Posted: 5/10/2010 7:21:20 AM EDT
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Please forward this PDF file to anyone you know who is in the military, especially those deployed overseas. I thought that it was important for LE/FF/EMS to know about this as well, since many of you may carry tourniquets.
Blog link Link to PDF file showing differences between real and fake tourniquets Fake tourniquets, manufactured in China, are apparently finding their way into the hands of American servicemen overseas. These fake tourniquets cannot be used to control bleeding and have reportedly contributed to at least one fatality. They are intended to be indistinguishable (to the casual observer) from real CAT tourniquets currently in use. We can thank the airsoft community for this fake product that can cause very real harm. 
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Damn airsofters! 
i've been using the israeli, how do the cats work?
narescue.com/Video_Downloads |
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Quoted:
i've been using the israeli, how do the cats work? two different devices for two different wounds. CAT= Combat Application Tourniquet. Is used to stop major hemorrhaging from a limb. Ie amputation, severe wound etc etc Israeli- Pressure bandage, key word being bandage. |
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I was training with both the Israeli bandage and CAT today. Good kit, we use this CAT...
http://www.combattourniquet.com/military-tourniquet.php |
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Thanks for the link. I ordered all my CAT's from NARP and I'll be checking them Wednesday when I'm by my warehouses. Direct from NARP should be GTG. The folks who have to worry bought from 3rd party vendors and eGay. Another discernable difference: 1. The CAT (GEN VI) with the thicker windlass is much easier to identify and differentiate between the CAT GEN VI and the E-CAT. 2. The CAT (GEN III) windlass looks exactly like the E-CAT windlass. They are the exact length, nearly the same thickness at all measurable points: 3. The E-CAT (replica) windlass will fold back on itself without breaking; however, you cannot tighten the tourniquet with it. 4. The CAT (GEN III) cannot be flexed. The composite used in its manufacturing is ridged, and will break with excessive force. However, it will tighten the tourniquet. How to find the FAKE CAT: 1. Stitching only (no heat welding spots) 2. Back of buckle has (6) 3mm mold marks: a. 2 on the lateral bar. b. 2 on the center bar. c. 2 on the (other) lateral bar. 3. No markings (M/D/Y) on the tourniquet. 4. Mold marks on windlass are small, only 3mm. 5. Windlass is very flexible, bends and then snaps back. 6. The hook and loop used to secure the windlass into the windlass lock will likely drop off the windlass lock—the glue is dry and does not hold. |
| I spot checked several of the ones I had in inventory as we have about 100 in different bags and in the warehouse. Even though I got them through NARP they came in the old packaging so I wanted to be sure. I passed it to the TEMS director also today and he passed it to the other teams. |
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WHatever happened to cloth and a stick.  I guess Im behind on the times. We will be adding one to our system soon. Im not sure which one. Will probably sit with the CPAP and Asherman chest seal ....... But I have the seal a lot.Not really behind the times, it's just old ideas being reinvented to be more compact. easier to operate. The sandbox has been great proving grounds for medical procedures and equipment. |
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WHatever happened to cloth and a stick. I guess Im behind on the times. We will be adding one to our system soon. Im not sure which one. Will probably sit with the CPAP and Asherman chest seal ....... But I have the seal a lot.You ever tried to find a stick laying around in the desert? |
| LOL no but a knife handle, glowstick, 9mm mag, ink sitck, flashlight come to mind. It just seems with the civvie commandoes here a rapid application of pressure is all the rage. I find that many devices can have multiple uses and we carry too much shit now. All good but doesnt get used but maybe once a year. For combat a definite yes I would carry two. LE/EMS I dont see it. The only plus with this is they are light and small. |
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Man that is all kinds of Fucked up, thanks for the heads up. Fuck those commie fucks, damn.
