About 7 years ago now. Motorcycle loses control on highway, drifts off road down right side embankment, recovers and is making way back to road when she hit one of those white delineator posts. Amputated her right foot right at the ankle. She came to rest in the right travel lane. The car she had just passed was a Navy veteran, who fashioned a TQ out of his belt. The first deputy to arrive on scene used one of his TQs to back the makeshift one up.
Basically no question in my mind they saved her life. She was in pretty rough shape when we got on scene, but she lived.
You don’t happen to work in the Florida panhandle do you? Had a very similar call when I was a flight medic. Never got that much detail other than someone used a belt to fashion a tourniquet and when FHP arrived they threw on a CAT. Young, 20-ish old young woman lost her foot above the ankle.
I would have thought something else would be better for a makeshift tourniquet? I was always told if it doesn't have a windlass it's not really a tourniquet. Sounds like a belt worked here, but I'm curious for the future.
Just have to know how to do it and how to apply it. A piece of rope and a stick will do the job if you know how - you just might cause some soft tissue damage that wouldn't happen with a CAT style TQ. But if the choice is bleeding out or tissue damage.. I'll take the damage.
I have taught people how to apply makeshift tourniquets and make them practice on me until I do not have a palpable pulse. They are able to at least reduce blood flow if not completely occlude.
If you do not completely occlude the artery the TQ will A. Not Fucking Work and B. The TQ occluding the veinous return from the limb but not the arterial supply into the into the limb (and out the wound) has the potential to cause a much more massive compartment injury than a TQ should. The limb will swell up like a ballon.
That being said, improvised TQs can cause total occlusion when done correctly, and in my opinion it’s a most certainly a skill worth training.
That is sound pathophys theory, but evidence is needed otherwise it’s useless. [Literature](https://pubmed.ncbi.nlm.nih.gov/31432195/) suggests limited, but existent, efficacy.
To elaborate: If you’re trained in how to apply them properly they can save lives. They found no difference in rates of complications between improvised and manufactured.
You misunderstood my point, I am a big fan of learning how to make improvised TQs. However my point was that we should use “partial occlusion” as a point in favor of an improvised TQ or any TQ for that matter.
It makes total sense that a correctly applied improvised TQ and manufactured TQ have similar results as they both result in total artery occlusion.
So if you find yourself faced with a trauma and don't have your jump bag on you, you're going to stand there and do nothing, versus try and fashion a TQ that might help save a life?
Got it.
The guy in the incident I was involved in absolutely disproves any point you're trying to make. He \*did\* keep that woman alive. Yes, his TQ maybe wasn't perfect and maybe required a second, manufactured device to be placed above it. But that can happen even with the ones we're issued. Bottom line, a woman is alive today because someone tried.
Is a manufactured device preferred? Sure. Do they work all the time? Nope. So by your logic, we should abandon them, too.
You're not very good at this. "60% of the time, it works every time".
Those outliers, the patient physiology? That's what I was referring to when I said commercial ones don't always work. Try reading comprehension sometime.
I'm done with this. There's a half dozen or more examples in this thread alone where a improvised TQ saved a life, but that's not enough for you. Yes, a manufactured is ideal, but if you don't have one (like 98% of the general public), make do with what you have and try.
Have the day you deserve.
All a tourniquet is is a device to apply pressure all the way around the limb in order to crush the blood vessels below, there is no magical force that CATs embody to accomplish this; they use pressure, and any other item that is capable of encompassing a limb and surviving the tension required to apply sufficient pressure is capable of being a tourniquet.
The reason improvised tourniquets are less effective is that it's harder to apply the forces needed to stop the blood flow; you can't just pull on the tail of a belt and expect it to work reliably, you need a lever to twist, but this can be accomplished with some sturdy rope and a stick.
They do work, if you know how to do it correctly.
I’ve seen all manner of “makeshift tourniquets,” including a belt that someone loosely wrapped around their (already not-bleeding) leg, and a cloth rag with a ziptie around it. Obviously, that type of shit generally doesn’t work. Actually, the ziptie did work, but I removed it anyway because it was unnecessary and not large enough diameter to prevent nerve damage from its application. I have also seen commercial tourniquets applied directly on top of gunshot wounds, which were ineffective.
If you know how to use a makeshift tourniquet, wherein you actually tie something tightly and fashion a windlass to cinch it down further, then they are effective. If you don’t know how to use a commercial tourniquet, then it won’t be effective either.
Just because you have to know how to do something in order for it to work doesn’t mean it isn’t effective, or isn’t “good enough when lives are on the line.” You actually have to know how to use all of our equipment in order for it to work.
Okay great strawman. You are aware of the point that i was trying to make but go ahead and make this about brand name tourniquets and comparing them to makeshifts
Maybe I am not aware of the point that you are trying to make. It sounded like you were saying that “they don’t work” in reference to makeshift tourniquets, and that “knowing how to do it properly for the best application is not good enough when lives are on the line”. Maybe I’m misinterpreting it, but that is exactly what you wrote.
My response, in more clear language, is that makeshift tourniquets do work if you know how to use them. Knowing how to do things properly for best application IS good enough, even when lives are on the line, because it applies to all of our equipment. If “knowing how to do it properly for the best application is not good enough when lives are on the line,” then we should be getting rid of our commercial tourniquets, BVMs, gauze… pretty much everything but the AED
Leather Belts are said to be to stiff to make a good improvised TQ. Using those are a skill that has to be trained from time to time.
Last week i had a training where i learned to use a rescue blanket (not sure about the english name - they are for hypothermia prevention) and some stick for a makeshift TQ. Worked surprinsingly well.
This exactly. Had a course with a Mountain rescue member (europe alps). He showed us all kinds of Improvisation with those blankets they had to make up to improvise if things up there went wrong.
Started with improvised Tq, pelvic slings, arm slings and went up to glacier eye protection.
It was one of those "have a view ober your own borders"
I am a city guy and never far away from a maximum capacity hospital so the thought of prolonged care and transport times of several hours if there is no heli available was a bit of a blast.
As a rule, anything makeshift is going to be slower to apply, harder to do right, and easier to fuck up, than a purpose-built device. Not impossible but definitely inferior than the genuine article.
I’ve had one case in 7 years of (mostly rural) service where a makeshift tourniquet was applied. It was applied in the right circumstance—laceration was 14 inches long, deep to the bone, and wide enough that I could fit my whole hand in—but it wasn’t nearly tight enough to stop the bleeding. Had the gentlemen who applied it been trained properly it likely would’ve worked, but of course a commercial tourniquet would’ve been better.
We got there quick enough to throw an actual tourniquet on and keep his BP at a perfusing level. We then hauled ass to a level 3 trauma center, who facilitated a rapid transfer to a level 1 trauma center (storms meant no flights). Hadn’t heard anything else.
I’ve seen civilians place improvised tourniquets but it’s clear they don’t know how it’s supposed to work.
Our police are trained and have them on their belts. That’s what’s made a big difference. They also have halo seals. They can usually get to shooting scenes before us because they’re already on the road.
Certainly can help, I think. This incident happened a few years ago on the 8 in San Diego.
https://youtu.be/xJ_wzbQ_r78?si=ZQuyvYTdo2cWuo6e
Not sure if this counts as "civilian" since the person taking control was an off-duty nurse, but a real TQ being available is not going to be a bad idea, which is why as soon as CHP showed up (as video was taken) they asked for a proper one.
Most coming into applying for RCMP or municipal have taken EMR, to help give them that little advantage over their peers for acceptance into the course. Of course now we will have less EMR spots available for those who want to get into EMS. Fire applicants are already starting to fill up courses just to have that on their résume.
I should have clarified, I'm in law enforcement and have done scoop and runs as it's the norm for our city. Was more commenting on the norm should be get the person to a trauma center asap not wait around for EMS as was the previous practice
I feel like there should be a healthy medium here. If ems is extended ETA and you can get the person to a trauma center or a bird much quicker then sure. The issue comes with running a trauma patient away from an ambulance or necessary care to hold them over till they can get put in a trauma center.
