Massive Bleeding – Tourniquets (Trauma Medicine Series, Episode 2)

By | June 14, 2022

Hi everybody it’s barry with and today for Today in our ongoing series about the March algorithm and two triple c we’re Talking about tourniquets this is Episode two We’re going to talk about the different Types of tourniquets about the three Most prevalent tourniquets that are out There Why they matter how to stage them how to Apply them So If you want to come in here mr cameraman This is a cat gen 7 tourniquet Okay when you get a cat Tourniquet it comes in plastic like this I’m gonna show you how to stage it So we’re gonna it does you no good to Keep this in the plastic the plastic is For shipping reasons only to keep them Clean And you’re going to see we’re going to Lose time here which is super important As we stage this tourniquet so we want To have our stuff pre-staged And ready to go So we don’t have to mess around When we need this because if we need a Tourniquet we’re dealing with a critical Bleed So It comes like this

We’re going to open it up We’re going to take this red tab right Here We’re going to fold it over about an Inch and a half two inches long The reason for that the red tab is Designed to draw your eye to this color But it takes fine motor skills to get This red tab up off of the hook and loop The velcro We don’t want to be using fine motor Skills in a stressful situation so we Fold it over like that so that we have a Big old tab rather like that that sticks Up so we can get a hold of it We’re gonna pull about six to eight Inches out like so and press it back on Itself Okay Now this is the buckle here this is the Windlass this is a windlass tourniquet This is the c-clip And inside of here Is a kevlar band And when we turn this windlass This kevlar band constricts It actually squeezes the artery the Bleeding vessel inside the musculature Against the bone so that it pinches off The bleeding vessel so that you stop the Critical bleed So this inner band is what’s doing the Constriction it’s made of kevlar this is A genuine cat tourniquet by the way

Okay and then this is the time tab Same thing with that fine motor skill We’re going to take the time tab Pull it off And put it on at an angle With a little bit overhanging like so That i can get my hands on that in a Stressful situation where it may be dark I probably will have bodily fluids on my Hands high stress it takes a lot less Um fine motor skills to pull that than It does to try and peel this Off of there Under stress So at an angle about a 45 degree angle With a little bit sticking up off the Top Now we’re going to fold up Fold up at the buckle And we’re going to fold back down On ourself like that And that’s a staged tourniquet the Reason for that is in this configuration I can grab this in with one hand Slide this over and go to work Now our british friends call these Tourniquets Tourniquets tqs The committee on triple c The committee on tactical combat Casualty care makes recommendations On tourniquets The two primary recommendations is a Tourniquet has to be at least an inch

And a half wide which this one is an Inch and a half wide And it has to be applied with one hand Because in many situations when you’re Dealing with the wound to the extremity You could have a mechanical failure of This extremity because of a broken bone Or something because of a bullet or a Puncture wound or um you know a compound Fracture or whatever Two of the lives that have been saved With refuge medical kits their hand was Missing they couldn’t use this hand so With without using this hand You have to be able to shake the Tourniquet out Get it on go to work Okay So The cat gen 7 Is a committee on t triple c recommended Tourniquet Because you can apply it with one hand And it’s an inch and a half wide this Has also been used 19 000 times During the global war on terror And It works So a tourniquet is not the type of thing Where we want to be doing research and Development in the moment because if it Doesn’t work the casualty could die and So this is a proven tourniquet it’s why It’s the primary tourniquet that we

Include with all of our kids at refuge Medical Additionally there’s a lot of bad Information the old doctrine was life Over limb you only apply a tourniquet To save somebody’s life but they’re Going to lose the limb well we know from 20 years of g watt and from t triple c In the march algorithm that that’s not True Your muscles are a completely different Type of cell than your internal organs Your internal organs can only go a few Moments without blood flow Before they lose oxygenation and you Begin cell death your internal organs Start to die That’s why when you experience Hypovolemic shock your body pulls all of Its blood from its extremities into its Core to keep your internal organs Oxygenated so that you don’t begin cell Death of the internal organs Your extremities by the way we use Tourniquets on extremities and so that’s Going to be arms and legs it’s not the Head or the neck it’s arms and legs and We’ll deal with junctional areas like Your neck your shoulders your pelvic Girdle your rear end in our third video About wound packing we can’t put a Tourniquet on a junctional area anything That moves any joints these junctions Can’t tourniquet it

