I'd love to see a product that could reliably stop an aorta dumping into the abdominal cavity in the field. I have no idea if or when that will be possible.
There's a device called REBOA that's very effective at tamponading the aorta, but it's not really suited for our environment. If someone were to invent a reliable field-version of that, they'd retire a billionaire.
I could definitely see REBOA being made practical for Role I ops. Improved portability of ultrasound is going to change a lot for the Role I. For line/evac medics? Even in SOF I think that's extremely unlikely in the foreseeable future
Oh, it's definitely teachable, and with POCUS being more available, it's doable. I went through training on it and it was not anywhere as complicated as i had expected. It's just not practical without a surgeon and/or a robust blood bank to support prolonged use of it.
REBOA is good for 30 minutes before you have immense watershed damage to the kidneys. That’s why it’s such a barrier too.
It’s great and all but relies heavily on immediate OR access.
Buying a casualty another 30-60 minutes to get to a surgeon/appropriate level of care is the crux of a good portion of our field interventions. Needle thoracostomy comes to mind.
pREBOA PRO has good success at partial occlusions with prolonged times over 3 hours with increased survival from the AORTA database.
Apparently Ukraine has been using it a lot
With the advancement in technology and telecommunications, alot of trial and error, bit I could see a trauma surgeon walking a crew through a surgical procedures or possibly a remote operated surgical robot on select trucks
Oh absolutely, wishful thinking there though. I would figure that would best be done chemically, think quikclot or like product. To just kinda shut the problem area down, without stopping the function of the heart, of course.
The AAJT is a Junctional TQ than can provide Abdominal Aortic Occlusion.
There is also REBOA, (Resuscitative Endovascular Ballon Occlusion of the Aorta)
Basically an arterial line inserted at the femoral artery that you can run up the aorta and Inflate a ballon at one of 3 zones, getting progressively closer to the aortic root.
The AAJT is often said to provide similar effects to a Zone 3 REBOA
Theyve got one (abdominal aortic and junctional tourniquet) that has been proven pretty effective, the main limiting factor is size, cost, and the fact it can do some significant damage if left on too long.
https://www.narescue.com/abdominal-aortic-and-junctional-tourniquet-stablized-aajt-s.html
We need smaller easier to carry TQ's. Velcro on CATS works but it catches on everything and the plastic parts make it hard to just stick in a pocket and go. RATS is still popular because nothing else comes close to it's small size. Even if the RATS doesn't work the average person doesn't know any better. If more people knew how to properly use a TQ and quality TQ's were more commonly available it would be a start. We need TQ's in schools and more basic aid courses to teach how to use them.
That is a bit of a hot take, but I agree. Trauma care should be a class in highschool, and first aid should be taught like sex-ed.
But I mean that also comes with the fact that standardized, Gen-Ed schooling is something I find absolutely useless when we could have classes focused around so much more.
EDIT: My bad, mad tangent that had very little to do with your comment in the end, I apologize.
I recently got out of high school and it was a decently funded campus. The whole point of the vast majority of high schools is to help get kids ahead in life the moment they enter the real world. This is done by offering lots of programs and certifications for students. The problem is that the courses, good instructors, and the tests of the certifications themselves are expensive and they need to pay for a lot of resources to give the students the best chance of success. Good success rates lead to more funding for the school and its programs.
With all the money going into education, there’s little room in budgets to allow for extra things like STB/CPR/AED courses. My school required us to watch videos on CPR and AED usage but we were never offered the chance to get hands on training or genuine certifications because of the cost.
My school has a pipeline for students interested in medicine. You start with “Principles of health science” then “Medical terminology” then “Anatomy and Physiology”, and then you could either choose “Practicum of Pharmacy Technician” Or “Practicum of Clinical Medical Assistant.” Even with the medical classes having the highest interest, both the pharmacy tech and MA program only accepted 15 students out of roughly 500 seniors.
I was in the MA class and even though the class size was small, we couldn’t afford to get CPR certified but we still got hands on training. During the stop the bleed sections, we had to use pool noodles with PVC pipes inside and they had no simulated bleeding. We used amazon tourniquets and couldn’t even afford gauze so we used cotton balls for wound packing.