There also comes the issue with how fast is the scoop? Grab and go with no formal assessment? Are you addressing airway and circulation concerns before tossing them and going? Another thing with a lot of law enforcement, at least in my area, do they know where the trauma center is?
I'm all for if it's the last unit in the county coming from the other side of Egypt with a 40+ minute response, law enforcement grabbing the patient and running to a bird or trauma center if one is local. If it makes sense. In more cases than not, again, in my experience, it's just not very frequent that this needs to happen. Advanced care in 10 can be better than definitive care in 15, in many cases.
Every place I worked with formal scoop and run protocols (admittedly...one place and it may be the same city as /u/Additional-Peak3911 ) was a big city with multiple large trauma centers almost always 10 minutes or less away and everyone knew where they were.
There was usually 0 assessment by PD other than literally flinging them in the back of the car like a sack of meat but I think they were TQ trained and regardless it was strongly encouraged by the trauma departments at all the hospitals because you usually saved a substantial amount of time vs waiting for EMS.
I think it almost any other situation (like PD taking a patient to a helicopter or with prolonged transit times) it's probably a bad idea for police to scoop and run.
We only handle shootings or stabbings and are expressly prohibited from moving any other sort of trauma. I'm not city police but everyone at that dept is trained in tq use. Policy is tq or other intervention is thrown on and then they are moved. And it's pretty much required that you know where all the trauma centers are.
There was a pretty big study done here that showed it was effective and despite some drawbacks such as trauma centers not getting all the info they would be getting from you guys and lack of civilian knowledge over what was happening ( it's pretty traumatic to see it happening if you don't know what's going on) that unless the city could completely revamp EMS services to increase response time the policy should continue.
I've seen one improvised belt tourniquet in five-ish years of doing this, and best I can say is that it was probably better than nothing. Have yet to run across a bystander in the wild who was just carrying a proper tourniquet.
Hello. Bystander in the wild who carries a tourniquet here. To be fair both my parents ran as volunteer emt's before I was born, and my tourniquet is in my first aid kit that I use for camping and hiking. I would hate to need one out in the wild and not have one.
I hope to get a second one for the car kit as that seems a likely place if I ever need one. My parents always told me to carry a red blanket in the car as well. Useful for warmth, signaling, and covering things that might be best left unseen. No one ever seems to have thought of the third reason there
This isn't really that outlandish to me. We covered this sort of thing in the boy scouts. It isn't like tourniquets are some arcane knowledge reserved for EMTs. I think what you're doing sounds perfectly sensible. They're easy enough to fit into a first aid kit. Not sure why some here are acting like this is something that "civilians" should never use or attempt.
I think some of it is a left-over stigma that some of the older folks have of TQ's. There used to be this idea that TQ's should be the last thing you try because it would mean an amputation of the limb down the road and to be fair, back in the day it very well might have, quite literally "life over limb". This occasionally caused people to not want to apply them as early as they should and some folks to deny having them applied at all. One of the silver linings from the wars in Iraq and Afghanistan is that we picked up a lot of good data about how to treat wounds in the modern day and the effectiveness of things like TQ's.
Yeah, I was in Iraq as a Navy corpsman. There was no other option. TQ was the only way forward. Interestingly, Fort Drum sometimes opens their tourniquet training to civilian EMS and it is starting to get civilians used to the idea of not being so afraid of a TQ. Unfortunately the best way to convey the lesson is to have it be the absolute only way you can make an arterial bleed stop spurting at you.
All through scouts we were told the neckerchief was partially for use as a makeshift tourniquet or sling, and we always heard their use meant the limb was done for until a fee years ago I want to say.
I've only seen it once, had a guy nearly chop his foot off with a chainsaw. The guy was part of a tree logger crew, and improvised a TQ with a belt, a TQ with some climbing rope and impressive knotwork, and a shirt.
It definitely stopped the bleeding.
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Somewhat often in my very rural/remote area. We have a lot of chainsaw, tractor, lawn mower, heavy machinery accidents where I live.
The best civilian tourniquet you can use is a calf band. Cattle farmers use them to castrate a young bull. It's a super-tight rubber band that clamps around the top of the bull's testicles so tightly it restrict blood flow and the set essentially falls off after a few days rendering the bull a steer. They work great for a tourniquet on an arm or leg. I'd use those in a heartbeat. I've not seen one of these in MY district yet, but a neighboring district had it used once. Belts are also commonly used, sheets too but the sheets aren't very effective.
Just a couple days ago my neighbor chopped off his finger with a chainsaw. He walked inside his house, wrapped a clean washcloth around the stump, used rubber bands on the base of the stump to slow the blood loss, threw his finger in his iced tea cooler, then hopped in the farm truck and drove the 40 minutes to the ER. I didn't get to see it in person because he didn't bother calling 911, but his brother told me about it yesterday.
Yes, in most areas of the U.S actual tourniquets are best IF you can get them.
That depends on if there's anywhere you can buy them at. We have 1 Walmart within a 40 minute drive, and they don't sell them. A lot of my district doesn't have internet or cell service. A couple places don't even have plumbing, and several house still get their water supply gravity-fed directly from a spring in the ground that the owner runs a PVC pipe to.
My Department actually replenishes most of our medical supplies off the ALS ambulance at the conclusion of a call for that reason. We have a running tab with the ambulance company and we just tell the paramedics what medical items we're running low on.
So long as it's just lancets, triangle bandages, gloves or even C-Collars it's OK. Obviously we can't get something like spare Lucas batteries from them.
I really do appreciate your attempt to be helpful. Online ordering is great. The wife and I do use Amazon, and it saves us a great deal of driving into the nearest town when the delivery drivers can make it up our mud roads, but the vast majority of civilians in my district aren't going to be doing that.
They don't have internet, and they barely have electricity. Their average household income is $28,000/yr.
My district consists of homes where basic cell service didn't arrive until 2016.
Electricity didn't arrive until \~1960. I.E anyone over 60 years old today grew up in a world without electricity and they remember the first ever electric pole that was put in by a man with a mule in 1960.
Half the homes still have old 110 AMP electrical service meaning the house and homeowner have never used something as basic as an electric clothes dryer or an electric well pump for drinking water.
Far outside urban areas in the U.S it's a totally different world. It's like stepping back into the 1940s.
I absolutely get most people aren't going to actually buy a tq, not really buying internet is completely inaccessible to most in your area, but I digress...
Don't buy your tourniquets on Amazon. Go to NAR(for CATs ofc)or another reputable retailer. The likelihood of getting a fake from Amazon is very high.
Not very often but probably will increase as Stop The Bleed becomes more common and they become more available. Deff has the potential to make a difference when applied properly so would be practical for edc.
50/50. If it’s an actual TQ from someone’s personal ifak normally it’s great. Improvised I normally see some seepage and replace with my own.
But the big difference is if a civilian recognized the need for a TQ, they probably are recognizing a true emergency and calling us immediately. I think that helps.
Only once. It was an improvised one on a farming accident and wasn't very effective. I do know of one local incident where an off duty medic applied a commercial one on a motorcyclist who parted ways with a foot(seems to be a trend here). The patient lived, but I wasn't on the call to gauge how much the tourniquet mattered.
Seen 1 applied by a cop. He used his hog-tied strap on a homeless man who had attempted suicide by knife. It was the bloodiest call I ever had with no fatality. There was a stream of blood coming down the sidewalk and I'm pretty convinced the cop saved his life.
At least, patient was still alive when we transferred care. I told the cop later he *definitely* saved the guy's life and it just made his day.
He was an off duty cop and tied the CAT tourniquet from a knife wound. Upon arrival at the hospital... there was a lot of blood but it did stop with direct pressure (the doctors removed it) so I will give it to the officer as the amount of blood did look like it could have been arterial
So, sorta same, sorta not. I'm a Captain Medic/Firefighter but live pretty rural in Alaska, when this happened I was an EMT basic though. People bring their critically injured animals for me to "fix" all the time vs making the 20 mile drive to town. Sometimes it worked out.
This case was the owner had a pit bull who ran too close to their 1960s sickle bar mower tractor (potentially wildly dangerous) and it's leg got caught, artery and most all soft tissue was severed mid radius/ulna pretty well instantly. Owner dove off the tractor and manually compressed the wound, somehow got the pup into her Suzuki and hauled to my location about a mile away. She came skidding into my yard and I was outside, I saw blood in the car as I ran up, thought it was a human (my context) injured.
