Tactical First Aid learning points

As I mentioned the other day Ry and I took a “Tactical First Aid” class. His mention of it is here.

This is not your standard first aid class. This is a class for dealing with traumatic injury. Heart attacks, drowning, choking, and even head injuries were not specifically addressed. I took this class to address the potential for gunshot and explosive injury at Boomershoot. The lessons learned are also applicable to automobile and industrial accidents.

There were some very interesting points made in class. Here are the ones that stuck in my mind:

  • One sentence summary of the class, “This is how you properly apply a tourniquet to stop the bleeding until expert help takes over.”
  • Poor tourniquets or ones applied incorrectly actually increase the bleeding.
  • Most bullet wounds are survivable. This includes some head and heart shots.
  • If you can survive most bullet wounds and keep fighting so can the bad guy.
  • Ballistic gelatin gives you a good idea how deep a bullet will penetrate a large muscle.
  • The tensile strength of Jell-O is not comparable to most tissues and hence the temporary stretch cavity observed in gelatin is meaningless when applied to the wounding of flesh.
  • If the victim will be in the hospital within two (and perhaps as long as six) hours the limb will not suffer permanent damage from the tourniquet.
  • Keep the victim very warm. Cold blood doesn’t clot well.
  • Don’t get hurt yourself. If someone has been deliberately injured (stabbed, shot, explosive injury, it doesn’t matter) you first job is to not get hurt yourself. Consider not giving aid or at least neutralizing the threat before giving aid and putting yourself at risk.
  • Direct pressure on an artery high on the limb can completely stop bleeding of an arm but not an adult leg.
  • Children are soft and squishy* and it is relatively easy to stop extremity bleeding.
  • Learn how carry and/or drag someone with and without help.
  • The Gabby Gifford shooting could have gone much worse due to misguided response by the police (details in private, not on the blog).
  • We got very, very lucky with the Boston Bombing (details available in private, not on the blog).
  • Use this tourniquet and this bandage after you get training.

*This was mentioned several times and I kept expecting to hear, “and tasty with ketchup.” I was disappointed but didn’t want to be known for contributing that to the conversation.


30 thoughts on “Tactical First Aid learning points

  1. Every time I’ve been taught about tourniquets, I’ve been taught that a proper tourniquet will pretty much guarantee an amputation below the tourniquet if any reasonable amount of time is going to lapse with the tourniquet applied.

    • This is not true. It depends on the tightness of the tourniquet, the length of time it is applied and the nature of the wound. They were used to great effect in the Gulf War and the Iraq War, and are being re-introduced in EMS in this country (I was originally taught the same thing when I entered this biz).

    • The Red Cross teaches this but it is wrong. Tourniquets are used all the time in the hospital for surgery. I had one on my leg for about an hour for knee surgery.

    • It’s absolutely, 100% wrong. The biggest danger is nerve damage, but the Army went with “all tourniquets all the time” for virtually all serious extremity wounds, and not only did the exsanguination death rate plummet, but there were NO amputations that weren’t the result of the original trauma recorded in the year long study period during the height of the fighting in Iraq (and very minor nerve damage, and only in extreme cases.)

      In fact, the current first aid doctrine for the Army is TQ everything. Pretty much all infantry are carrying multiples now, in multiple places on their body, for self-application.

      • Current Army Combat Lifesaver Training is continue the fight, move them to cover and get a tourniquet on it when you get the chance. Once the fight is over, then mess with pressure dressings and splints and anything else, and get them packed up for evac. (heavily paraphrased and simplified, of course)

        So, yeah, ditto. My flight vest always has 2, plus the built in goodies.

      • If you can “Keep the red stuff in and moving round and round, and the invisible stuff going in and out”, by and large, your casualty has a REALLY good chance of walking (or at least rolling) out of the hospital. Especially if you can get the trained professionals with the Big Bag of Toys on the Woo-Woo box to pick them up within an hour or so.