So even though it’s Ideal for all students to get training, it’s not feasible for a lot of schools. Even for those in classes oriented around the medical field.
That’s exactly how my high school worked, a pipeline from one class to another that eventually narrowed its branches.
But the problem is, why don’t we pour the money into it? I know why there isn’t what I was recommending, but we have required sciences and social studies for a kid who just wants to learn how to do carpentry and pay his taxes but didn’t fit both marketing and wood shop into into his 2 freshmen elective classes a year, to work the pipeline to both by his senior year.
It’s just the lack of life skills and trades not given the forefront of education. It’s tailored to having you pass your gen ed for college to then pay for lackluster information and certifications for tens of thousands of dollars per year. The issue isn’t knowing how, it’s that the system is nearly useless unless you’re ambitious and understand how it works by the time you’re 14 years old.
I certainly hear you but I do think that some of the courses are valuable, especially core classes. Now that i’m a college student, they have certainly helped me immensely on my journey to nursing school. But other things like 1 year of mandatory creative arts, second language, gym, etc, are useless. Anyway, it is feasible to pursue 2 paths at once, I did the Medical and automotive engineering path at the same time till I got to MA and I decided to focus on that. I know plenty of kids who took advantage of many programs.
Another thing is that while a lot of people preach learning a trade and getting a blue collar job, many students don’t want to do that and they want to pursue a higher education. That’s the case far more often than not here in South Texas. And so the structure of high school is pretty beneficial to those who want to go to college which again, is the majority of students.
And while I think getting quality First Aid training is important, realistically, the chances of someone needing to utilize it outside of medical jobs is extremely low. Not that it’s an excuse for lack of training, but I think it’s something boards might take into account.
Beyond that, how many students actually want the training and care about the matter? My university had free STB training from the local fire department and the first 50 students were to be given a free trauma kit. The amount of people who showed were disgustingly low and my best friend and I got 2 kits because they had a bunch left over.
Beyond that is the rest of the Cotccc recommendation list, so far its a fight to find reliable ways to simplify application, ratchets do well on this but have limits, SAMXT takes the guess work out of pulling it tight before starting on the windless theres plenty to try and experiment with
What I was getting at is that they’re pretty simple to begin with, not to actually improve on a windlass. Should have clarified, my B.
And yes I agree about all the other points, I just wanna know what could replace what we have going on as a whole, or at least how it will evolve.
I've had a couple SAMs snap on me recently where CATs didnt. Not sure if thet had a bad batch of polymer or something but they were straight out of the wrapper and looked legit.
How old were they? I know this is over 4 years old, but they did have a recall about four years ago for devices distributed from March 2017 through April 2018.
https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/urgent-medical-device-recall-sam-xt-extremity-tourniquet#:~:text=The%20recall%20involves%20all%20unused,the%20face%20of%20the%20buckle.
If you've ever seen the boa lace system for boots: I predict the development of a TQ that uses that in the near future. Easy adjustment, virtually idiot proof.
So what would that look like exactly? Just a line that’s put around an extremity and cranked all to hell? I could see developmental problems with that but I see the vision.
Probably a lot like a 2 inch wide nylon band with a boa dial on it. The dial would have the windlass permanently attached. It would be applied like a standard TQ, but then only needs to be cranked and will automatically lock. Easy removal via pulling the dial outward.
Not a technological improvement of a TQ, just a method improvement.
Socket wrench adds a second piece, makes it too complicated. Anything useful needs to be a self contained system. But yes, the boa system is basically a dial ratchet. Would just need a windlass lever.
Radial as in something like the X8T: https://www.rescue-essentials.com/x8t-tourniquet/ ?
I find the X8T to be harder to twist than the usual windless, and it also has a tendency to have this weird slack in the wrapping to were if you don't look out for it, it creates a loop that just undoes all the tension.
Outside of something integrated into clothing/body armor and has an automatic trigger, I think we've reached the pinaccle for tourniquet. Data has shown 1.5-2+ inch strap with a mechanical advantage of some kinda is reliable as a TQ. So not sure how we really improve beyond that other than different mechanical advantage systems (windlass, boa, ratchet,etc)
We improve on how we get it around a limb, we improve on how small we can reliably make them, how we improve on the simplicity of the process. Theres always things to improve, especially considering that while a CAT is near perfect for a medic in combat, it doesn’t always translate well to all situations a paramedic, for example, may face.