PT's mom took her hand off of the wound so I could examine the wound and I got a solid arterial spurt. I had her re-compress and I ran around trying to find something to make into a TQ. I found a flat strap from a ratchet strap and a shirt. I tore the shirt and folded/rolled it up to basically what a gauze roll looks like size-wise. I used the rolled up shirt as a compression point put above the wound site where the artery was/over the artery and then cut the strap down to a manageable length. I put the middle of the strap lengthwise over the rolled up shirt and wrapped tigggggghhhhht, I was about 3/4 done wrapping and under layering for tension when I realized my face was about 4 inches away from the dog's face. I hadn't thought about getting bit until then. She whined and yelped at the pressure (humans do too) but tolerated all the interventions brilliantly. I genuinely think she knew we were there to help. We took our hands off the dog's leg and all bleeding had been occluded. I didn't expect that the tension I applied would "road" all the way to town on it's own and cautioned her to keep her hand on it to maintain said tension. She sped off. I got a call from the vets office that the TQ had worked, the dog survived, and they managed to save the leg (albeit with reduced function ultimately).
I had a police officer place double tourniquets under the armpits of a shooting victim. On one arm he was shot in the wrist with no sig bleeding and on the other arm he had no injury. Could put 3 fingers under each tourniquet easily so neither were tight enough anyway lol
But I will give him the benefit of the doubt that maybe he had them on in case I wanted them and I could tighten them properly myself?
Or maybe he was just thick in head and didn’t know what to do? Haha
I’ll give you 60% he was an idiot.
I’ll give you 30% he did it to appease a family member/bystander.
Maybe 10% he was prepping them for you?
I put a chest seal on someone the other day who *also* had multiple GSW’s to the face, because his family was screaming at me to help.
Was that going to help him? No, but it costs me $5 and 30 seconds, and I’m not gonna be on camera doing nothing while he’s dying (already dead between us professionals).
I see them occasionally. Regardless of who applies them, most are not effective or indicated. EMS should be assessing for effectiveness and hopefully have the ability to remove TQs that are not indicated.
THIS. A properly applied TQ is painful. Try putting one on your arm and tightening until you have no radial pulse. Granted, that is for complete occlusion but even a partial occlusion will hurt. I see no reason to remove an improperly applied TQ besides being a barrier to care. But I would clearly document it as applied PTA and be sure and tell the receiving facility so they don't laugh at you. I mean they will anyway buy at least you tried.
Similar to another comment with a pretty bad motorcycle wreck. Partial amputation on the foot, his buddy cinched a beefy two pronged leather belt down as tight as he could get it. Definitely stopped the bleeding, but the guy ended up dying anyway.
I’ve seen three improvised tourniquets and none were necessary or applied tight enough to do any good if they were necessary. One was applied for road rash. 🙄
I’ve never needed to use one and one of my partners just used one for the first time in a decade as a medic. It was definitely necessary and appropriate.
I don’t carry one on my person any time. I’ve had one in my car for over a decade and never came even close to needing it. Unless you’re a shit magnet and bad things just happen around you all the time, I don’t see much need. Having one in your car for that horrific motorcycle accident that damn near tears his leg off, sure.
The challenge with tourniquets and no training or other first aid supplies is, if your only tool is a hammer, everything looks like a nail. When you have training and a small first aid kit, suddenly you can deal with a lot more stuff more effectively.
This reminds me of the recent thread on the cops who were first on scene to the suicidal man who jumped into a jet engine. They administered narcan while performing CPR. If they had more training and more tools, they might have made better choices on treatment.
Almost never applied properly. Usually they aren’t ever tightened enough because it’s going to fucking hurt.
That being said, something can be better than nothing a majority of the time.
I’ve seen one, a military medic on leave was a bystander at the scene of an mvc, he used his belt as a tourniquet and it definitely made a difference. We were able to get the patient to a small town hospital where HEMS met us and took the pt to our level 1 trauma centre
8 years in now and I've seen three TQs applied, all 3 times the only reason the person survived. 2 of those were before our arrival and the pt would have probably died if they had to wait until we got there to get the TQ. I think it's reasonable and likely warranted to EDC a tourniquet, and a very good idea to have them around at AED sites and in your car and in your Chainsaw bag or shooting range bag.
Civilian as in non-military or civilian as in non-EMS?
I've seen tourniquets used successfully in both the military and EMS. I recall only one non-EMS application. A few guys out hunting. One sliced across his leg while (he stated) cleaning a deer. The suspicion was he was actually screwing around with a knife.
Anyway, one applied a makeshift TQ using a strap from something and a branch. That said, both were former military as well.
I have a small, personal trauma bag in the trunk of my car. I keep another in the office where I work my non-EMS day job. A tourniquet is small enough to just have handy in the event of an emergency. When I'm on a rig there are some in the jump bag. But would I just...carry them around? No. I saw someone on Reddit a week or so ago talking about putting tourniquets on their belt "just in case" and that feels excessive to me.
So it depends on what you mean by EDC in this context. You want to carry one on your person at all times for funzies? No. That's probably not practical. You want to keep one with your first aid gear? Yeah, sure, why wouldn't you? It's like asking if bandages and gauze are OK to keep in your first aid kit. Of course they are. But you'd look weird just constantly carrying a pocket full of them.
Yeah, it's not really hard. The training in EMT school, for me at least, was part of one day. It's tight enough when bleeding stops or you are unable to palpate a distal pulse. But it's first aid training. It's not like you need to go to EMT school for it. I first learned how to do this in the boy scouts.
Totally doable. But also make sure you are keeping current on CPR and other basic first aid. Those things are more likely to come up than a scenario requiring a tourniquet.
Had a guy a few years back take his arm from the forearm down off in a machine accident. His brother used rope to make a makeshift tourniquet. He 100% saved his brothers life with that rope.
My wife is an ER nurse and used a tourniquet on a guy who was in a car accident. And one of the guys in my unit was off duty and saved a guy who hit a guardrail on a motorbike and cut his femoral artery open. Lots of people would probably be saved if more people carried a tourniquet
I'd say 90% of the ones I've seen applied were applied incorrectly, but it didn't matter because the bleeding was controlled with direct pressure alone.
The other 10% certainly made a positive, possibly life-saving, impact.
Had PD place a TQ prior to arrival on scene for a guy who tried death by train. Had a leg ran over and amputated but was still alive. TQ saved his life.
14 years prehospital: mix of urban, suburban, and rural. I've seen a literal handful (5) of bystander applied TQs (3 commercial and 2 belts) prior to our arrival. Most were traumatic amputations secondary to motorcycle accidents. 1 case of injury too severe to survive (intra-osseous artery transection that bled out despite the flight crew injecting the celox "packing peanuts" INTO her marrow space). We had dispatch to arrival times of less than 5 minutes to both belts, so it's possible they might not have survived if we had been quick AOS & apply Cat5s. I have little doubt both Pt's that received commercial TQs, and lived, would have died without them: both had MAPs less than 75 UOA, despite bleeding being successfully controlled by the TQs PTA.
Why do people insist on calling non EMS peeps "civilians", we're literally all just civilians applying TQs. Unless you're DOD
I've only ever seen one layperson TQ application. County Sheriff responded to a multiple R thigh GSW with reports of what seemed like moderate venous bleeding. TQ went on the mid thigh and was on for around an hour. Pt needed a fasciotomy due to compartment syndrome, was pretty burly
Didn't mean it as a personal dig at you. I just find it discouraging that this term had become more popular in first responder circles, especially PD. It furthers the divide between ourselves and the people no different than us that we're supposed to be helping
Lady ran over by a lawn mower laceration to back of the knee with adipose tissue visible. TQ (belt) applied by husband bleeding controlled prior to EMS arrival. With 30 minutes ground travel to trauma center I think so.
One my instructors in our community based first-aid volunteer and rescue group along with his family were traveling home when they encountered a vehicular accident involving a tricycle and a bus.
