All:

As you know, a couple years ago we made the commitment to purchasing high quality equipment and to improving our training in the areas of high risk law enforcement and tactical EMS. As part of that training, you've probably heard me say (1) carry your CAT on your person and (2) this equipment is meant for you and your peers, not the public.

Last week, in xxxxxxxxxxxxx, we treated a patient with an open humerus fracture with uncontrolled bleeding. By the time we arrived, the patient had lost a great deal of blood. After a brief time of working to fashion a tourniquet out of triangular bandages, the decision was made to use one of our CAT's on the patient. The CAT was extremely effective and, according to ER docs, was instrumental in saving the patient's life.

I fully believe that the training we've done was invaluable in helping us to make an informed, timely and confident decision to intervene with a life saving tool. I'm happy to report that our patient is expected to make a full recovery.

The result was great, but we learned some things during the incident that are worth mentioning.

We've all seen soft tissue injuries, but they are not all created equal. This one looked like a raw chicken turned inside out. The type of wound will effect how it bleeds. If the wound isn't "clean" you may not see textbook arterial bleeding.

In our case there was A LOT of blood, but no pulsating arterial fountain. Finding the source of the bleeding was next to impossible. It just sort of cascaded out of the tissue. The important facts were that blood was still hitting the ground, it was bright red and there was no way to stop it with direct pressure, elevation and dressings. The lesson is, it might not look like a duck, but if it's waddling around and quacking, treat it like a duck. You have to stop the bleeding.

We've been training on one handed application of the CAT and have them preloaded with the loop already in it. This arm was too mangled to move around so we had to unloop the strap and weave it under the arm and through the armpit. We really struggled with it for a while because I hadn't completely cut away the back side of the patient's coat. EXPOSE the wound as much as you can. It could save you a lot of frustration and time.

The CAT works really well. Our patient was a very large person, but I think it only took one full 360 degree turn of the windlass rod to get the blood flow to stop.

Your adrenaline makes you want to keep turning the windlass rod. Slow down. No sense in cutting the limb off.

Once you think the blood flow has stopped, check and keep checking. Everything is going to be covered in blood. It's hard to tell if it's still flowing, so take your time and be sure you really have it controlled.

Expect the limb to start looking really bad. Our patient's arm swelled and turned a dark, mottled purple. She complained about the arm going numb. It's easy to start second guessing if you're doing more harm than good, but you have to trust your training and your diagnosis.

Carry your CAT on your person. When you need it, you need quick.

After this experience, I wouldn't mess with triangular bandages or belts or anything other than a CAT. If you have a patient that needs a tourniquet, use your CAT. We will replace it.

Talk to your patient. They've probably heard bad things about tourniquets too.