Tourniquets, Chest Seals, and Pressure Dressings, Oh My!

 

Tourniquets get a lot of digital bandwidth in tactical and preparedness virtual circles. Rightfully so, since they’ve demonstrably saved a fuckton of lives over the last two decades of combat. Unfortunately though, in the process of bludgeoning a deceased equine, in order to overcome decades of medical institutional intertia about the supposed hazards of tourniquet use, many people—myself included, unfortunately—have neglected to make it a point to discuss the surrounding issues.

Let’s start with this, just to get it out of the way:

If you carry a gun, and you’re not carrying a tourniquet or two, you’re either LARPing, or you’re a fucking idiot. The fact is, a “gunfight” implies bilateral ballistics, and the enemy gets a vote. If you assume your one box of ammo a month “practice” regimen means you’re automatically a far better marksman than the bad guy you are going to end up in a gunfight with, well, I’ve got an 8 ounce jar of fairy dust I’ll sell you cheap, and it’s guaranteed to make you stronger, faster, higher flying, and generally more attractive to members of your preferred sex.

Sure, you COULD try using your belt or handkerchief or what-the-fuck-ever to improvise a tourniquet, but experiential research and laboratory study both pretty clearly demonstrate they are a piss-poor substitute, and don’t work particularly well (which is not the same thing as saying they DON’T work, AT ALL. I know people who have saved lives with improvised tourniquets, and you may too. Both they, and their patients, probably would have appreciated a manufactured, quality, tourniquet).

That having been said, we’ve got to look at the circumstances surrounding battlefield wounds, versus our likely circumstances, to see if tourniquets are even MOST of the answer, let alone all of the answer.

Soldiers in combat, in the last twenty years, as a general rule, are wearing—at a minimum—a plate carrier of some sort with rifle-rated plate protection for the upper torso. This means, by default, whether a victim of an IED blast, indirect fire weapons, or direct fire small-arms, the vast majority of wounds sustained will occur to the extremities. Tourniquets work splendidly on extremity wounds. It’s…well…what they’re for…

You and I however, for our EDC, probably do not wear even pistol-rated soft armor, and almost certainly, we’re not walking into the Stop-And-Rob, at 10 PM, with a rifle-rated plate carrier on. If you are, you need to seriously reconsider your life choices. We’re probably not sitting in traffic, waiting to deal with a potential road-rage attacked, kitted up like we’re gonna run Route Irish, circa 2007.

While we SHOULD carry tourniquets, for the inevitable limb injuries, we also need to consider the very real fact that not all miscreants and general shitheads are poor shots. We also need to consider the very real fact that, at arm’s length, the bad dude doesn’t even need to be a particularly skilled marksman to get solid upper torso hits on you. You know where tourniquets don’t do a shitting bit of good? On penetrating trauma to the torso…

You know what other item, besides tourniquets, the improvised/expedient version of is a fucking joke, and a pain-in-the-ass to use, and doesn’t work particularly well? Chest seals.

Dude, I get it. I used the “field dressing wrapper and 100mph tape” chest seal in training as a young soldier. It seems all high-speed, cool guy McGuyver-ish. Now, try doing it on someone with a quarter pint of blood on their chest, covered in sweat, thrashing around, because they’ve got three or four rounds lodged in their lungs, and they’re starting to have a LOT of trouble breathing…

It really is pretty easy to improvise a pressure dressing. A t-shirt will do it pretty well. It’s reasonably easy to improvise wound packing with a t-shirt too. Sure, neither is going to be sterile, but that’s what prophylactic antibiotic treatments are for.

Chest seals are cake to carry. I can fit a set of Fox Seals, or the Compact Hy-Fins, in my wallet, folded in half. I don’t. I either carry them folded in half behind the tourniquet in my cell phone pocket, or I keep a small Maxpedition pouch, with a set of them in it, if I’m wearing something with cargo pockets. Alternatively, I’ll tuck that wallet sized Maxpedition (actually, looking at the picture now, I see it’s NOT Maxpedition, but Vanquest. For some reason, I’ve always thought it was a Maxpedition pouch. Weird) pouch into my back pocket, opposite my wallet, and carry it there.

Seriously, if you’re savvy enough to be carrying a tourniquet, you better be carrying chest seals (and nitrile surgical gloves, unless HerpeSyphiGonorrhAIDS is your fetish) as well. If you’re not savvy enough to be carrying a tourniquet, well, fix your shit.

The other stuff illustrated in my EDC BOK? Meh. I can improvise, or, I can probably get by without, in a normal EDC scenario. Tension pneumothorax, requiring a needle decompression, doesn’t onset THAT quickly, and, outside of a grid-down scenario, I’m probably going to be able to get my patient, or myself, to a hospital, before it becomes an issue.

Same thing with the nose hose. Unless the situation is the onset of the Apocalypse, in which case, fuck a bunch of people I don’t know, I’m heading for the truck, with my people, where there is a full-blown trauma bag, I can probably use chin-lift/jaw-thrust, to maintain a patent airway.

Surgical gloves are sort of a pain to improvise, but I’ve actually dealt with blood-soaked patients who were strangers without them. If you don’t have any open wounds on your hands, you’ll probably be okay, and if you’re worried about getting cut, on scene, a pair of decent work gloves acts as a pretty decent barrier protection as well. That having been said, I found out a few years ago, after exactly that scenario, that going to the ER for a blood test, in my area, runs about $1800, so fuck that. I’ll carry surgical gloves.

If you don’t know what any of this gear is, how to use it, when to use it, when NOT to use it, and when you can improvise a work-around pretty easily, you need to get off your ass and get some medical training. Then, you need to practice it, under different scenarios.

 

(Author’s Note: I realize there is no tourniquet pictured. It is still in my pocket. It is a TX2 from RevMedX, courtesy of The Activity Group. Tell them Mosby sent you.)