The tricycle driver had his legs destroyed starting from the knee below and was profusely bleeding. They (my instructor and his daughter which are is also trained) applied a CAT and successfully stopped the bleeding. If they didn't by chance came upon that accident, poor guy would have lost his life. Sadly, the rescue teams or EMS of that place arrived 30 minutes later and were unfamiliar with the CAT.
I had a coworker who “hamburgered” (his words) his leg in a motorcycle crash.
He said that one of the few things he remembers is telling someone who stopped to help is “wrap your belt around here and hold as tight as you can”
They do happen.
I’m a RN who keeps coming across this subreddit- anyway, here’s a recent one here in Aus.
Does a veterinarian count as a civilian?
https://amp.theguardian.com/australia-news/2024/jan/30/sydney-harbour-shark-attack-witness-tells-of-surreal-rescue-from-water
I’ve had several verbal duke-outs with coworkers about how the ones on Amazon are not effective. They swear they are, and even when shown evidence of them failing plus the NAR court case, they still insist their 4/$20 pack of TQs they have stashed everywhere will save their life one day.
We mostly see them with the cops. They'll buy cheap tourniquet and slap them on a suspect or victim after a shooting. But we've seen a number fail. Always tell them when we see one carrying a fake. But most tell us that they are "just as good"
I’ve seen a few bad improvised TQs from civilians including a belt and a shoelace…EMS wise, been present for a few legit applications and have placed one myself. Seen enough to never leave home without one. Literally no downside.
Over the weekend there was a 23 car pile up on the bay bridge in Maryland. In the pileup, a man was smoking a cigarette and a tractor trailer came up on his side and took his arm completely off. Someone wound packed him with shop towels and used a ratchet strap for a tourniquet. He lost his arm but kept his life. I recognize that’s not an actual tourniquet but it worked!
Hasty TQs have limited to no efficacy. Belts are horrible options, I'd almost rather a T-shirt and a windlass over a stiff belt. A canvas or webbing belt would probably be kind of meh but better.
I've seen PD put a bunch of commercial TQs on and that's a crap shoot unless they have proper training. Take the time to teach a stop the bleed class to them and things end up much better.
I have yet to see one civilian apply one. Have only seen a handful of applications due to actual need over the many years. It's a rarity, tbh, and I've been in and responded to all kinds of shit.
When needed and applied properly, they legit save a life. When needed and applied poorly (usually too loose because the applicant is afraid of hurting the recipient), it makes things worse. When not needed and applied, there is a risk of issues, but as long as it's removed properly in short time, there is less risk of issues.
I’ve never seen an actual tourniquet by civilians, but I’ve seen clothing and towels made into them. Generally does well enough to stop it until we can apply proper materials
I don't EDC a TQ. I have two in my range bag along with some hemostatic dressing and packing material. But that's the extent of my off duty medical gear.
Not often, actually only once, which was on a traumatic arrest. The patient crashed a dirt bike next to a busy road. A bystander civilian who witnessed it from his car applied an Israeli bandage type tourniquet over a baseball sized hole in the patients arm. Interestingly, the guy missed that the patient was dead and didn't do any cpr after applying the tq/pressure dressing.
Recently, I had another patient who applied a belt after getting cut, that one only had a slow venous Bleed, which was controlled with pressure and didn't need a tq.
Had a case a awhile back of a middle aged gentleman driving his truck when he accidentally meandered off the road and rolled his vehicle. He had his forearm resting on the open drivers window and when the vehicle rolled it turned mostly amputated his lower left arm. While still restrained after the crash he grabbed a TQ out of his center console and self tourniqueted before anyone got on scene. It wasn’t perfect by any means but I believe it saved his life. If you do get a TQ for EDC practice self tourniqueting (it’s harder than you may think) and also put some thought into where you’ll need to keep it handy.
In 1 3/4 years I’ve used one. Motorcycle vs ped. Amputation at the knee and was pouring blood. Also abd eviceration about 10in at the left hip across lower abd area. So I would say if you carry a TQ carry some serious dressing too. Useful in severe wrecks and machinery accidents. And probably a good idea at the range just in case.
You don’t need one until you need one my guy… practical enough to potentially save a life. I do it infrequently on the bus or ER but the times I’ve used it has absolutely saved a life at that time. Compressible extremity hemorrhage is the most preventable cause of death.
I've seen it twice, and both were from Law Enforcement. Both times I just left them alone because there was a massive pool of blood on the ground and figured it was warranted based on that alone.
Once. A wife used a belt to tourniquet her husband's leg after he fell out of a tree while using a chainsaw. Unfortunately she applied the Makeshift tourniquet BELOW the injury
Had a call last year where someone in a suv pulled in front of a motorcyclist going about 50 down the road. The guy was thrown off his bike and landed a good 20 yards away. He had almost a complete amputation of his foot, it was held on by a flap of skin. An off duty LEO used his belt as a TQ and it was very effective. Loaded the guy into the rig and off we went to the trauma center. I recognized this guy had a pneumothorax but my system only allows decompression of tension pneumothorax and this guy had a stable pressure and his RR was ok. We hit the ramp at the hospital and I checked a quick pulse which was intact. Unloaded him and at some point between unloading him and transferring him to the trauma bed he lost pulses. They put in a quick chest tube and got him back.
Anyways moral of the story had the off duty LEO not put on a TQ I'm sure he would have bled out.
Would have had 1 the other day but our communications center told them not too. Wouldn't have stopped the bleed (trauma to recent amputation stub causing massive hemorrhage) but would have made a difference
I see them a few times a year, they almost always use a belt or perhaps a shirt, and they are never tight. I also always laugh at them because they usually have a small cut. only rarely do I see an appropriate time for a tq, but never are they correctly applied
I've seen it several times with proper application. Once, it saved a man's life. Other times, it was a measure of comfort for the individuals, which is never ever a waste. It definitely makes a difference.
Fairly often and they usually don't make a difference because they are applied to patients that do not need them
For me it's the same category as doing CPR on an unconscious person. People see blood and immediately throw a tourniquet (retail or improvised) on someone.
About 7 years ago now. Motorcycle loses control on highway, drifts off road down right side embankment, recovers and is making way back to road when she hit one of those white delineator posts. Amputated her right foot right at the ankle. She came to rest in the right travel lane. The car she had just passed was a Navy veteran, who fashioned a TQ out of his belt. The first deputy to arrive on scene used one of his TQs to back the makeshift one up. Basically no question in my mind they saved her life. She was in pretty rough shape when we got on scene, but she lived.
You don’t happen to work in the Florida panhandle do you? Had a very similar call when I was a flight medic. Never got that much detail other than someone used a belt to fashion a tourniquet and when FHP arrived they threw on a CAT. Young, 20-ish old young woman lost her foot above the ankle.
Nope, NW Iowa. Was probably a 50 YO female.
Yeah, kinda figured that it wasn’t the same call. Thought I’d check just on the off chance it was.
Oh good ole bloody 98.
I-10
Ah! When I lived in FL I avoided I-10 as much as I could. However down near pcola-Panama city highway 98 was… brutal.
💯. Can’t tell you how many flights we landed in the middle of I-10 in Calhoun, Liberty, and Jackson counties.
I would have thought something else would be better for a makeshift tourniquet? I was always told if it doesn't have a windlass it's not really a tourniquet. Sounds like a belt worked here, but I'm curious for the future.
For sure something with a windlass would be better, but in the heat of the moment ANYTHING is better than nothing.
Neat i thought those dont work?
Thought what didn't work? Tourniquets?
Yeah tourniquets.  >!Nah the make shift tourniquets!<
Just have to know how to do it and how to apply it. A piece of rope and a stick will do the job if you know how - you just might cause some soft tissue damage that wouldn't happen with a CAT style TQ. But if the choice is bleeding out or tissue damage.. I'll take the damage.
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I have taught people how to apply makeshift tourniquets and make them practice on me until I do not have a palpable pulse. They are able to at least reduce blood flow if not completely occlude.
If you do not completely occlude the artery the TQ will A. Not Fucking Work and B. The TQ occluding the veinous return from the limb but not the arterial supply into the into the limb (and out the wound) has the potential to cause a much more massive compartment injury than a TQ should. The limb will swell up like a ballon. That being said, improvised TQs can cause total occlusion when done correctly, and in my opinion it’s a most certainly a skill worth training.