But your extremities that’s where we’re Going to use the tourniquet So The cat gen 7 staged the way that it is The way you apply this Is you go high and tight okay right up Onto the joint You want to pull towards your center Line and so we call this the rule of Thumb If you put your thumb on the c-clip When you apply it no matter which hand You’re using You are now oriented to be able to pull Towards the center line okay So the rule of thumb thumb goes on the C-clip it goes high and tight and you Pull When you pull down like this You want to keep the windless the stick In what we call your work area you don’t Want this on the back over here where You can’t get at it you want you don’t Want it down inside of your armpit where You’re going to have an interference With your chest Right about here Is where you want it where you can get At it where you can work at it and as You can see it’s high but it’s not over The shoulder joint Now i mentioned that the tourniquet Works by constricting the inner blood The blood vessel inside of the

Musculature that constriction begins With the tightening of this band what we Call the tail so you’re gonna pull down Pull around And come all the way back around here And come right to about this spot right Here okay i’ve already got constriction Now i’m going to take the windlass And i’m going to turn And tourniquets work When they hurt I like to tell people it’s one turn past Bad words And so when you’re ready to start saying Bad words Oh my golly g willikers or whatever It’s one turn past that so right about Here i’m not very happy i’m gonna go one Turn past that And see that the windlass Is retained inside of the c-clip Okay so come around here Go inside And it holds it there Now Next step The tail Gets tucked Inside of the c-clip like so And then the time tab Comes across here And if you have a sharpie which most of Our kits do here you would write the Time

The time that the tourniquet was applied Life over limb right The longest known application of a Tourniquet this exact tourniquet was 18 Hours From eastern afghanistan to grafenwoehr Germany And that person did not lose their limb Because of the application of a Tourniquet You can keep these on safely for about Eight to ten hours We apply tourniquets we don’t take them Off Medical professionals a higher level of Care takes them takes the tourniquet off We apply them but we want to mark the Time here so that when they get to a Higher level of care they know when the Tourniquet went on There is something that can occur called Compartment syndrome which is outside The scope of this video i would Encourage you to come to class Where we go Way deep on all of this stuff and we do Myriad reps of how to actually apply a Tourniquet to yourself to others under Stress in the dark the whole nine arms Legs Everything you can think of scenario Based training refuge training dot com The reason

Additionally we pull this time tab Across is we don’t want this tail to Come loose This is important if you’re on a Carpeted surface if this Hook of the hook and loop of this velcro Grabs the carpet and you move the Casualty this can get stuck and it can Rip off well this time tab And by running the tail through the C-clip helps retain this part of the Tail so that doesn’t happen Now Go ahead and take my watch off you can See i’ve already got vascularity in the Back of my hand And that’s because the blood flow to This arm has been stopped You want to check the you can see also I’ve got veins popping up right here you Want to check the radial pulse These two fingers not your thumb because Your thumb has its own pulse These two fingers There’s a a divot in between Where the tendons and the blood vessel Flow and the bone right here you’re Going to press right in there you’re Going to feel for a pulse You should not feel a pulse If you feel a pulse The tourniquet’s not tight enough You do not want to feel a pulse If there’s a pulse that means that we’re

Still getting blood past the tourniquet Down into the extremity we want to shut The flow of blood off Additionally More bad old information is the concept Of weeping the tourniquet every 10 to 15 Minutes so you get a little bit of blood Flow to oxygenate the muscle So that the muscle doesn’t die well as I’ve told you the muscle can go hours And hours and hours without blood flow People don’t lose limbs because of Tourniquets they lose limbs because of The Injury that was sustained that required The use of a tourniquet in the first Place But not because of tourniquets these are Lessons that we’ve learned over the last 20 years in the global war on terror Triple c the march algorithm So that’s how you put a cat on okay and Remember we put them on we don’t take Them off we elevate to a higher level of Care Now As i mentioned this works by Constricting the inner vessel against The bone structure If you watch watch the vascularity in The back of my hand when i pull this off And all i’m doing is removing the tail See that Went away almost instantly

Because blood flow has been restored That’s why it’s super important To police that tail So that it doesn’t get Released when we’re moving the casualty And by the way there’s a hundred percent Chance we’re gonna move the casualty we Don’t put a tourniquet on somebody and Then leave them there because something Bad just happened here there was a car Wreck or there was a shooting or there Was an explosion or there was a Mechanical amputation we’re going to Move the casualty They are going to Go in an ambulance or in a pickup truck Or in a helicopter or on the back of a Four wheeler or something Buddy carry From where the problem happened to where The higher level of care is and so we Always move a casualty after we put a Tourniquet on so we want to make sure The tourniquet doesn’t come loose When we move the casualty Now we need to reset this tourniquet Okay if you zoom in right here you can See the inner band Is all bound up So what we’re going to do Is we’re going to Pop the windlass out Spin it back around like so Undo this tab on the end