I know im preaching to the choir here, but I can never hear the word touriquets and not feel the need to warn people. .mil Medicine especially developments/techniques that stem directly from combat medicine is absolutely and without a doubt responsible for countless amounts of the best and most advanced life saving treaments to filter down in Emergency Medicine ever. That being said, for anyone out there that is not properly trained in teh application and use of a true tourniquets system, please be aware, tourniquets can become extremely extremely dangerous and even life threatening when applied either uneccesarily or without the proper care and monitoring. I can cite hundreds of documented cases of tourniquet application that either turned deadly or resulted in uneccessary and/or negligent harm to a patient that could of easily been avoided by other more reasonable and appropriate measures, this includes tourniquet deaths that have resulted during planned surgery in a civilian operating room during constant observation and application by a doc. Unlike what you may have been taught in the boyscouts, toruniquets are almost always a no-go with the rare exception of a truly life threatening and extremely tramatic injury, generally an amputation. trauma bandages, direct pressure, proper training, etc. are almost always a more suitable and ultimatley more effective treatment. |
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uhhh guys, ive used both the CAT and IDF dressings numerous times as well, and the IDF/Trauma dressing can very easily be adjusted to function eactly as a true tourniquet if needed. It is about 9/10's the effectiveness of a dedicated tourniquet/CAT.
The fact that non-mil feel the need to even carry a CAT or a true tourniquet dressing at all as compared to a dual purpose trauma bandage is a little unsettling to me, maybe some of you guys (non-mil of course) should make sure you have recieved the appropriate training for the uses, applications as well as contraindications of applying any kind of tourniquet system in a non-combat non tramtic amputation situation.... These things aren't just cool pieces of kit to throw in a bug out bag, neither is celox for that matter, by all means get it if you want, but at least make sure you are familiar with what they do and when they should be used and what will happen if you fuck it up by mistake. "Immediate and effective direct pressure to the wound may reduce the need for a tourniquet application. This is an important benefit as tourniquet applications are to be avoided and used only as a last resort. If a tourniquet is required the closure bar is removed from above the pressure bar and inserted between previous revolutions of the wrapping leader 5cm above the wound, over the blood vessel, and rotated. This rotation twists the wrapping leader until the blood flow to the wound site is constricted. After a tourniquet has been achieved, the hooking clips are used to secure and maintain the tourniquet as well as the secondary sterile wound covering which is still in place". |
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LE/EMS I dont see it. The only plus with this is they are light and small. For cops it can fit into a pager pouch on their belt (or on SWAT gear of course). While we still carry triangular bandages on the squad (cravats anyone?  ) something makeshift might work as well, but folks in the sandbox have proven these devices work.
Why reinvent the wheel? ETA - I can see your point about urban commandos (ask me about my run-ins with new NHCS grads sometime ), but FWIW with most of the response and xport times a TK shouldn't compromise the Pt to any great degree... and nowdays if they stopped to assist at all I'd be surprised.
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Quoted:
uhhh guys, ive used both the CAT and IDF dressings numerous times as well, and the IDF/Trauma dressing can very easily be adjusted to function eactly as a true tourniquet if needed. It is about 9/10's the effectiveness of a dedicated tourniquet/CAT. The fact that non-mil feel the need to even carry a CAT or a true tourniquet dressing at all as compared to a dual purpose trauma bandage is a little unsettling to me, maybe some of you guys (non-mil of course) should make sure you have recieved the appropriate training for the uses, applications as well as contraindications of applying any kind of tourniquet system in a non-combat non tramtic amputation situation.... These things aren't just cool pieces of kit to throw in a bug out bag, neither is celox for that matter, by all means get it if you want, but at least make sure you are familiar with what they do and when they should be used and what will happen if you fuck it up by mistake. "Immediate and effective direct pressure to the wound may reduce the need for a tourniquet application. This is an important benefit as tourniquet applications are to be avoided and used only as a last resort. If a tourniquet is required the closure bar is removed from above the pressure bar and inserted between previous revolutions of the wrapping leader 5cm above the wound, over the blood vessel, and rotated. This rotation twists the wrapping leader until the blood flow to the wound site is constricted. After a tourniquet has been achieved, the hooking clips are used to secure and maintain the tourniquet as well as the secondary sterile wound covering which is still in place". That is because several years ago, there were numerous cases of guys bleeding to death while their compatriots were trying to apply improvised tourniquets or just didn't apply a tourniquet because of training tell them to use it as a last resort and by the time it was decided to use it the wounded was all ready too far gone. Than the army did some testing and the improvised ones that CLS trained troops were using actually took longer to assemble and apply than a person had for a sever bleeder. So big army decided simple solution, was instead of more training, it was easier to give everyone a tourniquet. |
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lafmedic- I don't agree with your point on not giving CAT's to LE. Where there is an established FD, LEO and hospital support in a close range it may be acceptable not to equip, but if you go to the more rural areas where the next officer is 20+ minutes, extended response time for ambulance and hospital it is a great asset to have.