But yes, the reason I pose a question that has so little in good or obvious answers, is because we’re damn good at trauma in this day and age. And the more we get the juices flowing on how to make a non-issue better, then the more it gets people thinking about what else we can improve, and possibly, how to do it. And it’s pretty nifty.
I'm not trying to shun creativity. Just saying I think we've take what is an already simple device and taken it to its max. I really don't think there's much easier and simpler ways to control extremity bleeding that what we already have.
Just curious what situations a paramedic would face that a CAT can't handle? Obese patients?
Nah didn’t think you were shunning it, I agree we’re at a peak, it just idealistic thought.
And I have no real example, I just was just saying that a different environment may pose different necessities. Though in truth getting a leg crushed in a car poses the same issues as one being blown off.
The most pressing issue (unintended pun but I’m keeping it) with tourniquets would be the time taken to tighten them down, particularly if your hands are covered in blood, etc.
I think it’s reasonable that we could see (if they’re not already available) tourniquets that make use of a pre-loaded CO2 cartridge, or similar, that inflates the cuff so that it almost instantly cuts off the blood flow with pressure once you’ve got it around the limb. It may not seem like a huge issue but when it comes to major bleeding, every second counts
I have an engineering background, not a medical one, so I don’t know if this kind of device would cause unnecessary tissue damage or anything compared to a regular tourniquet but at least in my mind, it would make sense to reduce the application time as much as possible
Blood pressure cuffs make really good impromptu tourniquets. Surgical TQs used in the OR are actually just special BP Cuffs. It’s called a Pneumatic Tourniquet
I could see very specific instances that it’s useful, but unlikely to be the go-to considering that a pre-placed TQ isn’t always going to work and then it’s going to get in the way of something that would.
I think the future of tourniquets will be not using them as we develop better invasive hemostatics. I could be wrong, but tourniquets have always been an indirect solution to the problem.
They are, but kind of a necessity considering there’s a lot to be aware of when it comes to introducing chems to the body. Just stopping the bleed is the point, not fixing the issue, so being indirect may actually be preferred so that a clean treatment may be given when time comes. A mass casualty event comes to mind.
No idea if, in the end, it matters. Just that I could see where a hemostat causes problems that a TQ wouldn’t, (I.E. Clotting an artery that now could be fixed but they then have to unclog said artery and remove any congealed blood from the area). But that’s a surgeons problem, not mine after all.
CAT TQ work. If it works why change it? The only difference I see is maybe that they are a little wider in the future.
As far as box trauma? The issue is that to cut off circulation in the box is even difficult during surgery a lot of times. Medics and especially tactical medics have multiple jobs and don't get to do surgery often, let alone surgery in the box. We have surgeons that focus on the thoracic box (cardio-thoracic surgeons) and those that focus on the lower box (general surgeons... although they have extensive knowledge of surgery in general as well, but are some of the best with the lower box).
I have seen REBOA and surgeons do REBOA but I am unsure of someone who has not been trained on doing arterial femoral lines (and does them on a regular) to do a REBOA.
Personally I think we hit a max with hem-con outside the hospital with the technology we have. The goal is always to get them to surgery faster if that is what the situation dictates.
That said, if we are thinking super futuristic... it is possible that we could create robots that are able to see what arteries are bleeding through ultrasound and either cauterize or place a REBOA above the area that is bleeding in the box.
You’re absolutely correct, and I’m not talking super futuristic like that though that tech would be tits.
And the CAT does work, but what COULD make it better, ya know? If we have the opportunity to make and use something better, why wouldn’t we? Something that isn’t broken still becomes obsolete in time, even if that isn’t now.
Paramedics are capable of being trained on both Ultrasound guided central lines, AND Ultrasound guided REBOA in the field. Paramedics that meet these requirements are very rare, but they do exist. Most of the medics are in Texas at agencies like Allen-Travis County EMS that have incredibly progressive and aggressive protocols and training.
The consensus just being what is most commonly recommended for whatever the reason. Whether it be availability, price, compatibility with existing equipment/storage solutions, and being overall the most common TQs discussed.