Pull this out And stretch Like that and you’ll feel it stretch Back out Now when you do restage the tourniquet Always keep your tourniquets staged and Ready to go Come through the buckle Fold over the last inch and a half or so Like we did before Pull six to eight inches out Press it down on itself Come up top here Make sure our time tab is squared away Wind list goes inside of the c-clip Fold up at the buckle Down at the c-clip Boom tourniquet is staged There is another way to stage this if You have a bunch of these in a kit and You don’t want the velcro out so that it Won’t stick to stuff You can Come down here and fold up velcro to Velcro Like that Now it makes a super tight Neat little package inside of a kit Inside of a bag inside of whatever what I don’t like about this for self-aid Is that It can be a challenge to shake this out To where i need it to apply it So for self-aid

Like i said We’re going to fold up At the buckle And now see we’ve got this smooth Surface of the cat tourniquet here And that smooth surface is not going to Grab this velcro so when i fold the Velcro back Down it doesn’t grab on anything so when I need to shake this out to use it Boom instantly i’ve got a nice loop size To fit over an extremity So that’s the cat gen 7 tourniquet That’s how you stage it that’s how you Apply it always restage it after you use It and when you get a new kit take it Out of the plastic and stage your Tourniquets Next tourniquet i want to talk about Is the soft tee tourniquet this is mine Carried around my back pocket Everywhere This requires a little bit more training The soft tee It’s a great buddy aid tourniquet Meaning it’s really great to use on Somebody else it’s more difficult to use On it on yourself and in fact in uh A lot of the Literature that comes from tactical Medical solutions or tacmed solutions That makes this tourniquet they talk About this being predominantly a buddy Care tourniquet using on somebody else

Not necessarily using on yourself But i’m me and i do a lot of training So This is also A windless tourniquet here’s the Windlass right here You can see it’s got a small pair of C-clip right here it’s also got this Triangle to retain the windlass After it’s installed Nice thing about the soft tee and one of The reasons it’s preferred By emergency medical technicians emts And paramedics is that right here This buckle comes undone and so if we’re Dealing with an impinged limb like Somebody’s leg is trapped in a car Accident you can go under the limb come Back around and re-hook that just like So you can do the same thing with the Cat if you have an impinged limb Undo the tail Come under the limb Go through the buckle pull back around Good to go so The cat is quite capable of dealing with Impinged limbs as well and the cat is my Favorite tourniquet For primary tourniquet for self-fade i Have to use this on myself This is the one the cat gen 7 made by North american rescue it’s the primary Tourniquet in all of our kits So back to

The soft tee Excellent tourniquet as well right here You can see the soft tourniquet Right here from tactical medical Solutions We have these in the store as well Okay Another nice feature of this Is this has a significantly longer Tail on it than the cat does so if you Have somebody that has large appendages Big tough guys that do a lot of lifting In the gym or people that are overweight This is a good tourniquet for them Because it’ll get around those big Thighs okay Versus the cat it’s not quite as long So This works the same way in theory as the Cat does but there’s a couple of nuances A couple of caveats here The first is Okay rule of thumb thumb on the c-clip Come up here When i pull this It doesn’t automatically cinch down like The cat does so you have to do a ratchet Style like this Okay We still want to be cognizant to keep The windlass in our workspace where we Can get at it not on the inside of our Arm not on the outside of our arm or our

Leg in our workspace we want to pull This down and yes you’re gonna get Tourniquet bite by the way you’re gonna Get a little bruised up from doing this You’ll have It it causes no major issues it’s all Minor you know superficial Take the windlass you can see again There’s an inner nylon band on this Right here that runs through the Windlass this windlass is aluminum Versus the cat which is plastic Some people say they prefer the aluminum Windlass well the cat has been iterated Upon six times this is the gen seven and Up until i believe the gen five they had An aluminum windlass and what they found Out was they didn’t need it this plastic Is strong enough being a legitimate cat Tourniquet which by the way a real cat Tourniquet we’ll say cat here on the Buckle Okay It will say cat here on the windlass And then on the back plate right here It will say cat with the manufacturer’s Information and the date of production There are lots of fakes of these out on The market and i break them for fun in Class all the time because they don’t Work a real gen seven cat tourniquet Should cost somewhere around thirty to Thirty five dollars if you’re finding a Cat for 5 or 10 bucks or 15 bucks that’s