Even in a more populated area if an officer is shot in an extremity and stuck in a cover situation, it may be the only simple thing to do until there is enough support to evacuate with support. |
| Good point. It has its niche albeit a very small one. I agree. Again though if you are 20 min out from the nearest hospital Im betting the device will save you and then you will lose the limb on the table at the bandaid station. Not the best trade off. I side with better training on the use and limited applications as to the one you mentioned. Yes far out with no help it rules but not in the city where im 5 mins from a level 3 trauma center. Elevation and direct pressure does wonders. BTW they are also teaching in PHTLS which is trauma for dummies that trendelenburg (elevating the feet) is not helpful too. I take everything I am issued and taught with a SPOON of salt. |
| Tourniquets work. Bottom line. You can go unconscious from a shot to the femoral artery in 20-30 seconds and die in 2 minutes. I don't know any ambulance that can get to me and then get me to the hospital that fast. Tactical Combat Casualty Care teaches tourniquet application FIRST for a reason. They save lives. All my fellow officers will carry them (along with a few other basic supplies) within the next few months if things go like I want them to. |
| Not arguing they work. Im saying they are used when they should not be used and also being encouraged by ranger rick tactical schools/magazines/tv shows and application is being tought by those who have a basic level of medical care and little to no expierience in the useage and detrimental effects after they are applied. Combat medicine is its own animal. I agree with yourtimes 20-30 seconds and 2 minutes until exsanguination occurs. Unless the officer has the thing in his hand or someone to apply it and its not stuck under 50 pounds of gear in the trunk of the car he is using for cover yea its a great idea. Again they are over rating this WAY to much. A lot more could be done to teach effect pressure and stabilization and be a lot more useful |
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Not arguing they work. Im saying they are used when they should not be used and also being encouraged by ranger rick tactical schools/magazines/tv shows and application is being tought by those who have a basic level of medical care and little to no expierience in the useage and detrimental effects after they are applied. Combat medicine is its own animal. I agree with yourtimes 20-30 seconds and 2 minutes until exsanguination occurs. Unless the officer has the thing in his hand or someone to apply it and its not stuck under 50 pounds of gear in the trunk of the car he is using for cover yea its a great idea. Again they are over rating this WAY to much. A lot more could be done to teach effect pressure and stabilization and be a lot more useful You have the time to do that, as a medic. An officer who may be dealing with an active shooter might not be able to simultaneously hold pressure and keep a rifle on a threat(s). It is also possible that EMS personnel - I do not mean this as a slight towards you or your chosen profession - would refuse to put themselves in to the middle of an active shooter situation. I am unfamiliar with any (serious) detrimental effects that would emerge within the time it would take to transport a patient to an ER in CONUS. I say this as someone who has used tourniquets and left them on for a little while. I went through a number of emergency medicine schools in the military, the basic Corpsman training was quite similar to fire/EMS training in its philosophy, the FMSS and followon training was obviously combat oriented. The basic difference was that the first type of training (the philosophy of which you would agree with) centered on the notion that one would be working with other Corpsmen or that they would be by to help shortly. The second type of training centered on the notion that one would be working alone and that help might be around the corner or hours away. None of what I learned in the second type of training would be detrimental to a patient in CONUS who would be picked up by an ambulance 5 minutes after I treated them - say with a tourniquet. You made a comment about the tourniquet not being readily available, this is obvious. In that case direct/indirect pressure or another method would obviously be required. It would reflect poorly on someone who based their emergency medicine "plan" on a device that was impossible to reach. |