        Basically, a TK isn’t going to cause tissue necrosis for AT LEAST six hours.

        However, the old rule on leaving it in place once applied is still pretty good. Not just because it is often harder to reapply the (now slippery) TK again, but there is a thing called “reperfusion injury”, which is basically when there is no blood flow to an area for an extended period, the normal metabolic toxins built up in the area and not carried off (since there is no blood flow) can make Bad Things Happen when the area is suddenly restored to full circulation. (There are other factors involved in reperfusion injuries — this is the 30,000 foot level, at “C-A-T spells ‘cat'” pass.)

    • Fixed.


      It depends on your threat model. For the expected worse case (except burns) scenario at Boomershoot it was a 10. If you taking care of the elderly then a 1.

    • I don’t know why Joe mentions burns, there’s hardly any chance of that happening at the shoot. As he says, though, for treating gunshots or blast injuries, it was a 10. Outside the subject matter area, it isn’t quite a 1, but very low.

      The reason I say not quite a 1 is the instructor beat self-rescue and don’t trust EMS into our heads. I don’t want to republish class material but if you’re injured and bleeding on the street, you’re in way better shape if you take your care into your own hand(s) and stop the bleeding. The number of people that die in presence of EMS, where a TQ or even direct pressure on the wound would have saved them, is shocking and worrisome.

      • “I don’t know why Joe mentions burns…” says the guy who was the reason for the “real men don’t need eyebrows” saying on a boomershoot tee shirt.

  2. Was the (urban legend?) gunshot treatment “stuff a tampon in the hole” mentioned?

  3. One more thing — If the tourniquet doesn’t hurt real bad (and probably more than the original wound) then it isn’t tight enough.

    I heartily endorse carrying these things and getting training on how to use them, even if it is just youtube videos. I keep a blowout kit in every car in the family, because you see a lot of the same trauma in car accidents. I pray that everything in it will expire from old age before it gets used, but if you need it, you need it.

    • The number of out-of-package failures of TQs and bandages is quite high. Doing the demo bandage application, the instructor had two or three fail in a row, right out of the package. Two is one and one is none.

  4. I’m teaching our newbies how to apply an IBD today. You can tighten them up with a cleaning rod/stick./pencil to stop 95% of the bleeding you will encounter.

    • As a field expedient to having a proper TK, sure. But they developed things like the CAT and SOF-T in large part to address the problem of “The stick slipped!”

      • And “the stick broke!” and “how in the hell I manage to get shot in the one part of the forest with no sticks?!?”

  5. First couple of comments on that particular product at Amazon say they think it’s not the “REAL” NAR product, but a knock-off. Any comments or input by the class instructor? If they are the real deal, then those Amazon review comments need to be commented on and corrected / removed.

    • AFAIK, they are comparable. CAT is standard now in the military, so the training is more standardized. Cat fully applies faster under stress, because you aren’t fumbling with locking knobs and such. SOF-T is better for long transport situations… because it has locking knobs.
      They are really just two different philosophies on TQ. CAT is designed exactly as in the name — combat. It’s designed to be easily self-applied, to apply quickly, and get the job done with the minimum of action. SOF-T is designed more as a medic’s TQ, with more steps to full application, but also more safeguards.
      Overall, they are both comparable, because in the tactical situation of, “get it on, crank until the bleeder has stopped, strap it down, get moving” is really the same for both.

    • What Phelps says, with a caveat —

      The answer I have for you is based in two questions: Can you apply your tourniquet above the elbow of your strong arm with your weak hand only, and can you apply it above the knee on either leg with your strong hand only? If the answer to both questions is not emphatically “Yes!”, you have the wrong TK in your kit. Bonus confirmation — you can do the above with your eyes closed (NOT because you wouldn’t look if doing it for real — but to add difficulty to simulate skill degradation from pain).

      • And get a training version to do that with. First, because you can hurt yourself with the real one training with it, and two, because once you are applying it for training, it’s too iffy to keep as your primary TQ (these are single-use devices.)

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