Not a real cat tourniquet it’s a chinese Knock off and you don’t want to save 10 Just to have somebody that you love Bleed out and die Okay so get real Equipment Back to the soft tee So this is a winless tourniquet this Works the same way i’m going to spin the Turn spin the windlass until it starts To constrict Right here i’m not very happy And then i get it in the c-clip okay one Of the issues with this is depending on The look at that a lone star tick right There Die buddy One of the issues with this is depending On the size of the limb that we’re Dealing with the size of the extremity This windlass may not get into This triangle right here You need to be okay with that Right now i definitely have constriction But i don’t necessarily want to be Messing around with this right now if I’m trying to treat casualties if you’re An emt or a licensed medical Professional you probably have more time You’re probably better at what you’re Doing to mess around with getting this In there like so okay This triangle retains that windlass That’s kind of the secondary retention

There so that we don’t lose tension On the tail And that’s it that’s the soft t As you can see vascularity in the back Of my hand it’s working go ahead and Check the radial pulse Don’t have one Okay So And visually we should be looking as Well we want to look for a full there’s Another one Look at that another tick Must be springtime in oklahoma We want to visually check for a full Stoppage of blood flow from the wound That’s what we’re doing with the Tourniquet we want to completely stop The flow of blood We want to keep as much blood inside the Body as possible So i’m going to go ahead and take this Off Lift up at the buckle here like so Pull this off And to reset this All i’m gonna do Put the tourniquet back inside the C-clip Fold up at the buckle then i’ve got this Long tail I’m gonna fold it back on top of itself Like that make a nice neat little Package

A third one what is going on Going to get some bug spray here in a Minute a nice neat little package like So this is why frankly why i carry this One everywhere because it fits in my Back pocket it weighs nothing these are About forty dollars um made in america Really good product Then i’ll just take a rubber band And come across here like so A few times so that it’s remains in a Nice tight little package This is also Committee on t triple c recommended it’s A winless tourniquet that can be applied With one hand and it’s an inch and a Half Wide Now let’s take a moment to talk about The rats or the rapid tourniquet I don’t like the rapid tourniquet or the Rats tourniquet because every time i use One in class to demonstrate i break it It’s also not an inch and a half wide And Generally speaking requires two hands to Apply Which means it does not conform to the Committee on triple c guidelines for What a tourniquet is Can it stop the flow of blood Yes Number four Right there

Look at him Can it stop the flow of blood yes it can Speaking of blood look at all these Bloodsuckers just showing up all over The place Uh will it reliably stop the flow of Blood For me the answer is no because i break The little aluminum retention clip Half the time fifty percent of the time I use it in class the first time and a Hundred percent of the time i use it in Class the second time and remember we’re Gonna move the casualty and i do not Like that little aluminum retention clip On the rats or the rapid tourniquet i i Do not recommend it at all Which brings us to a product that is It’s a good product Marketed as a tourniquet This is the swat tee the stretch wrap And tuck tourniquet okay this is Basically an exercise band i’m going to Open this up and show it to you But this does not conform to the Guidelines set forth by the committee on T triple c But it does have a lot of applications So i’m going to go ahead and open this Up Like so I don’t know why but they smell like Orange creamsicles so i guess that’s Cool

And you fold this out And it’s five foot long Okay Five foot long Now The way this works if you’ll zoom in Right here mr cameraman stretch wrap Tuck So We start with these Rectangles right here And when we stretch these rectangles Enough That they appear to be squares we have Enough tension on this to stop the flow Of blood on a bleeding vessel so for Example Right here they’re rectangles but if i Pull until they’re squares like that That’s an appropriate amount of tension That’s been applied To stem the flow of a bleeding vessel Now here’s the issue with this for Self-care Watch how i put this on Grab this end Come up here Wrap around Like so Get your beard stuck in it Tuck this underneath it here like so Stretch wrap and tuck Okay Vascularity in the back of my hand it’s

