Self Defense Medicine Session 3: Tourniquets: Overview

Now let's look at tourniquets. Tourniquets are your first line defense against moderate to sever bleeding out if the arms or legs. The body has only got about five and a half to six liters of blood in it, and if the blood spills out of the ground, well we can't scoop it back up and put it back in so we've got to maintain that blood and keep that blood inside the body. Tourniquets are a very very good way to do this. Now there are different types of tourniquets out there in the market, some are better than others, but today we're going to talk about the Combat Application Tourniquet and the Soft T Wide tourniquet.

Okay, now- What does a tourniquet do? Well let's talk about that for a second. A tourniquet is a mechanical device that restricts or limits the amount of blood flowing through the arms or legs through those arteries and veins. Now some people will say, "Oh well if I don't have a tourniquet I'll just use an improvised tourniquet". You really shouldn't be planning to improvise your medical equipment, okay.

You don't exactly improvise and plan on improvising your defensive tools, do you? No. So you make plans and you get in the mind set of, "I want to make sure I have the right tools on my person for when I need them." Same thing with a tourniquet, okay. Now first tourniquets we've got here are the Soft T Wides, we've got two different colors of them. You notice we've got the black one here and the blue one.

The blue is designated blue for our training tourniquet, all right. We've to our C-A-T or the Combat Application Tourniquet in this one here. We'll talk about the pros and cons of both, and how we actually use them. All right. The Soft T Wide...

Excuse me, talk about the Soft T Wide, the reason and necessity for a training tourniquet is because these, these tools were designed for a one time use only, okay. They weren't designed to be put on and taken off, put on and taken off several times okay. Now you can probably, with your, a real world tourniquet, get by with maybe applying it 10, 15 times during training. More than that though, you run the chance of it deteriorating because don't forget these are man made devices okay, they have a failure point. We've actually came across one of our tourniquets in training class, that after approximately 250 applications on a mannequin and on role players, it finally started to tear and break apart, we've had different, with different types of tourniquets.

Well... So please keep in mind that if you're going to use your real world tourniquet, only use it maybe about 10 times or so, all right. But talking about the Soft T Wide okay, how this works, well the part of the tourniquet, first let's look at that. I'll use the training one here, that blue will be easier to see. The parts...

This is a windlass tourniquet. We've got our, the windlass here, this metal bar here that spins clockwise or counter clockwise. We've got the metal buckle here, if you look there's two parts to the buckle. You can take up the slack by pulling on the strap here, the tail in, we're loosening it. You can also take the buckle and push it on the flat side and it comes off, so that way you can wrap it around the leg or arm or what need, what have you and then to reapply it you simple hook it back on there and pull it till you feel a metallic click.

You've got the tail here and also on the edge of the tail you've got this time stamp we're you can take your sharpy or a pencil or your marker and actually put what time you applied the tourniquet. We'll talk about why that's important. On the other side... The rest of it here, this loop here, we just call that the loop. The other side- the undercarriage here, this black rectangle piece here, they call that the base, and last but not least we have this plastic triangle here, that's actually your anchoring device.

Now looking at the way it differentiates from say the- that's the Soft T Wide. The C-A-T, or the Combat Application Tourniquet, it's a windlass tourniquet as well. It's got this, the windlass bar here, it's got your two anchoring devices here, there are one on each side, all right. We've also got a buckle. Now there's...

This buckle is a little bit different in that you've got two little slots that the tail can go through, so we're going to prepare this for our one handed use if we need, for one handed use for kind of our worst case scenario. As you'll notice, I'm putting it through that first, that bottom slot there and simply pulling it over onto itself okay, and then simply folding it back up underneath itself okay, and then I can store this configuration. All right. However, if I need to apply this to the legs, I actually have to go through that first slot and the also the second slot so that way not only is the Velcro engaged, that anchors and locks down that strap and the rest of the loop. To prep the Soft T Wide, the same type of thing, I'm going to make sure that the loop is just a little bit longer, then the, excuse me, the tail is a little bit longer than the loop, and then I've pulled all the slack out of this, out of the base here.

If you notice okay, it can slide through there pretty easily. Make sure you've pulled it tight, place the windlass bar in line with the base and simply just roll this up underneath it and then you have it ready to deploy, it's easy to deploy that way. So let's talk about different ways you can carry it. Well obviously there's, like I said, several different tourniquets out there in the market. Some are better than others.

