# Bleeding control



## bburnette252 (Jul 29, 2014)

Alright call me a noob or squirrel or whatever makes you happy but I have a question. 

I'm working on a very small IFAK for my EDC. I want it small enough to fit in a cargo pocket. I watched a training video where they discussed during an active shooter event, if you or family/friend get shot that you could very well bleed out before the scene is declared safe by LEOs and EMS can enter. So therefore I want a small kit to stop bleeding. 

Unfortunately a Combat tourniquet is big and bulky, so do you think a IV tourniquet (like we use when starting IVs) would control bleeding for at least a little while? I know it would hurt like a mother because it's not very wide but it beats dying. 

Of course it's gonna have some 4x4s and other random blood stoppers but give me ideas if you got them.


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## vcuemt (Jul 29, 2014)

bburnette252 said:


> Alright call me a noob or squirrel or whatever makes you happy but I have a question.
> 
> I'm working on a very small IFAK for my EDC. I want it small enough to fit in a cargo pocket. I watched a training video where they discussed during an active shooter event, if you or family/friend get shot that you could very well bleed out before the scene is declared safe by LEOs and EMS can enter. So therefore I want a small kit to stop bleeding.
> 
> ...



A combat tourniquet is big and bulky? It can fit in my pocket.

But to answer your question: cravats.


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## bburnette252 (Jul 29, 2014)

vcuemt said:


> Combat tourniquet is big and bulky? It can fit in my pocket.




True it can but I really don't wanna have to carry it daily.


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## teedubbyaw (Jul 29, 2014)

I've seen the reusable IV constriction bands where you pull to tighten. 
http://www.dixieems.com/Single-Hand...s&par=104&catname=Prep+Supplies&cp=2&pid=1786

It would probably do the job, but I'd find one made out of a cloth.


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## bburnette252 (Jul 29, 2014)

vcuemt said:


> A combat tourniquet is big and bulky? It can fit in my pocket.
> 
> But to answer your question: cravats.




Good thinking, I'll throw a triangle bandage in there and make it work


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## bburnette252 (Jul 29, 2014)

teedubbyaw said:


> I've seen the reusable IV constriction bands where you pull to tighten.
> http://www.dixieems.com/Single-Hand...s&par=104&catname=Prep+Supplies&cp=2&pid=1786
> 
> It would probably do the job, but I'd find one made out of a cloth.




I agree, cloth would be best. Them rubber tourniquets suck


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## rmabrey (Jul 29, 2014)

Just wear a belt that will work as a tourniquet. Problem solved. Then you dont have to carry a kit around for the 0.2% chance you have at being involved in an active shooter situation.


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## bburnette252 (Jul 29, 2014)

rmabrey said:


> Just wear a belt that will work as a tourniquet. Problem solved. Then you dont have to carry a kit around for the 0.2% chance you have at being involved in an active shooter situation.




I tend to agree with you but anymore I'd say the chances are greater than 0.2%. 

Especially the places I hang out lol.


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## STXmedic (Jul 29, 2014)

You want to put together an IFAK, but a tourniquet is too big? Tourniquets easily fit in your cargo pockets without you even realizing they're there. Every street officer in our police department is required to carry a tourniquet on duty, and many of them carry two. If you want something that's effective, get a commercial tourniquet. If you want something you'll fumble with and likely fail with while you're bleeding out, get a cravat. There's a reason the military and EMS systems don't use cravats (or IV tourniquets ).

Edit: I'll take a look for the various studies that show improvised tourniquets are worthless.


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## Carlos Danger (Jul 29, 2014)

bburnette252 said:


> I watched a training video where they discussed during an active shooter event, if you or family/friend get shot that *you could very well bleed out before the scene is declared safe by LEOs and EMS can enter.* So therefore I want a small kit to stop bleeding.



Rapid exsanguination is not generally from isolated extremity injuries; bleeding from those can often be slowed dramatically by a combination of improvised devices and/or direct arterial pressure.  

It's the trunk injuries that get ya quickly. Nothing a tourniquet can do about those.


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## VFlutter (Jul 29, 2014)

bburnette252 said:


> so do you think a IV tourniquet (like we use when starting IVs) would control bleeding for at least a little while? I know it would hurt like a mother because it's not very wide but it beats dying.



Does your patient lose distal pulses or get mottled when you start an IV? Does an IV tourniquet tamponade venous flow, arterial, or both? What type of bleed are you likely to exsanguinate from?


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## rwik123 (Jul 31, 2014)

The SWAT-T TQ might fit your bill. It's pretty compact but then again a CAT is pretty small too. You're disillusioned if you think an IV rubber TQ will stop arterial bleeding.


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## Handsome Robb (Jul 31, 2014)

I can vouch for the SWAT-T from personal experience. It's small, easy to use and apply and is effective. I've used it effectively multiple times but the most "memorable" was on a popliteal artery bleed secondary to a GSW on a patient who weighed 450#. Had to use two but they held.