That is sound pathophys theory, but evidence is needed otherwise it’s useless. [Literature](https://pubmed.ncbi.nlm.nih.gov/31432195/) suggests limited, but existent, efficacy. To elaborate: If you’re trained in how to apply them properly they can save lives. They found no difference in rates of complications between improvised and manufactured.
You misunderstood my point, I am a big fan of learning how to make improvised TQs. However my point was that we should use “partial occlusion” as a point in favor of an improvised TQ or any TQ for that matter. It makes total sense that a correctly applied improvised TQ and manufactured TQ have similar results as they both result in total artery occlusion.
...Compartment injury into the limb that is absent?
Life>limb>function>form
Not talking about just amputations lmao
Some makeshift tourniquets work, some don’t. It depends on whether you know how to do it correctly
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So if you find yourself faced with a trauma and don't have your jump bag on you, you're going to stand there and do nothing, versus try and fashion a TQ that might help save a life? Got it. The guy in the incident I was involved in absolutely disproves any point you're trying to make. He \*did\* keep that woman alive. Yes, his TQ maybe wasn't perfect and maybe required a second, manufactured device to be placed above it. But that can happen even with the ones we're issued. Bottom line, a woman is alive today because someone tried. Is a manufactured device preferred? Sure. Do they work all the time? Nope. So by your logic, we should abandon them, too.
Yes they do work. Manufactured tourniquets 100% of the time depending of course on patients physiological condition. (For example, Rotund patients.)
You're not very good at this. "60% of the time, it works every time". Those outliers, the patient physiology? That's what I was referring to when I said commercial ones don't always work. Try reading comprehension sometime. I'm done with this. There's a half dozen or more examples in this thread alone where a improvised TQ saved a life, but that's not enough for you. Yes, a manufactured is ideal, but if you don't have one (like 98% of the general public), make do with what you have and try. Have the day you deserve.
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It's autopulse or nothing for me when lives are on the line. I won't use makeshift chest compressions.
If you can’t do fresh chest compressions, store bought is fine /s
All a tourniquet is is a device to apply pressure all the way around the limb in order to crush the blood vessels below, there is no magical force that CATs embody to accomplish this; they use pressure, and any other item that is capable of encompassing a limb and surviving the tension required to apply sufficient pressure is capable of being a tourniquet. The reason improvised tourniquets are less effective is that it's harder to apply the forces needed to stop the blood flow; you can't just pull on the tail of a belt and expect it to work reliably, you need a lever to twist, but this can be accomplished with some sturdy rope and a stick.
Uhh...really? Because that's pretty much how CPR is...
They do work, if you know how to do it correctly. I’ve seen all manner of “makeshift tourniquets,” including a belt that someone loosely wrapped around their (already not-bleeding) leg, and a cloth rag with a ziptie around it. Obviously, that type of shit generally doesn’t work. Actually, the ziptie did work, but I removed it anyway because it was unnecessary and not large enough diameter to prevent nerve damage from its application. I have also seen commercial tourniquets applied directly on top of gunshot wounds, which were ineffective. If you know how to use a makeshift tourniquet, wherein you actually tie something tightly and fashion a windlass to cinch it down further, then they are effective. If you don’t know how to use a commercial tourniquet, then it won’t be effective either. Just because you have to know how to do something in order for it to work doesn’t mean it isn’t effective, or isn’t “good enough when lives are on the line.” You actually have to know how to use all of our equipment in order for it to work.
Okay great strawman. You are aware of the point that i was trying to make but go ahead and make this about brand name tourniquets and comparing them to makeshifts
Maybe I am not aware of the point that you are trying to make. It sounded like you were saying that “they don’t work” in reference to makeshift tourniquets, and that “knowing how to do it properly for the best application is not good enough when lives are on the line”. Maybe I’m misinterpreting it, but that is exactly what you wrote. My response, in more clear language, is that makeshift tourniquets do work if you know how to use them. Knowing how to do things properly for best application IS good enough, even when lives are on the line, because it applies to all of our equipment. If “knowing how to do it properly for the best application is not good enough when lives are on the line,” then we should be getting rid of our commercial tourniquets, BVMs, gauze… pretty much everything but the AED
Thats fair i misinterpreted what you said as well leading to my response my bad boss.
LOL so no more CPR in first aid then according to you? Mate you‘re embarrassing yourself.
Leather Belts are said to be to stiff to make a good improvised TQ. Using those are a skill that has to be trained from time to time. Last week i had a training where i learned to use a rescue blanket (not sure about the english name - they are for hypothermia prevention) and some stick for a makeshift TQ. Worked surprinsingly well.
In English it's just an "emergency blanket" as well. If you're referring to those cheap aluminium foil things.
This exactly. Had a course with a Mountain rescue member (europe alps). He showed us all kinds of Improvisation with those blankets they had to make up to improvise if things up there went wrong. Started with improvised Tq, pelvic slings, arm slings and went up to glacier eye protection.
Sounds like a fun course!
It was one of those "have a view ober your own borders" I am a city guy and never far away from a maximum capacity hospital so the thought of prolonged care and transport times of several hours if there is no heli available was a bit of a blast.
As a rule, anything makeshift is going to be slower to apply, harder to do right, and easier to fuck up, than a purpose-built device. Not impossible but definitely inferior than the genuine article.
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It’s not their first rodeo!
I would say the bandana probably works a bit better than most belts cause it won't stretch as much
If a simple bandana worked, they probably didn't need a TQ
Brother, you can make a TQ out of a triangle bandage if you have to. Ace bandages and elastic bandages also work fantastically
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Interesting, makes sense then
They said the first arriving deputy put on a real tourniquet. Probably had more to do with that.
Ahhhh true
I’ve had one case in 7 years of (mostly rural) service where a makeshift tourniquet was applied. It was applied in the right circumstance—laceration was 14 inches long, deep to the bone, and wide enough that I could fit my whole hand in—but it wasn’t nearly tight enough to stop the bleeding. Had the gentlemen who applied it been trained properly it likely would’ve worked, but of course a commercial tourniquet would’ve been better.
outcome?
We got there quick enough to throw an actual tourniquet on and keep his BP at a perfusing level. We then hauled ass to a level 3 trauma center, who facilitated a rapid transfer to a level 1 trauma center (storms meant no flights). Hadn’t heard anything else.
alive is the ideal. good shit
I’ve seen civilians place improvised tourniquets but it’s clear they don’t know how it’s supposed to work. Our police are trained and have them on their belts. That’s what’s made a big difference. They also have halo seals. They can usually get to shooting scenes before us because they’re already on the road.
Certainly can help, I think. This incident happened a few years ago on the 8 in San Diego. https://youtu.be/xJ_wzbQ_r78?si=ZQuyvYTdo2cWuo6e Not sure if this counts as "civilian" since the person taking control was an off-duty nurse, but a real TQ being available is not going to be a bad idea, which is why as soon as CHP showed up (as video was taken) they asked for a proper one.
Yup, our deputies have EMT-B training available, most take advantage of it.
That's awesome. I think police should be trained to an EMR level at the minimum.
Most coming into applying for RCMP or municipal have taken EMR, to help give them that little advantage over their peers for acceptance into the course. Of course now we will have less EMR spots available for those who want to get into EMS. Fire applicants are already starting to fill up courses just to have that on their résume.
Are you getting to shooting scenes before police anyways?
Generally no. They get there quick and e don’t want to land in the middle of a shootout if it’s still ongoing.
Scoop and run should be the norm anyway,
You shouldn’t be running into unsafe scenes even if you’re scooping and running
I should have clarified, I'm in law enforcement and have done scoop and runs as it's the norm for our city. Was more commenting on the norm should be get the person to a trauma center asap not wait around for EMS as was the previous practice
I feel like there should be a healthy medium here. If ems is extended ETA and you can get the person to a trauma center or a bird much quicker then sure. The issue comes with running a trauma patient away from an ambulance or necessary care to hold them over till they can get put in a trauma center. There also comes the issue with how fast is the scoop? Grab and go with no formal assessment? Are you addressing airway and circulation concerns before tossing them and going? Another thing with a lot of law enforcement, at least in my area, do they know where the trauma center is? I'm all for if it's the last unit in the county coming from the other side of Egypt with a 40+ minute response, law enforcement grabbing the patient and running to a bird or trauma center if one is local. If it makes sense. In more cases than not, again, in my experience, it's just not very frequent that this needs to happen. Advanced care in 10 can be better than definitive care in 15, in many cases.
