Tourniquet use and which one to buy?

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Tourniquet use and which one to buy?

Postby Moondog55 » Fri 04 Jun, 2021 6:13 pm

It's been a decade since I last requalified and many things have changed since I last did an advanced first aid class.
I am in the process of repacking my first aid kit ready for ski touring.
Catastrophic amputation isn't of concern to me but deep puncture wounds into the femoral artery are.
My old 40mm wide constrictive bandage has perished and I'd like some expert help on a possible replacement and what size to buy and from where.
Already have stocks of other stuff for bandages etc; this is the main area where my kit is now deficient
I am considering investing in both an Israeli bandage and possibly a RATS or something similar'
Still have an army FFD too.
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Re: Tourniquet use and which one to buy?

Postby Tortoise » Fri 04 Jun, 2021 8:13 pm

Moondog55 wrote:Catastrophic amputation isn't of concern to me but deep puncture wounds into the femoral artery are.
Just out of curiosity, what might you use to puncture your femoral artery with, Moondog?
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Re: Tourniquet use and which one to buy?

Postby wildwanderer » Fri 04 Jun, 2021 8:25 pm

It's not something I've considered or planned for so if I thought I needed to use a tourniquet I'd just improvise I think with something like a shoelace or rope.

However Id be reluctant to use a tourniquet in the bush (or anywhere) unless was told to do so by expert medical advice. In the case of a gushing wound.. applying pressure would be my first go to treatment.

I have heard that the femoral artery has a tendency to retreat up into the leg which makes stopping the flow extremely difficult without surgical intervention. I'm not sure if that is accurate or not..

(Tortoise maybe falling and impalling on a sharp broken branch could cause such a puncture.. just speculating.)
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Re: Tourniquet use and which one to buy?

Postby Moondog55 » Fri 04 Jun, 2021 10:23 pm

Tortoise wrote:
Moondog55 wrote:Catastrophic amputation isn't of concern to me but deep puncture wounds into the femoral artery are.
Just out of curiosity, what might you use to puncture your femoral artery with, Moondog?


Either an ice axe or a ski pole.
I witnessed a rather unusual accident my first year at Mt Buller when a persons ski pole punctured a thigh and broke off, an open conduit for arterial blood and there was lots of it. I never found out if the prompt action of the ski patrol and the use of a constrictive bandage worked well enough to save her.
Ski patrol don't talk about work much and I did ask them in the bar later that week
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Re: Tourniquet use and which one to buy?

Postby ILUVSWTAS » Sat 05 Jun, 2021 4:49 am

Tortoise wrote:
Moondog55 wrote:Catastrophic amputation isn't of concern to me but deep puncture wounds into the femoral artery are.
Just out of curiosity, what might you use to puncture your femoral artery with, Moondog?



During a remote area first aid course we watched a video where a mountain biker had the bar pierce his leg. They saved him by applying pressure until the medivac. He nearly bled out. It's not an uncommon injury within mountain biking.

I came close to bleeding out last year. A tournie saved my life.
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Re: Tourniquet use and which one to buy?

Postby Mechanic-AL » Sat 05 Jun, 2021 9:40 am

Completed a first aid certificate refresher course 2 weeks ago. A few things have changed since I last did this.
One of them being that the use of tourniquets is no longer recommended. The only exception being in the case of total amputation. A pressure bandage is the preferred treatment for all other injuries until professional help arrives.

No harm in carrying one I guess but I would hope your skiing isnt so bad that you risk losing a limb !!
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Re: Tourniquet use and which one to buy?

Postby Moondog55 » Sat 05 Jun, 2021 9:59 am

I have contact with some people in the USA where every person in combat carries a tourniquet and an Israeli bandage on their person and I hunt with large calibre so while unlikely a bullet wound is also possible.
In the US at least the use of tourniquets is now standard practice it seems.
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Re: Tourniquet use and which one to buy?

Postby ChrisJHC » Sat 05 Jun, 2021 10:12 am

They teach the use of a tourniquet on marine first aid courses. These are for when you are likely to be hours or days from help.

As previously mentioned, only for catastrophic limb injuries (eg shark attack, getting your arm caught in the Diesel engine) where pressure doesn’t stop the bleeding.

The reality is that, when you are forced to use a tourniquet, you are choosing to sacrifice the limb in order to save the life.

As I’m not an expert, I won’t give any details, but I’m sure there will be plenty on line.
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Re: Tourniquet use and which one to buy?

Postby Biggles » Sat 05 Jun, 2021 10:29 am

An arterial bleed is not going to give you much time to fossick through your pack for the tourniquet before you go into shock. By that time, if you are alone and unassisted, things will not be looking good at all.

Seek professional training for using a tourniquet (e.g. advanced first aid/emergency medicine) and particularly, the specific compression treatment for serious injuries like arterial punctures which, in and of themselves, are an emergency situation. You simply won't have the time to do things yourself! Elevation and localised compression are standard and seek help. I have never seen a tourniquet used to subdue an arterial bleed; it would actually dramatically worsen the situation (vascular surgery is very different and an entirely specialised area altogether).
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Re: Tourniquet use and which one to buy?

Postby slparker » Mon 07 Jun, 2021 8:36 am

If you think you need a tourniquet as part of your risk assessment then the one to get would be a CAT, or whatever derivation that the army now uses.

But do you need to carry a tourniquet? Most bleeding can be stopped with the application of direct pressure on the wound and indirect pressure on the artery above the wound (pulse point).

The advantages of a CAT tourniquet are that they can stop all bleeding below the point of application (if they are applied correctly), can be self- fitted in a hurry (useful if alone or you are being shot at and your mates can't help you) and is easier to stop bleeding in a complicated injury (such as an open fracture). The disadvantages are that carrying one doesn't replace first aid know how, they can be applied for too long and they can be applied incorrectly. As Biggles points out, if you really need one, and you're alone, it has to be literally at arms reach or chances are you'll bleed out before you get it from your pack. I mean are you really going to take both hands off that fountain of blood in your thigh to take off your pack and rummage around for your CAT?