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Quoted: Quoted: uhhh guys, ive used both the CAT and IDF dressings numerous times as well, and the IDF/Trauma dressing can very easily be adjusted to function eactly as a true tourniquet if needed. It is about 9/10's the effectiveness of a dedicated tourniquet/CAT. The fact that non-mil feel the need to even carry a CAT or a true tourniquet dressing at all as compared to a dual purpose trauma bandage is a little unsettling to me, maybe some of you guys (non-mil of course) should make sure you have recieved the appropriate training for the uses, applications as well as contraindications of applying any kind of tourniquet system in a non-combat non tramtic amputation situation.... These things aren't just cool pieces of kit to throw in a bug out bag, neither is celox for that matter, by all means get it if you want, but at least make sure you are familiar with what they do and when they should be used and what will happen if you fuck it up by mistake. "Immediate and effective direct pressure to the wound may reduce the need for a tourniquet application. This is an important benefit as tourniquet applications are to be avoided and used only as a last resort. If a tourniquet is required the closure bar is removed from above the pressure bar and inserted between previous revolutions of the wrapping leader 5cm above the wound, over the blood vessel, and rotated. This rotation twists the wrapping leader until the blood flow to the wound site is constricted. After a tourniquet has been achieved, the hooking clips are used to secure and maintain the tourniquet as well as the secondary sterile wound covering which is still in place". That is because several years ago, there were numerous cases of guys bleeding to death while their compatriots were trying to apply improvised tourniquets or just didn't apply a tourniquet because of training tell them to use it as a last resort and by the time it was decided to use it the wounded was all ready too far gone. Than the army did some testing and the improvised ones that CLS trained troops were using actually took longer to assemble and apply than a person had for a sever bleeder. So big army decided simple solution, was instead of more training, it was easier to give everyone a tourniquet. I'm with you, that's why I specifically mentioned non-mil situations before every statement. TQ's absolutely should be standard practice for combat med., but unfortunately this often leads people to believe that whats right for a medic under fire is also the suitable treatment in the civilian world, even though that is often the case and emergency medicine has and will alway benefit tremendously from whats learned on the battlefield, the tq unfortunaty is one of the few shining examples of what is needed for the .mil but what will also do potentially serious harm when copied by .civ/lay rescuers. |
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I can cite hundreds of documented cases of tourniquet application that either turned deadly or resulted in uneccessary and/or negligent harm to a patient. I haven't found any info like this. Please help me out. The latest TCCC protocol calls for tourniquets early and often. In Butler's presentation he goes through a retrospective on hundreds of cases of application. He cites no such harm. The worst reported was a few instances of "transient nerve palsy". Similar results from the recent Israeli study. Even with extended applications. This was the Lakstein report. I am not aware of anything like this coming out of OIF / OEF. -Z |
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Quoted: Quoted: I can cite hundreds of documented cases of tourniquet application that either turned deadly or resulted in uneccessary and/or negligent harm to a patient. I haven't found any info like this. Please help me out. The latest TCCC protocol calls for tourniquets early and often. In Butler's presentation he goes through a retrospective on hundreds of cases of application. He cites no such harm. The worst reported was a few instances of "transient nerve palsy". Similar results from the recent Israeli study. Even with extended applications. This was the Lakstein report. I am not aware of anything like this coming out of OIF / OEF. -Z okay, for the third time now I will repeat myself. I fully and wholeheartedly advocate the immediate and rapid application of any type of touriquet system in any type of combat medicine/TCCC environment. THIS IS EXACTLY MY POINT. TQ application on the battlefied saves