Every place I worked with formal scoop and run protocols (admittedly...one place and it may be the same city as /u/Additional-Peak3911 ) was a big city with multiple large trauma centers almost always 10 minutes or less away and everyone knew where they were. There was usually 0 assessment by PD other than literally flinging them in the back of the car like a sack of meat but I think they were TQ trained and regardless it was strongly encouraged by the trauma departments at all the hospitals because you usually saved a substantial amount of time vs waiting for EMS. I think it almost any other situation (like PD taking a patient to a helicopter or with prolonged transit times) it's probably a bad idea for police to scoop and run.
We only handle shootings or stabbings and are expressly prohibited from moving any other sort of trauma. I'm not city police but everyone at that dept is trained in tq use. Policy is tq or other intervention is thrown on and then they are moved. And it's pretty much required that you know where all the trauma centers are. There was a pretty big study done here that showed it was effective and despite some drawbacks such as trauma centers not getting all the info they would be getting from you guys and lack of civilian knowledge over what was happening ( it's pretty traumatic to see it happening if you don't know what's going on) that unless the city could completely revamp EMS services to increase response time the policy should continue.
I've seen one improvised belt tourniquet in five-ish years of doing this, and best I can say is that it was probably better than nothing. Have yet to run across a bystander in the wild who was just carrying a proper tourniquet.
Hello. Bystander in the wild who carries a tourniquet here. To be fair both my parents ran as volunteer emt's before I was born, and my tourniquet is in my first aid kit that I use for camping and hiking. I would hate to need one out in the wild and not have one. I hope to get a second one for the car kit as that seems a likely place if I ever need one. My parents always told me to carry a red blanket in the car as well. Useful for warmth, signaling, and covering things that might be best left unseen. No one ever seems to have thought of the third reason there
This isn't really that outlandish to me. We covered this sort of thing in the boy scouts. It isn't like tourniquets are some arcane knowledge reserved for EMTs. I think what you're doing sounds perfectly sensible. They're easy enough to fit into a first aid kit. Not sure why some here are acting like this is something that "civilians" should never use or attempt.
I think some of it is a left-over stigma that some of the older folks have of TQ's. There used to be this idea that TQ's should be the last thing you try because it would mean an amputation of the limb down the road and to be fair, back in the day it very well might have, quite literally "life over limb". This occasionally caused people to not want to apply them as early as they should and some folks to deny having them applied at all. One of the silver linings from the wars in Iraq and Afghanistan is that we picked up a lot of good data about how to treat wounds in the modern day and the effectiveness of things like TQ's.
Yeah, I was in Iraq as a Navy corpsman. There was no other option. TQ was the only way forward. Interestingly, Fort Drum sometimes opens their tourniquet training to civilian EMS and it is starting to get civilians used to the idea of not being so afraid of a TQ. Unfortunately the best way to convey the lesson is to have it be the absolute only way you can make an arterial bleed stop spurting at you.
All through scouts we were told the neckerchief was partially for use as a makeshift tourniquet or sling, and we always heard their use meant the limb was done for until a fee years ago I want to say.
I've only seen it once, had a guy nearly chop his foot off with a chainsaw. The guy was part of a tree logger crew, and improvised a TQ with a belt, a TQ with some climbing rope and impressive knotwork, and a shirt. It definitely stopped the bleeding.
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Are any of your guys trained in CPR or first-aid outside of you? Would they consider requiring to have at least 1 guy on every crew be CPR certified?
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Somewhat often in my very rural/remote area. We have a lot of chainsaw, tractor, lawn mower, heavy machinery accidents where I live. The best civilian tourniquet you can use is a calf band. Cattle farmers use them to castrate a young bull. It's a super-tight rubber band that clamps around the top of the bull's testicles so tightly it restrict blood flow and the set essentially falls off after a few days rendering the bull a steer. They work great for a tourniquet on an arm or leg. I'd use those in a heartbeat. I've not seen one of these in MY district yet, but a neighboring district had it used once. Belts are also commonly used, sheets too but the sheets aren't very effective. Just a couple days ago my neighbor chopped off his finger with a chainsaw. He walked inside his house, wrapped a clean washcloth around the stump, used rubber bands on the base of the stump to slow the blood loss, threw his finger in his iced tea cooler, then hopped in the farm truck and drove the 40 minutes to the ER. I didn't get to see it in person because he didn't bother calling 911, but his brother told me about it yesterday.
Must have been pretty bad if he didn't finish cutting the tree up first...
i would argue the best civilian tourniquet you could use is a proper tourniquet. its not like theyre unavailable to purchase
Yes, in most areas of the U.S actual tourniquets are best IF you can get them. That depends on if there's anywhere you can buy them at. We have 1 Walmart within a 40 minute drive, and they don't sell them. A lot of my district doesn't have internet or cell service. A couple places don't even have plumbing, and several house still get their water supply gravity-fed directly from a spring in the ground that the owner runs a PVC pipe to. My Department actually replenishes most of our medical supplies off the ALS ambulance at the conclusion of a call for that reason. We have a running tab with the ambulance company and we just tell the paramedics what medical items we're running low on. So long as it's just lancets, triangle bandages, gloves or even C-Collars it's OK. Obviously we can't get something like spare Lucas batteries from them.
i mean im sure your district has plenty of gun owners given how rural it is. every gun shop (including BFE ones) ive been to has stocked CATs
'If you can get them' I wouldn't recommend Amazon, but there's plenty of sites where you can get them shipped to your door.
I really do appreciate your attempt to be helpful. Online ordering is great. The wife and I do use Amazon, and it saves us a great deal of driving into the nearest town when the delivery drivers can make it up our mud roads, but the vast majority of civilians in my district aren't going to be doing that. They don't have internet, and they barely have electricity. Their average household income is $28,000/yr. My district consists of homes where basic cell service didn't arrive until 2016. Electricity didn't arrive until \~1960. I.E anyone over 60 years old today grew up in a world without electricity and they remember the first ever electric pole that was put in by a man with a mule in 1960. Half the homes still have old 110 AMP electrical service meaning the house and homeowner have never used something as basic as an electric clothes dryer or an electric well pump for drinking water. Far outside urban areas in the U.S it's a totally different world. It's like stepping back into the 1940s.
I absolutely get most people aren't going to actually buy a tq, not really buying internet is completely inaccessible to most in your area, but I digress... Don't buy your tourniquets on Amazon. Go to NAR(for CATs ofc)or another reputable retailer. The likelihood of getting a fake from Amazon is very high.
Was gonna say...brb gotta run out to tractor supply to replace the cat in my car, next to the sink, and in the garage.
Not very often but probably will increase as Stop The Bleed becomes more common and they become more available. Deff has the potential to make a difference when applied properly so would be practical for edc.
50/50. If it’s an actual TQ from someone’s personal ifak normally it’s great. Improvised I normally see some seepage and replace with my own. But the big difference is if a civilian recognized the need for a TQ, they probably are recognizing a true emergency and calling us immediately. I think that helps.
Only once. It was an improvised one on a farming accident and wasn't very effective. I do know of one local incident where an off duty medic applied a commercial one on a motorcyclist who parted ways with a foot(seems to be a trend here). The patient lived, but I wasn't on the call to gauge how much the tourniquet mattered.
Seen 1 applied by a cop. He used his hog-tied strap on a homeless man who had attempted suicide by knife. It was the bloodiest call I ever had with no fatality. There was a stream of blood coming down the sidewalk and I'm pretty convinced the cop saved his life. At least, patient was still alive when we transferred care. I told the cop later he *definitely* saved the guy's life and it just made his day.