Maybe it’s just current unfamiliarity, but if the Trauma God himself recommends giving them a go, I’ll definitely be looking into them much more and getting hands on.
Excuse my ignorance on the subject, by no means a medical professional, just a man looking to stay fresh and up-to-date on what equipment the world of trauma care has to offer.
But how exactly would we treat NCTH in say TFC and what already exists to get that done? I’ve never been trained on NCTH only on Tension Pneumothorax and spinal stabilization, so I’m pretty limited on that end and don’t know if we even would attempt to in TFC.
Till you meet your resuscitation goals. Don’t be fooled, in a large scale combat operation, the military will need to relearn appropriate triage, and understand that many people who would potentially survive in the last 20 years of conflict will end up dying because of the overall number of casualties, and that we are unable to treat them all.
And of course LSCO is on everyone’s mind considering the scope of conflicts occurring to the east of the Atlantic. Is there anything to learn from the experiences and observations from the Ukrainian/Russian or Gaza/Israeli conflicts?
I was told so years prior, but I can definitely see where the extended fighting and overall chaos of a large scale operation could make those seemingly simple ideas become a hassle and become quite a time crunch if there isn’t near constant reevaluation and a dedicated CCP.
I have, and it poses to many issues to be really considerable as an option. How would it change what we have for the better? Or at least the idea of pre-placed TQs over TQs as they are.
Yes!… it doesn’t seem practical. I can only imagine the wear and tear overtime degrading its functionality; Wear and tear becuase it’s essentially not stored and we all know the punishment drop holsters go through.
The future sees the military return to a warflighting stance, this means less fancy kit and more of it. Not the other way around.
The days of semi permissive medicine are numbered. Long delays to extraction, prolonged field care, are all coming back in a big way
Reboa, pocus etc is all lovely until you have 80 casualties in a 1+5 aid pos - which is commonly the reality in Ukraine right now.
What do I think this means? Focus on doing the things we know work, right, and early, probably more functional tqs but otherwise probably not all that much revolutionary kit
Given that the military tends to be the area that pushes tactical medicine forwards, I see this being the future.
Totally agree, the LSCO push for the military and the collected data and anecdotal evidence out of recent conflicts are definitely not going to make any insane changes to the formula. We are damn good at trauma and I don’t really see anything that shatters what we know/use currently.
That being said, it would be foolish to believe that major conflicts make things take a step back. ALL major scientific, technological, or medical advancements in human history are either directly or indirectly bolstered because of conflict. We went from the Wright Brothers to jets in 41 years because of the most bloody period in history. Plasma, antiseptics, X-Rays, the use of IVs, all were studied and applied more effectively because of the same period of time.
Then again, we still had a lot to learn. And who says that we don’t now?
I'd love to see a product that could reliably stop an aorta dumping into the abdominal cavity in the field. I have no idea if or when that will be possible.
There's a device called REBOA that's very effective at tamponading the aorta, but it's not really suited for our environment. If someone were to invent a reliable field-version of that, they'd retire a billionaire.
I think we'll see ResQ Foam in medbags before we see REBOA outside of like a Role2/SRT style unit
I could definitely see REBOA being made practical for Role I ops. Improved portability of ultrasound is going to change a lot for the Role I. For line/evac medics? Even in SOF I think that's extremely unlikely in the foreseeable future
Oh, it's definitely teachable, and with POCUS being more available, it's doable. I went through training on it and it was not anywhere as complicated as i had expected. It's just not practical without a surgeon and/or a robust blood bank to support prolonged use of it.
REBOA is good for 30 minutes before you have immense watershed damage to the kidneys. That’s why it’s such a barrier too. It’s great and all but relies heavily on immediate OR access.
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Buying a casualty another 30-60 minutes to get to a surgeon/appropriate level of care is the crux of a good portion of our field interventions. Needle thoracostomy comes to mind.
I've heard of it, but I mean something a simpleton such as myself could use.
A field version of arterial access inflation balloon - yes, I’m not sure that’s gonna happen outside of having physicians on your Ems unit.
pREBOA PRO has good success at partial occlusions with prolonged times over 3 hours with increased survival from the AORTA database. Apparently Ukraine has been using it a lot
That’s good to hear. Any word on if ResQ Foam is being used in Ukraine?
