product. I think that may be the reason for disagreement in the necessity of tourniquets between those in the field (law enforcement, EMS) vs those in an ER setting, such as ER physicians.

As for improvising tourniquets, I’d caution against using cordage such as shoe laces or paracord. First, this generally is not wide enough and will often damage the extremity by lacerating through the skin at pressures high enough to prevent arterial blood flow, especially in the thigh where very high pressures are needed. Second, tourniquets are designed to be extremely strong in order to handle the amount of force/pressure required to stop arterial flow and I would be worried many forms or cordage (such as shoe laces) would break or fail before reaching the needed pressure. For reference, many of the original CAT tourniquets (Gen 1 - 4) have been known to tear at the stitching or break the windlass when attempting to apply them with enough force to occlude the femoral artery. We broke a few older CAT tourniquets when practicing with them for wilderness medicine training during my residency.

For anyone hoping to learn more and wanting to see data rather than opinions and suggestions, I dug up a few studies that may be of interest.

This is a great overall review of tourniquet use that was published in Emergency Medicine Journal in 2007. Reading it will help you understand why there is no obvious answer to how long a tourniquet can be in place before permanent damage occurs (for those skimming, under an hour is considered low risk and it appears that somewhere between 2-6 hours is when permanent damage occurs depending on a variety of factors). It also explains the physics of why a wider tourniquet is better (less total force needed to occlude an artery thanks to increased surface area). Lots of good history about tourniquet use in the military as well.

Tourniquet use in the civilian prehospital setting - PMC

Tourniquets are an effective means of arresting life‐threatening external haemorrhage from limb injury. Their use has not previously been accepted practice for pre‐hospital civilian trauma care because of significant concerns regarding the potential ...

www.ncbi.nlm.nih.gov

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

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma - PubMed

Therapeutic/Care Management; Level IV.

pubmed.ncbi.nlm.nih.gov

Last, this journal article from 2017 tries to take the data gathered from tourniquet use by soldiers during war and then apply it to similar situations encountered in a wilderness medicine setting. It is long and dense, but also makes a lot of good points.

https://www.wemjournal.org/article/S1080-6032(16)30285-X/pdf

Based on these studies and my own knowledge/experience, here are my thoughts:
- A tourniquet can be a life saving device, especially in a wilderness or pre-hospital setting.
- It is very easy to use them incorrectly and so training and familiarity to ensure proper tourniquet use is essential.
- They should only be used in severe, life threatening arterial bleeds when other less aggressive methods have failed, such as wound packing and direct pressure.
- It is probably a poor idea to rely on improvising a tourniquet as most improvised methods will either fail to work, break, or cause significant tissue damage when compared to a real tourniquet. That said, if you don’t have a tourniquet, then improvising is probably still better than doing nothing.
- The best options to buy in my experience are the SOF-T tourniquet, followed closely by the CAT tourniquet.

Edit - Typo about second study.

 

[The Guide]

Lots of varying thoughts and opinions on tourniquet use from a variety of people with different backgrounds. I initially planned to quote and reply to some of these thoughts but it became too much so I’ll just make one large reply. My experience is as a recently trained family medicine physician who now works in a rural hospital that includes shifts in the ER. I also have additional training and certification in wilderness medicine as well.

To the point of what injuries tourniquets help, most have it right - they are specifically for arterial bleeds that are life threatening and/or cannot be stopped adequately with less invasive methods. While we do have lots of great tools in the ER to stop bleeding (including our surgical colleagues), which make tourniquets less necessary in that setting, when talking wilderness or civilian medicine it’s mostly just wound packing, direct pressure and if you’re lucky, perhaps some Quick-Clot or a similar clot forming product. I think that may be the reason for disagreement in the necessity of tourniquets between those in the field (law enforcement, EMS) vs those in an ER setting, such as ER physicians.

As for improvising tourniquets, I’d caution against using cordage such as shoe laces or paracord. First, this generally is not wide enough and will often damage the extremity by lacerating through the skin at pressures high enough to prevent arterial blood flow, especially in the thigh where very high pressures are needed. Second, tourniquets are designed to be extremely strong in order to handle the amount of force/pressure required to stop arterial flow and I would be worried many forms or cordage (such as shoe laces) would break or fail before reaching the needed pressure. For reference, many of the original CAT tourniquets (Gen 1 - 4) have been known to tear at the stitching or break the windlass when attempting to apply them with enough force to occlude the femoral artery. We broke a few older CAT tourniquets when practicing with them for wilderness medicine training during my residency.

For anyone hoping to learn more and wanting to see data rather than opinions and suggestions, I dug up a few studies that may be of interest.

This is a great overall review of tourniquet use that was published in Emergency Medicine Journal in 2007. Reading it will help you understand why there is no obvious answer to how long a tourniquet can be in place before permanent damage occurs (for those skimming, under an hour is considered low risk and it appears that somewhere between 2-6 hours is when permanent damage occurs depending on a variety of factors). It also explains the physics of why a wider tourniquet is better (less total force needed to occlude an artery thanks to increased surface area). Lots of good history about tourniquet use in the military as well.

Tourniquet use in the civilian prehospital setting - PMC

Tourniquets are an effective means of arresting life‐threatening external haemorrhage from limb injury. Their use has not previously been accepted practice for pre‐hospital civilian trauma care because of significant concerns regarding the potential ...

www.ncbi.nlm.nih.gov

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

AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma - PubMed

Therapeutic/Care Management; Level IV.

pubmed.ncbi.nlm.nih.gov

Last, this journal article from 2017 tries to take the data gathered from tourniquet use by soldiers during war and then apply it to similar situations encountered in a wilderness medicine setting. It is long and dense, but also makes a lot of good points.

https://www.wemjournal.org/article/S1080-6032(16)30285-X/pdf

Based on these studies and my own knowledge/experience, here are my thoughts:
- A tourniquet can be a life saving device, especially in a wilderness or pre-hospital setting.
- It is very easy to use them incorrectly and so training and familiarity to ensure proper tourniquet use is essential.
- They should only be used in severe, life threatening arterial bleeds when other less aggressive methods have failed, such as wound packing and direct pressure.
- It is probably a poor idea to rely on improvising a tourniquet as most improvised methods will either fail to work, break, or cause significant tissue damage when compared to a real tourniquet. That said, if you don’t have a tourniquet, then improvising is probably still better than doing nothing.
- The best options to buy in my experience are the SOF-T tourniquet, followed closely by the CAT tourniquet.

Edit - Typo about second study.

Thanks for sharing your experience! I'm always interested in learning.

Jay