lives, I do not agree with Butler's decision to skew his findings by inserting inferences and theories alongside fact, but the basis of his argument is in many ways the major contribution to mine. Quoted: uhhh guys, ive used both the CAT and IDF dressings numerous times as well, and the IDF/Trauma dressing can very easily be adjusted to function eactly as a true tourniquet if needed. It is about 9/10's the effectiveness of a dedicated tourniquet/CAT. The fact that non-mil feel the need to even carry a CAT or a true tourniquet dressing at all as compared to a dual purpose trauma bandage is a little unsettling to me, maybe some of you guys (non-mil of course) should make sure you have recieved the appropriate training for the uses, applications as well as contraindications of applying any kind of tourniquet system in a non-combat non tramtic amputation situation.... These things aren't just cool pieces of kit to throw in a bug out bag, neither is celox for that matter, by all means get it if you want, but at least make sure you are familiar with what they do and when they should be used and what will happen if you fuck it up by mistake. "Immediate and effective direct pressure to the wound may reduce the need for a tourniquet application. This is an important benefit as tourniquet applications are to be avoided and used only as a last resort. If a tourniquet is required the closure bar is removed from above the pressure bar and inserted between previous revolutions of the wrapping leader 5cm above the wound, over the blood vessel, and rotated. This rotation twists the wrapping leader until the blood flow to the wound site is constricted. After a tourniquet has been achieved, the hooking clips are used to secure and maintain the tourniquet as well as the secondary sterile wound covering which is still in place". <o:p></o:p> Quoted: <o:p></o:p> I'm with you, that's why I specifically mentioned non-mil situations before every statement. TQ's absolutely should be standard practice for combat med., but unfortunately this often leads people to believe that whats right for a medic under fire is also the suitable treatment in the civilian world, even though that is often the case and emergency medicine has and will alway benefit tremendously from whats learned on the battlefield, the tq unfortunaty is one of the few shining examples of what is needed for the .mil but what will also do potentially serious harm when copied by .civ/lay rescuers. <o:p></o:p> Butler makes the clear distinction between a TCC setting and .civ Trauma protocol. My argument is based exactly around this concept. I spent many hours working in two major urban level 1 trauma centers, and the procedures that are are adopted from advancements in emergency medicine derived from the battlefield has saved literally tens of thousands of lives over the course of modern combat medicine in a the civilina trauma setting. We all agree on this and can cite dozens of examples. My major major problem is not with the 99% of mutual benefits that are derived from lessons learned from combat medicine, but specifically the 1% of cases in which TCCC instead poses a major health hazard when certain applications are considered in civilian trauma management. The most major exception by far is the widespread use of TQ applications to save lives in combat while under fire, where there is a much larger degree of risk that is acceptable given the circumstances then when these same techniques are applied in a controlled hospital or ED environment. If you have access to pubmed or medline feel free to read through all of these, i'm not gonna turn this discussion into a thesis. The tourniquet. Instrument or weapon?PMID: 4715692 [PubMed - indexed for MEDLINE] Pneumatic tourniquet paralysis. Case report.AbstractWedescribe a 31-year-old man in whom a paresis and sensory defect of the left arm developed after amputation of the index finger. The operation was performed in a bloodless field, using a pneumatic tourniquet. The sensory defect resolved in two months and the paresis in five and a half months. We consider that direct pressure produced by the tourniquet caused the nerve lesion. The incidence of large venous emboli during total knee arthroplasty without pneumatic tourniquet use.Department of Anesthesiology, Allegheny University of the Health Sciences, Hahnemann Division, Philadelphia, Pennsylvania, USA "Compared with previous investigations of large venous emboli during total knee arthroplasty with a pneumatic tourniquet, multiple logistic regression