Improvised Tourniquets

belt

I’ve received a couple of comments about a previous article and I think it is important that I put my Can a Watch Tell More Than Time? article in context. The gist of the article is that the material things that I choose to fill my life with are not single-function items, i.e. a watch just as a watch or a belt solely as a belt. One important aspect that may have been lost is the depth to which I go to ensure my choices fit my lifestyle. Since the comments dealt specifically with using my belt in combination with my carabiner as a tourniquet, let’s talk about the belt that I wear and how it can be used effectively.

As I write this I am watching sunrise over Taylor Ranch, nestled in the hills outside of Asheville, North Carolina, while enjoying the final day of presenting at Overland Expo East. Lined up before me, a short distance away across the lake, I can see the Land Rover staging area: Rovers of all shapes, sizes, and ages lining up to make a run at the offroad obstacle and skills course. They’re sparkly clean right now. I doubt they will return that way.   The obstacle and skills course is modeled off of the famous Camel Trophy competitions from years past – people will be pushing these vehicles to their operational limits through the meaty red clay, across the clear mountain water, and over obstacle after obstacle of felled mountain elm. Winches will be used. Fording will be attempted. And recovery operations will linger on throughout the day. Without question I can look across the lake and see that the vehicles are more than equipped to handle the circumstances they will be asked to face…how about the people? I see plenty of Arcteryx, lots of Kuhl, and it looks like a Patagonia bomb was dropped after I left last night, but of the hundreds of people I see I can’t find one single individual carrying a tourniquet. Maybe they’re hidden away in the sleek Ex Officio bags, but none are catching the eye. Hence: my belt. But we’ll circle back to that in a bit.

A writing teacher taught me never to invent my own words if someone else has already said it better, so in keeping with that rule here is an excerpt from “Effectiveness of self-applied tourniquets in human volunteers” published in Prehospital Emergency Care 2005 Oct-Dec; 9 (4): 416-22:

Tourniquet use in extremity trauma is familiar to military field medical personnel, and the tourniquet is frequently a lifesaver in combat medicine around world. The controversy regarding the use of tourniquets is, however, a subject of active debate. Despite their known benefit and relative lack of complications from use in military situations, the devices are aseen as a last resort for control of hemorrhage in civilian prehospital care. Though exsanguinating extremity hemorrhage is uncommon in civilian practice, tourniquets can still play a role in the prehospital care of severely injured patients who fail other methods of hemorrhage control, especially in remote or austere environments where transport times to definitive surgical hemorrhage control are prolonged.

If you read the study you will find that they tested a total of seven different commercially available tourniquets, and of those tested three were found to be 100% effective, per their study standards. Of those three, one is the Combat Application Tourniquet, or CAT, that I carry in all of my vehicles, in each of my designated medical bags, and in any pack or bag that I happen to be carrying around. If you’ve attended a GC shooting course you have been issued a CAT and taught how to use it. Use of the CAT tourniquet, along with direct pressure, is my go-to move in medical trauma situations where it is necessary. When available I will always choose to use the CAT first.

But I don’t always carry one – I can’t always fit one in my pocket, and the profile of the CAT doesn’t always “mesh” with the profile I am presenting. Therefore I have a back-up: the NATO tourniquet. The NATO tourniquet is a smaller profile, easily concealable, lower profile choice. I always have a NATO tourniquet on me. Always. Regardless of clothing choice, environment, or circumstances. Always. In the absence of my CAT tourniquet, I will always choose to use the NATO tourniquet.

The Land Rovers have headed out, over the hill, into the wild. Exploring.

Extremity injury is common in wilderness medicine, where injuries can occur to isolated individuals far from even basic emergency medical services. An accessible, east-to-apply, effective tourniquet can be lifesaving in these situations in the face of severe extremity hemorrhage. Rural and farm machinery accidents represent other potential applications for tourniquets in civilian prehospital care. These incidents frequently involve long transport times and mangled extremities with severe blood loss (“Effectiveness of self-applied tourniquets in human volunteers published in Prehospital Emergency Care 2005 Oct-Dec; 9 (4): 416-22)

My perch at the lake, watching and writing, is 13 miles by air from the closest hospital, which is only a Level II Trauma Center. It is close to 100 miles to a Level I. And we are alone. In the wild. With heavy churning vehicles measured by the tonne, and cables as fat as my thumb measured by the foot, cranking, tires churning deep in the mud measured by pounds per inch, with men and women – shoveling, pulling, laughing, dirty, smiling – measured in life by the second.

Pierre Rouzier, a staff physician at UMass, was in the epicenter of Boston Marathon bombings, treating people, everyone, as well as he and others could. Here is an excerpt from a great article in The Massachusetts Daily Collegian,

Last June, every time his wife dragged him out shopping to a department store, Rouzier would venture off to the men’s belt section. He’d look for a webbed belt with a two-ring buckle that he could stitch across. In his own words, he was looking for a belt that could be used as the perfect tourniquet.

“I was on a mission,” Rouzier said. “I was like, ‘I’m going to find the right belt.’

A lot has changed in the year that’s passed since last April’s Boston Marathon bombings. One thing that hasn’t changed, though, is Rouzier’s passion to help others. That’s why he immediately jumped to attention when that truck made a loud sound near his home as he instinctively wondered how he could help. That’s why he shopped for that belt and why he even bought a pair of cargo pants with bigger pockets so he can stash more things. (Read full article)

I wear my leather belt not because it is fashionable and definitely not because it matches my shoes. I wear it because it can save a life. I wear it because in the absence of my NATO and CAT tourniquets, I will always choose to use my belt, with my carabiner as a windlass. They are not a replacement for my professionally manufactured tourniquets. It’s clear that the tried, true, and tested tourniquets are my go-to moves, straight out of the gate. Every time. But what other options do we have? I choose to set myself up for success by choosing a belt that, when properly applied and in combination with direct pressure, is likely to save a life.

Doing nothing has never saved anyone.

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