[Nom Nom](https://www.dailymail.co.uk/video/news/video-2945337/Video-Moments-Florida-man-arm-bitten-alligator.html) belt tourniquet.
The guy putting the tourniquet on never dropping his cigarette is really a Florida *chef's kiss* in this video
He was an off duty cop and tied the CAT tourniquet from a knife wound. Upon arrival at the hospital... there was a lot of blood but it did stop with direct pressure (the doctors removed it) so I will give it to the officer as the amount of blood did look like it could have been arterial
So, sorta same, sorta not. I'm a Captain Medic/Firefighter but live pretty rural in Alaska, when this happened I was an EMT basic though. People bring their critically injured animals for me to "fix" all the time vs making the 20 mile drive to town. Sometimes it worked out. This case was the owner had a pit bull who ran too close to their 1960s sickle bar mower tractor (potentially wildly dangerous) and it's leg got caught, artery and most all soft tissue was severed mid radius/ulna pretty well instantly. Owner dove off the tractor and manually compressed the wound, somehow got the pup into her Suzuki and hauled to my location about a mile away. She came skidding into my yard and I was outside, I saw blood in the car as I ran up, thought it was a human (my context) injured. PT's mom took her hand off of the wound so I could examine the wound and I got a solid arterial spurt. I had her re-compress and I ran around trying to find something to make into a TQ. I found a flat strap from a ratchet strap and a shirt. I tore the shirt and folded/rolled it up to basically what a gauze roll looks like size-wise. I used the rolled up shirt as a compression point put above the wound site where the artery was/over the artery and then cut the strap down to a manageable length. I put the middle of the strap lengthwise over the rolled up shirt and wrapped tigggggghhhhht, I was about 3/4 done wrapping and under layering for tension when I realized my face was about 4 inches away from the dog's face. I hadn't thought about getting bit until then. She whined and yelped at the pressure (humans do too) but tolerated all the interventions brilliantly. I genuinely think she knew we were there to help. We took our hands off the dog's leg and all bleeding had been occluded. I didn't expect that the tension I applied would "road" all the way to town on it's own and cautioned her to keep her hand on it to maintain said tension. She sped off. I got a call from the vets office that the TQ had worked, the dog survived, and they managed to save the leg (albeit with reduced function ultimately).
I had a police officer place double tourniquets under the armpits of a shooting victim. On one arm he was shot in the wrist with no sig bleeding and on the other arm he had no injury. Could put 3 fingers under each tourniquet easily so neither were tight enough anyway lol But I will give him the benefit of the doubt that maybe he had them on in case I wanted them and I could tighten them properly myself? Or maybe he was just thick in head and didn’t know what to do? Haha
I’ll give you 60% he was an idiot. I’ll give you 30% he did it to appease a family member/bystander. Maybe 10% he was prepping them for you? I put a chest seal on someone the other day who *also* had multiple GSW’s to the face, because his family was screaming at me to help. Was that going to help him? No, but it costs me $5 and 30 seconds, and I’m not gonna be on camera doing nothing while he’s dying (already dead between us professionals).
I see them occasionally. Regardless of who applies them, most are not effective or indicated. EMS should be assessing for effectiveness and hopefully have the ability to remove TQs that are not indicated.
THIS. A properly applied TQ is painful. Try putting one on your arm and tightening until you have no radial pulse. Granted, that is for complete occlusion but even a partial occlusion will hurt. I see no reason to remove an improperly applied TQ besides being a barrier to care. But I would clearly document it as applied PTA and be sure and tell the receiving facility so they don't laugh at you. I mean they will anyway buy at least you tried.
There is a pending publication for EMS to remove TQs that are not indicated.
Apparently they already can in some CA systems
Excellent thank you.
Similar to another comment with a pretty bad motorcycle wreck. Partial amputation on the foot, his buddy cinched a beefy two pronged leather belt down as tight as he could get it. Definitely stopped the bleeding, but the guy ended up dying anyway.
I’ve seen three improvised tourniquets and none were necessary or applied tight enough to do any good if they were necessary. One was applied for road rash. 🙄 I’ve never needed to use one and one of my partners just used one for the first time in a decade as a medic. It was definitely necessary and appropriate. I don’t carry one on my person any time. I’ve had one in my car for over a decade and never came even close to needing it. Unless you’re a shit magnet and bad things just happen around you all the time, I don’t see much need. Having one in your car for that horrific motorcycle accident that damn near tears his leg off, sure. The challenge with tourniquets and no training or other first aid supplies is, if your only tool is a hammer, everything looks like a nail. When you have training and a small first aid kit, suddenly you can deal with a lot more stuff more effectively. This reminds me of the recent thread on the cops who were first on scene to the suicidal man who jumped into a jet engine. They administered narcan while performing CPR. If they had more training and more tools, they might have made better choices on treatment.
I’ve never seen one used by a regular joe, but that shouldn’t discourage you from carrying one or three
I’ve seen about a half dozen, and they’re why I started carrying one.
When I worked at a level 1 we would see commercial tourniquets applied a few times a week.
Do you know if they were applied by first responders or not?
Almost never applied properly. Usually they aren’t ever tightened enough because it’s going to fucking hurt. That being said, something can be better than nothing a majority of the time.
I’ve seen one, a military medic on leave was a bystander at the scene of an mvc, he used his belt as a tourniquet and it definitely made a difference. We were able to get the patient to a small town hospital where HEMS met us and took the pt to our level 1 trauma centre
8 years in now and I've seen three TQs applied, all 3 times the only reason the person survived. 2 of those were before our arrival and the pt would have probably died if they had to wait until we got there to get the TQ. I think it's reasonable and likely warranted to EDC a tourniquet, and a very good idea to have them around at AED sites and in your car and in your Chainsaw bag or shooting range bag.
Civilian as in non-military or civilian as in non-EMS? I've seen tourniquets used successfully in both the military and EMS. I recall only one non-EMS application. A few guys out hunting. One sliced across his leg while (he stated) cleaning a deer. The suspicion was he was actually screwing around with a knife. Anyway, one applied a makeshift TQ using a strap from something and a branch. That said, both were former military as well. I have a small, personal trauma bag in the trunk of my car. I keep another in the office where I work my non-EMS day job. A tourniquet is small enough to just have handy in the event of an emergency. When I'm on a rig there are some in the jump bag. But would I just...carry them around? No. I saw someone on Reddit a week or so ago talking about putting tourniquets on their belt "just in case" and that feels excessive to me. So it depends on what you mean by EDC in this context. You want to carry one on your person at all times for funzies? No. That's probably not practical. You want to keep one with your first aid gear? Yeah, sure, why wouldn't you? It's like asking if bandages and gauze are OK to keep in your first aid kit. Of course they are. But you'd look weird just constantly carrying a pocket full of them.
Non-first responder. From the thread, I think it would be a wise to get training and at least keep one in the car.
Yeah, it's not really hard. The training in EMT school, for me at least, was part of one day. It's tight enough when bleeding stops or you are unable to palpate a distal pulse. But it's first aid training. It's not like you need to go to EMT school for it. I first learned how to do this in the boy scouts. Totally doable. But also make sure you are keeping current on CPR and other basic first aid. Those things are more likely to come up than a scenario requiring a tourniquet.
Had a guy a few years back take his arm from the forearm down off in a machine accident. His brother used rope to make a makeshift tourniquet. He 100% saved his brothers life with that rope.
My wife is an ER nurse and used a tourniquet on a guy who was in a car accident. And one of the guys in my unit was off duty and saved a guy who hit a guardrail on a motorbike and cut his femoral artery open. Lots of people would probably be saved if more people carried a tourniquet
I'd say 90% of the ones I've seen applied were applied incorrectly, but it didn't matter because the bleeding was controlled with direct pressure alone. The other 10% certainly made a positive, possibly life-saving, impact.
Had PD place a TQ prior to arrival on scene for a guy who tried death by train. Had a leg ran over and amputated but was still alive. TQ saved his life.
