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

May 20, 2019

pocket med

 

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.)

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14 Comments
  1. somedude permalink

    improvised TQs. I attended a Trauma AAR of the Las Vegas Shooting. speakers were ER nurses inside the venue and 2 ER docs that treated/triaged at the trauma centers. 80% of the improvised TQs applied to the victims of the Las Vegas mass-shooting failed. best to carry a few TQ. as for gloves. get the ones with heavy mils and long cuffs.

  2. ^^ Just about all of that. 4 1/2 stars, minimum.

    My additional 2¢ of medical minutiae:

    1) FWIW: Gloves degrade, esp. with time and heat, like in a car.
    Buy the big box, store it in a cool, dry place, and change the ones in the car/your EDC quarterly, at minimum.
    Monthly would be better.
    If you notice the ones you’re taking out failing, change more frequently.
    And on-body should be more than one single pair.
    (I keep 3-4 pairs on me constantly in the ER, and still run out mid-patient, but I see a few more patients than I hope you ever do.)

    If anyone’s inner cheapskate Scotsman is butthurt about the pairs you’re rotating out, and they’re still serviceable, use them to wear while you clean the weapon(s) with which you should be keeping proficient, instead of just tossing them out. You’ll learn to get good with them on as a bonus, and you’ll be better able to fight like you train. And it’ll be easier to clean yourself up after you clean weapons.

    2) TQs: You have four extremities. If you don’t have 4 TQs nearby, you’re probably effing up.
    Esp. as protocol is to place a second TQ above the first one, if you aren’t stopping bleeding with the first one. So you might, ergo, figure out you should have maybe up to eight handy.
    Unless you’d rather run out of blood because you ran out of TQs.
    Suture self.

    3) NP Airways, i.e. Nose Hose:
    Yes, you can do chin tilt-jaw thrust to get an airway in a pinch.
    And now, you’re the airway device.
    Full-time, both hands, can’t do anything else, until help arrives.
    Can’t apply a TQ. Can’t assess bleeding. Can’t do anything else.
    Because you’re busy holding that airway open.
    Okay if you have more medical help; not so great if you’re a solo act, esp. with more than one patient, or they have more than one problem.
    -Or-
    You could tear open the $0.05 packet of surgi-lube, slather the nasal trumpet in it, slide it up a snotstril, and then go on about what you were doing. The noisy audible solo your patient is now playing will assure you the airway is patent while you attend to other things.
    They’re small. They’re cheap. Have an NP airway, and use if necessary.

    4) And any gear that’s old/expired is not trash. Only used bloody gear is trash.
    Old/expired gear is training material. For you. For noobs.
    You bought it.
    Get your money’s worth out of it, even if you aren’t That Guy doing emergency trauma first aid at the next mass shooting.
    But if you save your old gear to train other people with, one of them may be That Guy.
    The handoff guy is just as important as the guy who actually makes the lay-up.

    And there is a special circle in Hell reserved for those who make or sell cheap Chinese TQ knock-offs. If I ever read about someone whacking such a person, and I were on the jury, I would vote to acquit.

  3. Curious if the chest seals you carry are vented or non-vented? Since you aren’t as concerned about tension pneumothorax do you carry non-vented?

  4. Glenn permalink

    John,

    You’re not the only one.

    I too swore the pouch I’d picked up at the PX at Anaconda in 2004 was Maxpedition.    Until you mentioned Vanquest and I looked them up and recognized the same damn pocket organizer I lost long ago.

    Definitely worth a chuckle.

    Glenn

  5. Norman B permalink

    Great article; Thank You.
    The Activity Group is , apparently no longer carrying the TX2.
    I found it @: https://www.revmedx.com/store/

  6. Practical Man permalink

    Sir

    Can you recommend a reliable or preferred vendor for occlusive dressings, hemostatic agents, and compressed flat pack gauze?

    Amazon seems to be full of counterfeit goods lately. Would like to replace my long expired issue IFAK expendable items.

    Thanks for the exceptionally entertaining fireside chats. Great gouge delivered in memorable humor.

  7. Harry Balzac permalink

    Hmmm… Sounds like great advice! One should also carry on their person an AED, because your chance of having a heart attack is SIGNIFICANTLY greater than getting shot! Oh, and you should lug around a gallon of cranberry juice in case you get a kidney stone! Hell, if you’re not driving around in a goddamn AMBULANCE, you’re a FUCKING IDIOT!
    Seriously, how many civilian (non-LEO) self-defense gunfight (not active shooter incident) survivors have bled to death in the last 10 years because they weren’t carrying tourniquets? We’re already expected to carry our handgun, a back-up gun, spare magazines for both, a tactical folding knife, a flashlight (with spare battery) & a non-lethal option. Now a trauma kit, too? Add wallet, keys, phone & I don’t have enough pockets for all this shit!
    And besides, since we’re going to get shot ANYWAY, why bother carrying the gun in the first place?

  8. James(Califwin) permalink

    Very Complete information. If in California, Texas, Arizona, N.Mexico PAY ATTENTION to this GM MOSBY message.
    We are OVER FLOWING with Diseases & Shit. And it’s coming to You thanks to UN, Congress(Pelosi& Schiff & Rhinos)Narco Politicians , Calif. Gov. Newsom, Sanctuary States and Democrats. Wounded Tattooed strangers LEAVE FOR PROFESSIONALS. Anyone south of Border or Homeless Street People maybe Diseased. Medicine and Drugs is my daily profession . Carry gloves, N95 mask, Q-Clot, TQ, Chest Seals , Israeli wound gauze in pockets or Red Grab Bag in Jeep/Truck(14 G Needle for pneumothorax if 30 miles from ER DEPT.) some ERs are shit.

  9. Mike Pesta permalink

    MG, this is one of my favorite subjects. I am a EMT in a rural area. So I have treated gsw’s and gruesome farm injuries. When I advise people who have permits to carry to carry medical kit. I usually get the blank look. And then “well, I do not plan on getting shot”. I follow up with that neither is the other guy. And it will be a two way gun range. Mike.

Trackbacks & Pingbacks

  1. John Mosby: Tourniquets, Chest Seals, and Pressure Dressings – Lower Valley Assembly
  2. dustbury.com » Stanch that flow

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