analysis discloses a 5.33-fold greater risk of large venous embolism accompanied the use of a tourniquet during total knee arthroplasty. Implications: One third of knee replacements performed without a tourniquet demonstrated large emboli. Reducing marrow cavity invasion did not decrease the release of large emboli. Compared with knee replacement without tourniquet, tourniquet use places patients at a 5.33-fold greater risk of having a large emboli." Complications are sometimes associated with use of a tourniquet. Among these the most feared, (although very infrequent) is death caused by pulmonary embolism from leg vein thrombi before tourniquet inflation (1) or after tourniquet deflation (2,3). Frequently, hemodynamic alterations are observed after tourniquet release, including hypotension, bradycardia, or even asystole (4). Neurologic deficits (“tourniquet paralysis”), caused usually by high tourniquet pressure and/or prolonged ischemic times, are sometimes observed (5,6). Lower limb exsanguination and embolism.Department of Anaesthesiology, Charleroi University Hospital Centre, Belgium. AbstractWe report a case of fatal pulmonary embolism during lower limb exsanguination in orthopaedic surgery. A 76-year-old woman underwent an open fixation of an external femoral condyle fracture one day after injury. Subarachnoidal anaesthesia was performed and Esmarch compression bandages were applied in preparation for tourniquet ischaemia. At this time, the patient lost consciousness, became apneic and collapsed. Resuscitation procedures were instituted and transoesophageal echocardiography revealed pulmonary embolism. In spite of haemodynamic support and thrombolytic therapy, the patient died. Postmortem examination revealed multiple thromboemboli of recent origin in the right heart cavities, in the pulmonary arteries and in the popliteal and tibial veins of the injured leg. Preventive, diagnostic and therapeutic options of this catastrophic event and indications of pulmonary embolectomy are discussed. Rhabdomyolysis-myoglobinurea: consequences of prolonged tourniquet.AbstractThe authors review the literature on rhabdomyolysis and myoglobinuria and relate these phenomena to prolonged intraoperative tourniquet time in a case report. They alert the practitioner to the clinical manifestations, diagnosis, and treatment of such problems and emphasize the importance of early recognition.
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Affiliations: | a Department of Clinical Physics and Bioengineering, Glasgow, UK |
| b Division of Anaesthesia, Glasgow Royal Infirmary, UK |
DOI:
10.3109/03091908309032577
The list goes on and on, these are all TQ related major complications that occurred in a controlled hospital setting.
99% of combat med leads to tremendous advances in trauma med. TQ use is an exception and it is a major one, and I wish non combat medics/.civ lay persons would stop thinking that the application of a TQ is a safe and commmonly appropriate treatment, because its simply not. Convential methods are not only safer, but also can be much more effective as well.
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99% of combat med leads to tremendous advances in trauma med. TQ use is an exception and it is a major one, and I wish non combat medics/.civ lay persons would stop thinking that the application of a TQ is a safe and commmonly appropriate treatment, because its simply not. Convential methods are not only safer, but also can be much more effective as well.  - and I thought I provided supporting docs for my posts. 
While our protocols include TK's, they are "to be considered after other (conventional) means have failed". The only arena I could see them as any sort of primary is where conventional means are impractical - situations that are as close to TC3 environments as we can get stateside - which in my AO is pretty much limited to a "hot" environment involving flying bullets and rapid extraction (SWAT or active shooter incidents). I think it should remain an "uncommon" treatment, but shouldn't be excluded based on anectdotal evidence. |
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Our instructions are pretty clear for the use of tourniquets:
Only for use to stop 'catastrophic bleeding that can kill in minutes' and first try direct pressure, direct pressure(again), indirect pressure, only then tourniquet. We get the limitations and time factor drummed into us but fortunately the odds of us being out of reach of proper medical care for any significant time are small. |