It starts with your mind set, are you prepared today to defend yourself? Your family? Your loved ones? Sure. Well then you should also be prepared to render aid if need be, so sure, there's you know, tourniquets that'll fit in your back pocket and hey they're easy to carry, but are those really the ones you want to risk your life on, versus hey, something that may be a little bit bigger and maybe have to rethink about if whether I'm using the ankle med kit or how I carry that IFAK, whether it's in my bag in my vehicle or if it's in a, you know, the wife's carrying it in her hand bag or what not, whatever the case may be, but we, how will we carry that, we want to make sure that we've carried, we're carrying a configuration that it's readily available and also we can apply in one handed with either hand.

Let's talk about how we train with them, or why we should train with them. Just like anything else, we've got to practice makes perfect. We talked a little bit about, yes you should have a training tourniquet. I highly recommend that, you get a training tourniquet and that way you're not relying upon your Rummel tourniquet every time you go practice with you or your family or your loved ones or your buddies. Now the Combat Application Tourniquet comes in blue as well, you can get either one in a blue tourniquet.

Just make sure , hey that blue one is specifically for training only, and we don't get the two confused. As far as training how do we, "How tight should we put this on?". Well first off, we're going to talk about application in a moment but whenever you're putting this, applying this on, when you turn that windlass you should probably turn it till it's just a little bit snug, okay. We talk about taking up all the slack, when you turn that windlass, give it one or two turns until it gets a little snug, then when you anchor it down you can probably, for training purposes you can probably leave it on for about 10 to 15 minutes, okay. In a real world application you can actually leave a tourniquet on for six to eight hours, okay, and that brings up some other things we need to talk about.

There's this big myth that tourniquets are your last resort, well for years they've been teaching this and telling EMT's and paramedics and doctors and nurses and even service members and soldiers that, "Hey, a tourniquet is your last resort." They used to say, "Well okay, the first thing we're going to do is we're going to apply direct pressure and if that doesn't work then we're going to apply pressure to a pressure point, and if that doesn't work then we're going to elevate that wound or that injury above, or that limb, above the heart, and if that fails, we've tried everything else, then we'll use a tourniquet." Well, we don't always ask, "Why do, why do we have to apply a tourniquet?" Well because they work. Well okay, why take up all that time? Remember the patient is still bleeding out. We don't really have time for trail and error and to see what works and what doesn't, so let's go and put that tourniquet up front, so the tourniquet is your first line defense against any moderate to severe bleeding, okay. Now some myths that we hear, well what's- Some myths that we hear is, "Oh you'll lose the limb", that's one thing everybody is worried about, like "Oh well you've got to get that blood and the oxygen to the limb or otherwise you'll lose it." Well no, not really.

We've learned after two wars on two different fronts for over a dozen years, okay, we've learned some things. Now these things have, and we learned to debunk these myths, these things that we've learned have come to us at great expense, so I want you guys at home to please keep that at the back of your mind, there's some empty chairs around dining room tables across America in or out of our life forces because we didn't have this stuff back when Iraq and Afghanistan first kicked off. So we know that the six to eight hours, well we can leave these things on, these tourniquets on for six to eight hours. "Well what happens after six to eight hours?" After six to eight hours at the cellular level of the body, the tissue and the cells start breaking down. They start giving off some toxic gases and some toxic...

They're just toxins and that's really bad, so we don't want to loosen that tourniquet up either once we've applied it, cause then we might start circulating some of those, those bad toxins throughout the body or well, "What happens when blood gets exposed to air?" Well it becomes a clot. Well if we start letting some of, if we start letting, turning the tourniquet loose and loosening up that tourniquet well, or taking it off too soon, we might start circulating some of those clots to the body and that could cause some serious problems later on or immediately, so once the tourniquet goes on, you tie it up as tight as you can and then you start turning that windlass and you turn the windlass until the bleeding stops, okay. But for training I want you guys to actually just turn it, give it two or three turns until it gets a little snug and then anchor it and for training purposes only, leave it on for about 10 to 15 minutes max, okay. Cause think about that, "Why 10 to 15 minutes?", well we already know that's it's going to take 12 to, excuse me, nine to 12 minutes for that ambulance to get there but let's add on another few minutes because hey, it's been a violent altercation and we have to wait till law enforcement and let them do their job and make sure the scene is safe for everybody to enter it. So we've got the Combat Application Tourniquet, we've got the Soft T Wide, and we've got the Soft T Wide trainer.

If you're serious about self defense medicine, you should be carrying a tourniquet on your person at all times. Don't forget, tourniquets are your first defense against moderate to severe bleeding out of the arms and legs.