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Posted: 8/18/2020 9:11:32 PM EST
Are there concerns with the CATs being used on small children (im talking as young as 1?) God forbid its ever needed, I want to be prepared. I’ve read both sides online and a medic featured in a warrior poet society video dismissed the CAT on children, pushing another product instead (maybe the RATs?).

It’s been over a year since I took the Stop the Bleed course and we mostly focused on adults due to the population. Cant recall details related to kids.

Kids have such small arms (and legs) I’m concerned the TQ won’t get small enough to do what they’re supposed to do. Should I look to supplement with another product?
Link Posted: 8/19/2020 5:13:40 AM EST
[#1]
From the classes Ive taken, they reccomend a swat t or manual pressure.  The limbs on children can supposedly be held tight enough/restrict bloodflow manually.  I dont love this idea due to having to use two hands.  For what its worth, i have a (2) swat t in my bag for the exact same thought.  Not sure if thats "right" or if better things would work.  My thread ab the school tq's is somewhat the same concern.
Link Posted: 8/19/2020 5:54:50 AM EST
[#2]
Discussion ForumsJump to Quoted PostQuote History
Originally Posted By Chadsc:
From the classes Ive taken, they reccomend a swat t or manual pressure.  The limbs on children can supposedly be held tight enough/restrict bloodflow manually.  I dont love this idea due to having to use two hands.  For what its worth, i have a (2) swat t in my bag for the exact same thought.  Not sure if thats "right" or if better things would work.  My thread ab the school tq's is somewhat the same concern.
View Quote


I saw that and didn’t want to hijack your thread. I typed the whole response out but ultimately decided to make a new thread.

I don’t like manual compression either due in case of moving the victim.

Thanks, I’ll look into the swat t TQs
Link Posted: 8/19/2020 6:08:33 AM EST
[#3]
Who is recommending SWAT?

Good info in this thread.

CAT or SOFTT


WMS article on CoTCCC approved TQ's
Link Posted: 8/19/2020 8:20:22 AM EST
[#4]
Discussion ForumsJump to Quoted PostQuote History
Originally Posted By trails-end:
Who is recommending SWAT?

Good info in this thread.

CAT or SOFTT


WMS article on CoTCCC approved TQ's
View Quote



Ill add this, i have ALWAYS been advised/carry Cat's for older kids/adults.  The only reason I have been told Swat's is in an extreme case of an infant. The classes/emt's ive talked to never really address it, its always been me asking the question.  They always say direct pressure, and SWAT with a "that should work?" .  Definately not saying this is a professional opinion.  They are a pain in the butt to apply, especially to yourself.  But my concern is from a standpoint of If i need to be hands free there is really nothing else on the market that would work on a 2yr olds arm.  Definately open to options here until my boys get older.  I wonder if even a good elastic bandage would suffice.
Link Posted: 8/19/2020 8:32:37 AM EST
[#5]
For small ones direct pressure, RATS or SWAT-T (maybe some others that perform similarly) are the best option.

CAT, SOFT-T are for normal sized people.  

For my daily carry trauma kits I carry either the RATs or SWAT-T because they will do anyone.  On my"kit" I carry CATs.
Link Posted: 8/19/2020 8:47:57 AM EST
[#6]
Discussion ForumsJump to Quoted PostQuote History
Originally Posted By trails-end:
Who is recommending SWAT?

Good info in this thread.

CAT or SOFTT


WMS article on CoTCCC approved TQ's
View Quote

This is all new to me so anyone reading this should not take anything I say as reliable.

There still doesn’t appear to be a consensus. Some claim a CAT could work on small kids, some claim the SOFFT-W can be used on smaller patients.

@KR20 and others (including one user who claims an ER friend’s recommendation) suggested SWAT-T TQs. With the ER friend suggesting caring two types. I didn’t read the whole 15 page thread but skimmed and looked for a few key words on every page.



There don’t appear to be many studies or concerns us online one way or another. I guess it’s a good thing there isn’t a lot of data on child patients from which reliable studies can be published, but I want to make sure I’m doing what’s right.