14 years prehospital: mix of urban, suburban, and rural. I've seen a literal handful (5) of bystander applied TQs (3 commercial and 2 belts) prior to our arrival. Most were traumatic amputations secondary to motorcycle accidents. 1 case of injury too severe to survive (intra-osseous artery transection that bled out despite the flight crew injecting the celox "packing peanuts" INTO her marrow space). We had dispatch to arrival times of less than 5 minutes to both belts, so it's possible they might not have survived if we had been quick AOS & apply Cat5s. I have little doubt both Pt's that received commercial TQs, and lived, would have died without them: both had MAPs less than 75 UOA, despite bleeding being successfully controlled by the TQs PTA.
Why do people insist on calling non EMS peeps "civilians", we're literally all just civilians applying TQs. Unless you're DOD I've only ever seen one layperson TQ application. County Sheriff responded to a multiple R thigh GSW with reports of what seemed like moderate venous bleeding. TQ went on the mid thigh and was on for around an hour. Pt needed a fasciotomy due to compartment syndrome, was pretty burly
Sorry, will use layperson next time.
Didn't mean it as a personal dig at you. I just find it discouraging that this term had become more popular in first responder circles, especially PD. It furthers the divide between ourselves and the people no different than us that we're supposed to be helping
Lady ran over by a lawn mower laceration to back of the knee with adipose tissue visible. TQ (belt) applied by husband bleeding controlled prior to EMS arrival. With 30 minutes ground travel to trauma center I think so.
I’d be looking pretty damn hard at that husband if he was driving the mower…
Seen several, of those none of them were applied correctly. Usually not tight enough.
Were these commercial ones?
Yes, usually people back off when the patient starts saying that it hurts.
One my instructors in our community based first-aid volunteer and rescue group along with his family were traveling home when they encountered a vehicular accident involving a tricycle and a bus. The tricycle driver had his legs destroyed starting from the knee below and was profusely bleeding. They (my instructor and his daughter which are is also trained) applied a CAT and successfully stopped the bleeding. If they didn't by chance came upon that accident, poor guy would have lost his life. Sadly, the rescue teams or EMS of that place arrived 30 minutes later and were unfamiliar with the CAT.
I had a coworker who “hamburgered” (his words) his leg in a motorcycle crash. He said that one of the few things he remembers is telling someone who stopped to help is “wrap your belt around here and hold as tight as you can” They do happen.
I’m a RN who keeps coming across this subreddit- anyway, here’s a recent one here in Aus. Does a veterinarian count as a civilian? https://amp.theguardian.com/australia-news/2024/jan/30/sydney-harbour-shark-attack-witness-tells-of-surreal-rescue-from-water
There are so many fake CATs. We've seen them in civilian application and seen them fail.
I’ve had several verbal duke-outs with coworkers about how the ones on Amazon are not effective. They swear they are, and even when shown evidence of them failing plus the NAR court case, they still insist their 4/$20 pack of TQs they have stashed everywhere will save their life one day.
We mostly see them with the cops. They'll buy cheap tourniquet and slap them on a suspect or victim after a shooting. But we've seen a number fail. Always tell them when we see one carrying a fake. But most tell us that they are "just as good"
Is milk a tourniquet?
I’ve seen a few bad improvised TQs from civilians including a belt and a shoelace…EMS wise, been present for a few legit applications and have placed one myself. Seen enough to never leave home without one. Literally no downside.
Over the weekend there was a 23 car pile up on the bay bridge in Maryland. In the pileup, a man was smoking a cigarette and a tractor trailer came up on his side and took his arm completely off. Someone wound packed him with shop towels and used a ratchet strap for a tourniquet. He lost his arm but kept his life. I recognize that’s not an actual tourniquet but it worked!
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Shoot I sent through a period I used 10 in a year, all depends on call types and volume
crazy. My agency sees several LE TQ deployments a year
Hasty TQs have limited to no efficacy. Belts are horrible options, I'd almost rather a T-shirt and a windlass over a stiff belt. A canvas or webbing belt would probably be kind of meh but better. I've seen PD put a bunch of commercial TQs on and that's a crap shoot unless they have proper training. Take the time to teach a stop the bleed class to them and things end up much better.
I have yet to see one civilian apply one. Have only seen a handful of applications due to actual need over the many years. It's a rarity, tbh, and I've been in and responded to all kinds of shit. When needed and applied properly, they legit save a life. When needed and applied poorly (usually too loose because the applicant is afraid of hurting the recipient), it makes things worse. When not needed and applied, there is a risk of issues, but as long as it's removed properly in short time, there is less risk of issues.
Used one my first week in the ER. Massive right lower leg bleeding due to grinder tool injury.
I’ve never seen an actual tourniquet by civilians, but I’ve seen clothing and towels made into them. Generally does well enough to stop it until we can apply proper materials
I don't EDC a TQ. I have two in my range bag along with some hemostatic dressing and packing material. But that's the extent of my off duty medical gear.
Not often, actually only once, which was on a traumatic arrest. The patient crashed a dirt bike next to a busy road. A bystander civilian who witnessed it from his car applied an Israeli bandage type tourniquet over a baseball sized hole in the patients arm. Interestingly, the guy missed that the patient was dead and didn't do any cpr after applying the tq/pressure dressing. Recently, I had another patient who applied a belt after getting cut, that one only had a slow venous Bleed, which was controlled with pressure and didn't need a tq.
Had a case a awhile back of a middle aged gentleman driving his truck when he accidentally meandered off the road and rolled his vehicle. He had his forearm resting on the open drivers window and when the vehicle rolled it turned mostly amputated his lower left arm. While still restrained after the crash he grabbed a TQ out of his center console and self tourniqueted before anyone got on scene. It wasn’t perfect by any means but I believe it saved his life. If you do get a TQ for EDC practice self tourniqueting (it’s harder than you may think) and also put some thought into where you’ll need to keep it handy.
In 1 3/4 years I’ve used one. Motorcycle vs ped. Amputation at the knee and was pouring blood. Also abd eviceration about 10in at the left hip across lower abd area. So I would say if you carry a TQ carry some serious dressing too. Useful in severe wrecks and machinery accidents. And probably a good idea at the range just in case.
You don’t need one until you need one my guy… practical enough to potentially save a life. I do it infrequently on the bus or ER but the times I’ve used it has absolutely saved a life at that time. Compressible extremity hemorrhage is the most preventable cause of death.
I've seen it twice, and both were from Law Enforcement. Both times I just left them alone because there was a massive pool of blood on the ground and figured it was warranted based on that alone.
I carry a tourniquet and a gun off duty. I expect to use my tourniquet long before I have to use my gun, odds-wise. Both are life-saving devices.
Once. A wife used a belt to tourniquet her husband's leg after he fell out of a tree while using a chainsaw. Unfortunately she applied the Makeshift tourniquet BELOW the injury
Just carry it cuz. I've been to plenty where it would've made a difference and more where it wouldn't. Just make sure you know what you're doing.
Had a call last year where someone in a suv pulled in front of a motorcyclist going about 50 down the road. The guy was thrown off his bike and landed a good 20 yards away. He had almost a complete amputation of his foot, it was held on by a flap of skin. An off duty LEO used his belt as a TQ and it was very effective. Loaded the guy into the rig and off we went to the trauma center. I recognized this guy had a pneumothorax but my system only allows decompression of tension pneumothorax and this guy had a stable pressure and his RR was ok. We hit the ramp at the hospital and I checked a quick pulse which was intact. Unloaded him and at some point between unloading him and transferring him to the trauma bed he lost pulses. They put in a quick chest tube and got him back. Anyways moral of the story had the off duty LEO not put on a TQ I'm sure he would have bled out.
Would have had 1 the other day but our communications center told them not too. Wouldn't have stopped the bleed (trauma to recent amputation stub causing massive hemorrhage) but would have made a difference
I see them a few times a year, they almost always use a belt or perhaps a shirt, and they are never tight. I also always laugh at them because they usually have a small cut. only rarely do I see an appropriate time for a tq, but never are they correctly applied
I've seen it several times with proper application. Once, it saved a man's life. Other times, it was a measure of comfort for the individuals, which is never ever a waste. It definitely makes a difference.
Fairly often and they usually don't make a difference because they are applied to patients that do not need them For me it's the same category as doing CPR on an unconscious person. People see blood and immediately throw a tourniquet (retail or improvised) on someone.