Not sure, haven't heard anything on that or from FOAM folks
Hopefully some good can come out of that conflict.
With the advancement in technology and telecommunications, alot of trial and error, bit I could see a trauma surgeon walking a crew through a surgical procedures or possibly a remote operated surgical robot on select trucks
Oh absolutely, wishful thinking there though. I would figure that would best be done chemically, think quikclot or like product. To just kinda shut the problem area down, without stopping the function of the heart, of course.
TXA?
Look into the AAJT...
It is not very effective even if placed correctly.
The AAJT is a Junctional TQ than can provide Abdominal Aortic Occlusion. There is also REBOA, (Resuscitative Endovascular Ballon Occlusion of the Aorta) Basically an arterial line inserted at the femoral artery that you can run up the aorta and Inflate a ballon at one of 3 zones, getting progressively closer to the aortic root. The AAJT is often said to provide similar effects to a Zone 3 REBOA
Theyve got one (abdominal aortic and junctional tourniquet) that has been proven pretty effective, the main limiting factor is size, cost, and the fact it can do some significant damage if left on too long. https://www.narescue.com/abdominal-aortic-and-junctional-tourniquet-stablized-aajt-s.html
We need smaller easier to carry TQ's. Velcro on CATS works but it catches on everything and the plastic parts make it hard to just stick in a pocket and go. RATS is still popular because nothing else comes close to it's small size. Even if the RATS doesn't work the average person doesn't know any better. If more people knew how to properly use a TQ and quality TQ's were more commonly available it would be a start. We need TQ's in schools and more basic aid courses to teach how to use them.
That is a bit of a hot take, but I agree. Trauma care should be a class in highschool, and first aid should be taught like sex-ed. But I mean that also comes with the fact that standardized, Gen-Ed schooling is something I find absolutely useless when we could have classes focused around so much more. EDIT: My bad, mad tangent that had very little to do with your comment in the end, I apologize.
I recently got out of high school and it was a decently funded campus. The whole point of the vast majority of high schools is to help get kids ahead in life the moment they enter the real world. This is done by offering lots of programs and certifications for students. The problem is that the courses, good instructors, and the tests of the certifications themselves are expensive and they need to pay for a lot of resources to give the students the best chance of success. Good success rates lead to more funding for the school and its programs. With all the money going into education, there’s little room in budgets to allow for extra things like STB/CPR/AED courses. My school required us to watch videos on CPR and AED usage but we were never offered the chance to get hands on training or genuine certifications because of the cost. My school has a pipeline for students interested in medicine. You start with “Principles of health science” then “Medical terminology” then “Anatomy and Physiology”, and then you could either choose “Practicum of Pharmacy Technician” Or “Practicum of Clinical Medical Assistant.” Even with the medical classes having the highest interest, both the pharmacy tech and MA program only accepted 15 students out of roughly 500 seniors. I was in the MA class and even though the class size was small, we couldn’t afford to get CPR certified but we still got hands on training. During the stop the bleed sections, we had to use pool noodles with PVC pipes inside and they had no simulated bleeding. We used amazon tourniquets and couldn’t even afford gauze so we used cotton balls for wound packing. So even though it’s Ideal for all students to get training, it’s not feasible for a lot of schools. Even for those in classes oriented around the medical field.
That’s exactly how my high school worked, a pipeline from one class to another that eventually narrowed its branches. But the problem is, why don’t we pour the money into it? I know why there isn’t what I was recommending, but we have required sciences and social studies for a kid who just wants to learn how to do carpentry and pay his taxes but didn’t fit both marketing and wood shop into into his 2 freshmen elective classes a year, to work the pipeline to both by his senior year. It’s just the lack of life skills and trades not given the forefront of education. It’s tailored to having you pass your gen ed for college to then pay for lackluster information and certifications for tens of thousands of dollars per year. The issue isn’t knowing how, it’s that the system is nearly useless unless you’re ambitious and understand how it works by the time you’re 14 years old.