Working a couple things i want to point Out the first is No tourniquet feels good but this sucks This hurts like a lot So it’s not comfortable why is it not Comfortable Is this an inch and a half wide No it’s not Okay so that’s the second point i’m Distributing that pressure over a more Narrow area which can potentially lead To nerve damage And muscle damage which is why cot c Committee on t triple c recommends an Inch and a half wide tourniquet as you Can see This covers that right up okay so it’s Not an inch and a half wide and how did I apply it With two hands i had to hold one end Here to be able to apply it here so for Self-fade Using this on yourself i don’t recommend These at all For sulfate as a tourniquet However where these really shine first Of all is they’re five foot long So you can take this tourniquet About like so Sharpen your knife a little bit And cut it in half This Is a great tool For children who have small diameter

Limbs Now the cat tourniquet Will work on limbs down to an inch and a Half in diameter But the bigger the limb the better it Works and so for very small children The stretch wrap and tuck or swat t Tourniquet works better Than a windlass tourniquet now this is a Buddy aid scenario you are rendering aid To them they’re not rendering aid to Themselves okay so in that scenario this Is great For small kids and so i actually carry Around One of these in my back pocket as well Because i have small children and Several of our teammates at refuge Medical Have these Cut in half and rolled up in their first Aid kit just like so that if they need One for their small children they have It ready to go The second place that these really shine Is from making improvised compression Bandages so if i have a wound That i need to apply pressure to I’m going to put gauze in the wound if It’s a deep wound otherwise i’m going to Put gauze over the top of it then i can Take this And i can wrap this around and stretch It like so

And then Tuck one end in Like so And now i’ve got compression i’ve got a Compression bandage on that wound And they they’re great for that We offer a product At refuge medical called an s mark Bandage that is essentially the exact Same thing as the stretch wrap and tuck Tourniquet That um You’re not paying the name brand for It’s uh it’s a medical industry standard Compression bandage just like this Called an smart bandage and we have Those at refuge they’re in Several of our kits as is the swat tea I’m sorry the soft yeah the swat tea And so Here’s our three types of tourniquets Here we have this stretchy type here Not recommended for self aid great for Body aid great for kids We have our soft tee tourniquet Great for buddy aid if you’re going to Use it for self aid for yourself you Need to need to train with it And then the cat gen 7 Cat is combat combat application Tourniquet from north american rescue Phenomenal for selfade highly Recommended for buddyaid as well and the Primary tourniquet that we use

In all of our kits The whole idea here the reason we’re Using a tourniquet is if we have a Critical bleed Which critical bleeding looks like oh Crap bleeding it’s a lot of blood coming Really fast okay that’s indicative of an Arterial bleed it will usually be bright Red and it may be likely is Going with the pulse of the heart Spurting out That’s not always the case but Oftentimes it is So with a critical bleed in the Extremity we’re going to use the Tourniquet preferably a cot c approved Committee on t triple c Approved tourniquet that’s an inch and a Half wide can be applied with one hand Like so That has a windlass We’re gonna go high and tight We’re gonna get the tail around We’re gonna keep the windlass in our Workspace we’re gonna go one turn past Bad words We’re gonna pull the tail through We’re gonna put the time tab on That’s how you apply a tourniquet that’s Why you apply a tourniquet You’ve only got approximately the Average adult has approximately five Liters of blood in their body if you Lose two and a half liters of blood you

Have a 50 50 chance of survival if we Get you to a trauma surgeon right now A coin toss So we want to keep as much blood inside Of the body as possible and that five Liters is based upon body weight so Children have a lot less blood in them Than adults do so that’s something to Consider as well and so having some Tools in your tool kit whether it’s a Windlass tourniquet or a stretch wrap And tuck tourniquet you can deal with Those critical bleeds that’s the m of The march algorithm Part one of the m of the march algorithm Tourniquets tourniquets save lives this Has been unequivocally Proven In the areas of law enforcement ems Tactical fire and global war on terror Militaries and law enforcement agencies Around the world Understand the value Of having a tourniquet on you So Thank you for joining us again please Share this with anybody you think needs To see it I really want to reach as many educators As we can I am tired of our children falling Victim to people perpetrating evil And i will accept nothing less than Excellence from our educators from our

Law enforcement officers and from myself In addressing this and so You need training whether it’s from us Or anybody else And you need good trauma first aid kits Whether it’s from us refuge medical or Anybody else You need a good kit and the basis of a Good kit is a good High quality tourniquet preferably a cat Gen 7 Or a soft tee I appreciate you all very much please Share this with everybody that needs to See it if you’re new here go ahead Subscribe ring the little bell icon Thank you for all the support and for All the love bless y’all shalom