The CAT works very well but, in saying that, it is also possible to improvise a tourniquet from a triangular bandage (or any wide piece of cloth) and a tent peg for a windlass.

For bushwalking the requirement to use one would be very small and in my opinion it is an example of packing your fears. But, if you're doing, say, some walking to a climb with roping, or you are the first-aider for a party, or you are prone to puncturing your femoral artery with spiky things, then the risk assessment changes. If you are going to carry one I recommend doing a first aid course that shows you to when, and when not, to use one as well as the 'how'.

@ Moondog - I recommend still carrying the army FFD that you already have or its modern equivalent the israeli bandage. The army first aid dressing is essentially a big combine dressing that works well to control bleeding with the application of sufficient pressure. Unfortunately, they come with an ineffective gauze bandage meant to secure the dressing. Medics, when the army used to use them, tore off the crappy gauze bandage straight away and would secure it immediately with a separate 10cm elastic bandage. The Israeli bandage comes with the elastic roller bandage attached (and a tensioning/securing clip) already - so is a better option if you can get one. FWIW I take a couple of combines and a 10cm elastic roller bandage in my FAK, as the roller bandage also doubles as a snake bite bandage - the key to bushwalking FAKs, IMO, is versatility. I don't take a CAT bandage bushwalking but I do now have one in my car.

Israeli bandage - https://www.thefirstaidshopau.com.au/product/military-trauma-hemorrhage-control-dressing-green/?attribute_size=10cm+x+17cm+(4%22)&utm_source=Google%20Shopping&utm_campaign=FAS%20Feed&utm_medium=cpc&utm_term=3371&gclid=Cj0KCQjw5PGFBhC2ARIsAIFIMNfs7vRfuFXj_VLDbR-4_CwF664FUXGzJTTzu-pi4hFAEcha5g8WyfQaAtelEALw_wcB

CAT - https://www.thefirstaidshopau.com.au/product/cat-tourniquet/
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Re: Tourniquet use and which one to buy?

Postby Moondog55 » Mon 07 Jun, 2021 9:43 am

Way back when I last updated my qualification it was the wide elastic "constrictive bandage " we were taught to use, no windlass on those. But after 10+ years the rubber has perished. Israeli bandages aren't much dearer than a combine dressing and an elastic roller.
I do a lot of my ski touring with sharp spiky things on my back and a deep penetrating wound is always in the back of my mind as a possibility
My remote area car kit even has a collar in it, although my training to use it was long ago; a mate broke his neck in a car crash driving down from Mt Buller years back and the only reason he can walk now is that the car behind him had 2 surgeons in it and they carried collars in their own car kit; I bought the collar that week and updated my training ASAP. Long long time ago tho
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Re: Tourniquet use and which one to buy?

Postby Hiking Exped » Thu 14 Oct, 2021 9:28 am

Good important subject this

I train people going into hostile environments for my work and whilst qualified first aid is not an assessment component we do talk about medical kits and combat type first aid. Tourniquets are still on the first aid agenda, but as a last resort. We strongly push quick clot though. If a compression bandage or FFD alone is not doing it then adding some quick clot gel in most instances does.

I carry sachets in my med kit when overseas with work or hiking back here. We use the CAT G7 tourniquets so I carry one of those too. These are faster and easier to apply than some others, important factor when panic can set in.

Not sure if that helps at all. Good subject though. Nothing better than people that plan for the worst like me.
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Re: Tourniquet use and which one to buy?

Postby bluewombat » Sat 16 Oct, 2021 9:54 am

If you are dealing with a true femoral artery injury in the thigh it is unlikely that a tourniquet or pressure bandage will assist greatly as the artery lies deep (which is a good thing, as it means it is less likely to be injured)
The 'hips and bits' technique https://www.abc.net.au/news/2021-09-24/anu-shark-bite-new-life-saving-technique-fist-in-groin-area/100488934 would be of value if you were with someone but would be very difficult to apply to yourself for any length of time
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Re: Tourniquet use and which one to buy?

Postby Gadgetgeek » Fri 05 Nov, 2021 7:22 pm

The latest iteration of the Survival brand snakebite bandage are pretty good. Bigger and longer than their previous version.
As far as tourniquets themselves, there is still a lot of conflicting info. A couple decades of GWOT taught us that most of what was taught about TKs in the 90s was false, but also in response to that, some trainers don't want people to think that they are a solution for everything everywhere at any time, and most first aid courses are not long enough to have coverage on it. A buddy of mine did a one day "stop the bleed" course which is marketed to forestry workers and similar industries, and he found that it mixed well with his wilderness first aid, and complimented it, but they also explained why you wouldn't do some things if the ambulance was 20 min away.

If you get a tourniquet, the main thing is to get one from a reputable source. There are fakes out there that will fail, are not even safe for training, and generally all round, bad.
Also, if nothing else, my refreshers have taught me that you need to get refreshers. Nothing quite like being in a class with people you trained with before and watch the instructor go "who the hell taught you that??!!!?"
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Re: Tourniquet use and which one to buy?

Postby Hiking Exped » Sat 06 Nov, 2021 5:56 am

Very good advice about refreshers too! So important. Things change and we forget small things. The circumstances surrounding the injury, the environment, resources, aid on its way, time, distance, the patient, your medical expertise and training all impact if and when to use one.

I’m involved in lots of scenario training with all sorts of people and refreshers are crucial. In real life scenarios people often just go to bits, so the training has to actually be absorbed and tested.

Good topic this.
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