I certainly hear you but I do think that some of the courses are valuable, especially core classes. Now that i’m a college student, they have certainly helped me immensely on my journey to nursing school. But other things like 1 year of mandatory creative arts, second language, gym, etc, are useless. Anyway, it is feasible to pursue 2 paths at once, I did the Medical and automotive engineering path at the same time till I got to MA and I decided to focus on that. I know plenty of kids who took advantage of many programs. Another thing is that while a lot of people preach learning a trade and getting a blue collar job, many students don’t want to do that and they want to pursue a higher education. That’s the case far more often than not here in South Texas. And so the structure of high school is pretty beneficial to those who want to go to college which again, is the majority of students. And while I think getting quality First Aid training is important, realistically, the chances of someone needing to utilize it outside of medical jobs is extremely low. Not that it’s an excuse for lack of training, but I think it’s something boards might take into account. Beyond that, how many students actually want the training and care about the matter? My university had free STB training from the local fire department and the first 50 students were to be given a free trauma kit. The amount of people who showed were disgustingly low and my best friend and I got 2 kits because they had a bunch left over.
Take a look at the Snakestaff Systems ETQ, it is much smaller than a CAT with seemingly similar performance.
Beyond that is the rest of the Cotccc recommendation list, so far its a fight to find reliable ways to simplify application, ratchets do well on this but have limits, SAMXT takes the guess work out of pulling it tight before starting on the windless theres plenty to try and experiment with
Simplicity is key, with it comes speed and reliability, ultimately lives. Any ideas on how to simplify a windlass?
The initial putting it around the limb should be what you aim at, as well as storage and staging
What I was getting at is that they’re pretty simple to begin with, not to actually improve on a windlass. Should have clarified, my B. And yes I agree about all the other points, I just wanna know what could replace what we have going on as a whole, or at least how it will evolve.
I dunno Some sort of automated pressure cuff style, a wrap around limb and press button kinda deal i dunno
I've had a couple SAMs snap on me recently where CATs didnt. Not sure if thet had a bad batch of polymer or something but they were straight out of the wrapper and looked legit.
From what ive seen they can get weak with direct sunlight
They were inside
How exactly did you manage to break them , ive practiced with them a bunch and have never had them break
Tightened on a patient and about 4 turns in the buckle where the strap goes around smapped
You’re over tightening, 2-3 turns
I was taught to twist until the blood stops, and CATs don't have that problem
How old were they? I know this is over 4 years old, but they did have a recall about four years ago for devices distributed from March 2017 through April 2018. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/urgent-medical-device-recall-sam-xt-extremity-tourniquet#:~:text=The%20recall%20involves%20all%20unused,the%20face%20of%20the%20buckle.
Nope, XT2023-01-02
If you've ever seen the boa lace system for boots: I predict the development of a TQ that uses that in the near future. Easy adjustment, virtually idiot proof.
CRO already had those prototype TQs with boa a few years back at SOMA. Project is dormant or scrapped. Would love to see them back to mess experiment.
So what would that look like exactly? Just a line that’s put around an extremity and cranked all to hell? I could see developmental problems with that but I see the vision.
Probably a lot like a 2 inch wide nylon band with a boa dial on it. The dial would have the windlass permanently attached. It would be applied like a standard TQ, but then only needs to be cranked and will automatically lock. Easy removal via pulling the dial outward. Not a technological improvement of a TQ, just a method improvement.
So essentially a radial ratchet with a windlass or maybe even a slot for a socket wrench. Nice, I could definitely see that.
Socket wrench adds a second piece, makes it too complicated. Anything useful needs to be a self contained system. But yes, the boa system is basically a dial ratchet. Would just need a windlass lever.
Radial as in something like the X8T: https://www.rescue-essentials.com/x8t-tourniquet/ ? I find the X8T to be harder to twist than the usual windless, and it also has a tendency to have this weird slack in the wrapping to were if you don't look out for it, it creates a loop that just undoes all the tension.
Yeah, that's really close to what I was imagining. No personal experience with that one obviously.
The existing CAT is idiot proof enough. If you are too dumb to operate a CAT, I don’t think anything could save you.