Like I said, this concern first arose due to a YT video which suggested the RATs was the way to go for children. But there seems to be a general consensus not to use RATs, especially without training and certainty you are applying correctly. I’m sure they work for the guy who invented them, due to his intimate knowledge, but I wouldn’t try it based on my research.
Link Posted: 8/19/2020 8:50:33 AM EST
[#7]
Discussion ForumsJump to Quoted PostQuote History
Originally Posted By Chadsc:



Ill add this, i have ALWAYS been advised/carry Cat's for older kids/adults.  The only reason I have been told Swat's is in an extreme case of an infant. The classes/emt's ive talked to never really address it, its always been me asking the question.  They always say direct pressure, and SWAT with a "that should work?" .  Definately not saying this is a professional opinion.  They are a pain in the butt to apply, especially to yourself.  But my concern is from a standpoint of If i need to be hands free there is really nothing else on the market that would work on a 2yr olds arm.  Definately open to options here until my boys get older.  I wonder if even a good elastic bandage would suffice.
View Quote


In the linked thread (above and in my recent quote) I recall one poster suggesting a SWAT with a rolled gauze at a particular point to apply direct pressure. No idea if this should be done and I’ve never handled a SWAT.

I’m considering driving to my local Fire/ems station and just asking their opinion.
Link Posted: 8/22/2020 12:53:18 AM EST
[#8]
The CAT is effective to a minimal limb circumference of 5", or 1.6" diameter.  Everything else should be controllable with direct pressure.

This JEMS article gives data on pediatric tourniquet use.
Link Posted: 8/22/2020 12:58:00 AM EST
[Last Edit: Everythingisawesome] [#9]
The drafted TECC Pediatric Guidelines recommend TQ usage in pediatric patients.

TQ application is the primary “medical” intervention to be considered in Direct Threat Care.
View Quote


a. Provider should not hesitate to apply tourniquets to pediatric casualties.
b. Apply a tourniquet over the clothing as proximal-- high on the limb-- as possible.
c. Tighten until cessation of bleeding and move to safety. Consider moving to
safety prior to application of the TQ if the situation warrants.
d. Consider instructing casualty to apply direct pressure to the wound if no
tourniquet available or application is not tactically feasible.
View Quote
Link Posted: 8/22/2020 2:36:31 PM EST
[Last Edit: AesopsWildBoar] [#10]
Discussion ForumsJump to Quoted PostQuote History
Originally Posted By Everythingisawesome:
The drafted TECC Pediatric Guidelines recommend TQ usage in pediatric patients.



View Quote View All Quotes
View All Quotes
Discussion ForumsJump to Quoted PostQuote History
Originally Posted By Everythingisawesome:
The drafted TECC Pediatric Guidelines recommend TQ usage in pediatric patients.

TQ application is the primary “medical” intervention to be considered in Direct Threat Care.


a. Provider should not hesitate to apply tourniquets to pediatric casualties.
b. Apply a tourniquet over the clothing as proximal-- high on the limb-- as possible.
c. Tighten until cessation of bleeding and move to safety. Consider moving to
safety prior to application of the TQ if the situation warrants.
d. Consider instructing casualty to apply direct pressure to the wound if no
tourniquet available or application is not tactically feasible.


Thank you! This is exactly the information I was looking for.

For others reading this thread, I also found the following information helpful:

The pressure applied with a tourniquet need only exceed the patient’s systolic blood pressure. There is no current data that suggests that the application of direct pressure, a commercial tourniquet, or an improvised tourniquet may fail to control pediatric extremity hemorrhage.

Something as simple—and time tested—as a cravat fashioned into a girth hitch, placed around a child’s extremity, can and will suffice.

If you have a non-pediatric commercial tourniquet available for use, and are concerned about the patient’s limb circumference, consider placement of a rolled gauze or pad underneath the constricting band prior to securing the tourniquet—this essentially increases the extremity’s circumference.


One more question:
Can someone provide additional clarification though?
Specifically, the above quote indicates the systolic blood pressure in pediatric patients (children) isabout 70-90 (see quotes table below which came through a little funky). When compared to an adult systolic pressure of 120 (ideal) or higher, does this indicate a the TQ does not need to be as tight in a pediatric patient? I wonder is this is why it’s acceptable to use a rolled piece of gauze to widen the TQ circumference (if needed).

Again, I’m not recommending anything, just asking questions (I’m making some assumptions and don’t want someone to read this and misinterpret this as advice)

Table from article on pediatric systolic pressures

0–28 days< 60 mmHg
1–12 months< 70 mmHg
1–10 years< 70 + (2 x age in years) mmHg
> 10 years< 90 mmHg


And finally:
Conclusion
Current evidence suggests that direct pressure, commercial tourniquets and improvised tourniquets can adequately control pediatric extremity hemorrhage.



Edit: the above quotes are all pulled from the JEMS article:https://www.jems.com/2018/11/01/pediatric-extremity-hemorrhage-and-tourniquet-use/
Link Posted: 9/30/2020 3:36:24 PM EST
[#11]
Systolic BP is going to directly correlate to the amount of pressure required for occlusion. The amount of tissue that must be compressed plays a large role as well.
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