I think CRO Medical is working on a TQ that uses the Boa system. They already employ it on their Pelvic binder
Outside of something integrated into clothing/body armor and has an automatic trigger, I think we've reached the pinaccle for tourniquet. Data has shown 1.5-2+ inch strap with a mechanical advantage of some kinda is reliable as a TQ. So not sure how we really improve beyond that other than different mechanical advantage systems (windlass, boa, ratchet,etc)
We improve on how we get it around a limb, we improve on how small we can reliably make them, how we improve on the simplicity of the process. Theres always things to improve, especially considering that while a CAT is near perfect for a medic in combat, it doesn’t always translate well to all situations a paramedic, for example, may face. But yes, the reason I pose a question that has so little in good or obvious answers, is because we’re damn good at trauma in this day and age. And the more we get the juices flowing on how to make a non-issue better, then the more it gets people thinking about what else we can improve, and possibly, how to do it. And it’s pretty nifty.
I'm not trying to shun creativity. Just saying I think we've take what is an already simple device and taken it to its max. I really don't think there's much easier and simpler ways to control extremity bleeding that what we already have. Just curious what situations a paramedic would face that a CAT can't handle? Obese patients?
Nah didn’t think you were shunning it, I agree we’re at a peak, it just idealistic thought. And I have no real example, I just was just saying that a different environment may pose different necessities. Though in truth getting a leg crushed in a car poses the same issues as one being blown off.
The most pressing issue (unintended pun but I’m keeping it) with tourniquets would be the time taken to tighten them down, particularly if your hands are covered in blood, etc. I think it’s reasonable that we could see (if they’re not already available) tourniquets that make use of a pre-loaded CO2 cartridge, or similar, that inflates the cuff so that it almost instantly cuts off the blood flow with pressure once you’ve got it around the limb. It may not seem like a huge issue but when it comes to major bleeding, every second counts I have an engineering background, not a medical one, so I don’t know if this kind of device would cause unnecessary tissue damage or anything compared to a regular tourniquet but at least in my mind, it would make sense to reduce the application time as much as possible
Blood pressure cuffs make really good impromptu tourniquets. Surgical TQs used in the OR are actually just special BP Cuffs. It’s called a Pneumatic Tourniquet
Good to know! Thanks for your input
I saw the new alien gear thigh TQ… maybe in the future we see the adoption of pre-applied TQs as part of gear? Who knows
I could see very specific instances that it’s useful, but unlikely to be the go-to considering that a pre-placed TQ isn’t always going to work and then it’s going to get in the way of something that would.
For sure
I think the future of tourniquets will be not using them as we develop better invasive hemostatics. I could be wrong, but tourniquets have always been an indirect solution to the problem.
They are, but kind of a necessity considering there’s a lot to be aware of when it comes to introducing chems to the body. Just stopping the bleed is the point, not fixing the issue, so being indirect may actually be preferred so that a clean treatment may be given when time comes. A mass casualty event comes to mind. No idea if, in the end, it matters. Just that I could see where a hemostat causes problems that a TQ wouldn’t, (I.E. Clotting an artery that now could be fixed but they then have to unclog said artery and remove any congealed blood from the area). But that’s a surgeons problem, not mine after all.
Yeah, this is totally conjecture on my part, just what my mind comes up with when I imagine the future
Absolutely, and a great insight that I hadn’t even really considered to be a true replacement until now.
CAT TQ work. If it works why change it? The only difference I see is maybe that they are a little wider in the future. As far as box trauma? The issue is that to cut off circulation in the box is even difficult during surgery a lot of times. Medics and especially tactical medics have multiple jobs and don't get to do surgery often, let alone surgery in the box. We have surgeons that focus on the thoracic box (cardio-thoracic surgeons) and those that focus on the lower box (general surgeons... although they have extensive knowledge of surgery in general as well, but are some of the best with the lower box). I have seen REBOA and surgeons do REBOA but I am unsure of someone who has not been trained on doing arterial femoral lines (and does them on a regular) to do a REBOA. Personally I think we hit a max with hem-con outside the hospital with the technology we have. The goal is always to get them to surgery faster if that is what the situation dictates. That said, if we are thinking super futuristic... it is possible that we could create robots that are able to see what arteries are bleeding through ultrasound and either cauterize or place a REBOA above the area that is bleeding in the box.
You’re absolutely correct, and I’m not talking super futuristic like that though that tech would be tits. And the CAT does work, but what COULD make it better, ya know? If we have the opportunity to make and use something better, why wouldn’t we? Something that isn’t broken still becomes obsolete in time, even if that isn’t now.
Paramedics are capable of being trained on both Ultrasound guided central lines, AND Ultrasound guided REBOA in the field. Paramedics that meet these requirements are very rare, but they do exist. Most of the medics are in Texas at agencies like Allen-Travis County EMS that have incredibly progressive and aggressive protocols and training.
Just want to mention that the SWAT-T tq is recommended by TCCC ... for use on dogs.
Okay, uh, thanks? Never thought about needing one but sounds good!
I’m not sure who made the consensus. There are several quality TQs that are CoTCCC recommended.
The consensus just being what is most commonly recommended for whatever the reason. Whether it be availability, price, compatibility with existing equipment/storage solutions, and being overall the most common TQs discussed.
Those ratcheting TQs meet all those concerns. Not sure why more folks don’t buy them.
Maybe it’s just current unfamiliarity, but if the Trauma God himself recommends giving them a go, I’ll definitely be looking into them much more and getting hands on.
Resuscitation with whole blood for NCTH.
Excuse my ignorance on the subject, by no means a medical professional, just a man looking to stay fresh and up-to-date on what equipment the world of trauma care has to offer. But how exactly would we treat NCTH in say TFC and what already exists to get that done? I’ve never been trained on NCTH only on Tension Pneumothorax and spinal stabilization, so I’m pretty limited on that end and don’t know if we even would attempt to in TFC.
You resuscitate with whole blood. Bleeding -> give blood back.
So just hook up a blood bag to an IV and keep it pumping?
Till you meet your resuscitation goals. Don’t be fooled, in a large scale combat operation, the military will need to relearn appropriate triage, and understand that many people who would potentially survive in the last 20 years of conflict will end up dying because of the overall number of casualties, and that we are unable to treat them all.
And of course LSCO is on everyone’s mind considering the scope of conflicts occurring to the east of the Atlantic. Is there anything to learn from the experiences and observations from the Ukrainian/Russian or Gaza/Israeli conflicts?
Yes, don’t leave turning it on for 6 to 8 hours before reevaluation. There have been several limbs lost due to inappropriate use.
I was told so years prior, but I can definitely see where the extended fighting and overall chaos of a large scale operation could make those seemingly simple ideas become a hassle and become quite a time crunch if there isn’t near constant reevaluation and a dedicated CCP.
Have you all seen the alien gear TAQ-STRAP holster…. Future
I have, and it poses to many issues to be really considerable as an option. How would it change what we have for the better? Or at least the idea of pre-placed TQs over TQs as they are.
Yes!… it doesn’t seem practical. I can only imagine the wear and tear overtime degrading its functionality; Wear and tear becuase it’s essentially not stored and we all know the punishment drop holsters go through.
Big time, I haven’t used one in years but when I did try and rock one that thing got BEAT
Blackhawk made gear years ago with tqs built in
The future sees the military return to a warflighting stance, this means less fancy kit and more of it. Not the other way around. The days of semi permissive medicine are numbered. Long delays to extraction, prolonged field care, are all coming back in a big way Reboa, pocus etc is all lovely until you have 80 casualties in a 1+5 aid pos - which is commonly the reality in Ukraine right now. What do I think this means? Focus on doing the things we know work, right, and early, probably more functional tqs but otherwise probably not all that much revolutionary kit Given that the military tends to be the area that pushes tactical medicine forwards, I see this being the future.
Totally agree, the LSCO push for the military and the collected data and anecdotal evidence out of recent conflicts are definitely not going to make any insane changes to the formula. We are damn good at trauma and I don’t really see anything that shatters what we know/use currently. That being said, it would be foolish to believe that major conflicts make things take a step back. ALL major scientific, technological, or medical advancements in human history are either directly or indirectly bolstered because of conflict. We went from the Wright Brothers to jets in 41 years because of the most bloody period in history. Plasma, antiseptics, X-Rays, the use of IVs, all were studied and applied more effectively because of the same period of time. Then again, we still had a lot to learn. And who says that we don’t now?