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## bburnette252 (Jul 31, 2014)

Handsome Robb said:


> I can vouch for the SWAT-T from personal experience. It's small, easy to use and apply and is effective. I've used it effectively on a popliteal artery bleed on a patient who weighed 450#. Had to use two but they held.




That's good to hear, I heard some bad reviews on them but this is somewhat reassuring. I might pick one up someday but for now I bought the CavArms TQ for my EDC and I keep the handy dandy CATs in my jump bag


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## Handsome Robb (Jul 31, 2014)

bburnette252 said:


> That's good to hear, I heard some bad reviews on them but this is somewhat reassuring. I might pick one up someday but for now I bought the CavArms TQ for my EDC and I keep the handy dandy CATs in my jump bag




They take two people to apply effectively in my experience. I've used them on 4 different occasions and all took two providers to apply but they do work. 

My biggest thing about the SWAT-T is you have options. You can use it as a TQ or use it as a pressure dressing. Just depends how and where you wrap it. 

My biggest piece of advice is take the extra 5-10 seconds to make sure it's not rolled around itself applying pressure over a tiny area.

Edit: our TEMS team uses the CAT with the SWAT-T as their third or fourth backup.


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## rwik123 (Aug 1, 2014)

A large majority of cops around me carry the SWAT due to its ability to lay flat behind a plate carrier or armor bundled with some quik-clot. I've only used one as a pressure dressing and it worked great. Probably wouldn't use one as a first line TQ if I had a CAT handy just due to the fact its not as secure as a locked off conventional TQ.


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## MackTheKnife (Aug 6, 2014)

*No to the iv tourniquet*



rwik123 said:


> The SWAT-T TQ might fit your bill. It's pretty compact but then again a CAT is pretty small too. You're disillusioned if you think an IV rubber TQ will stop arterial bleeding.



The SWAT-T or the CAT. The CAT is the default for military and isn't that big. An IV tourniquet is not a tourniquet. Exsanguination can happen very rapidly. It's the number one cause of preventable death on the battlefield. Don't compromise.


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## InNoViSiOn (Aug 9, 2014)

Read through the thread and I agree that the rubber IV TQ for EDC isn't practical and I wouldn't bet my life on it.  The Swat-t and a triangular bandage are both good suggestions. Another option might be the Tk4 TQ.  It isn't as effective as a CAT or SOFT-W, but is definitely more effective than an IV TQ and is just as compact.  The best option is the CAT since you can manipulate it one handed.  The SOFTT-W is nice because its extra wide and has aluminum buckles (the CAT is plastic). 

I carry this same kit on my person since I saw this video a couple years ago.    




I also have a IFAK in my backpack that I've carried for years that is usually with me that has a CAT and SOFTT-W and other things (israeli bandage, quickclot, gauze, SAM splints ect...)


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## Akulahawk (Aug 9, 2014)

A good friend of mine is a Corpsman and he teaches a First Aid class that basically specializes in what to do if you get shot. He's become a fan of the CAT, though he can use others. Normally he carries two of them and they really don't take up much room in his IFAK. All of the Marines he looked after also carried them... From what I've heard from him over the years, they worked really well.


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## WildlandEMT89 (Aug 10, 2014)

I have a cat and a couple of TK4s.
The TK4 is very compact (even more so than a cat) and fits in the palm of your hand. Both are very intuitive and can be used with one hand. One thing I would consider is that the cat will degrade over time when exposed to the elements, whereas the TK4 comes packaged and will be protect and in my mind last longer.


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## Tigger (Aug 10, 2014)

Our CATs come shrink-wrapped...


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## DesertMedic66 (Aug 10, 2014)

Tigger said:


> Our CATs come shrink-wrapped...



Same. Shrink wrapped and sometimes in a case with a belt loop


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## jwk (Aug 10, 2014)

Simple rubber IV tourniquets won't work since you can't get them tight enough to stop arterial flow.  They're too narrow and stretch too much, so they can't compress the surrounding tissue enough to stop forward flow.


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## InNoViSiOn (Aug 10, 2014)

The CAT WILL degrade since it has plastic components.  The SOFTT being made of aluminum, is more durable from the sun for obvious reasons.  I've been issued both but the CAT is the most widely issued TQ in the DoD. I've met many medics who swear by them and the fact you can manipulate it one handed easily (with a lil practice of coruse) is crucial... I also heard that the defense health agency issued a warning about the Tk4 that it is less effective then other TQ.  The SWAT-T is a great idea because it can act kind of like a improvised pressure dressing and they are affordable. This thread wasn't about how to properly apply a TQ or make an improvised one..  But knowing how to and being creative with what material is around if a dedicated TQ isn't present is invaluable... Fact is, nothing can beat a dedicated TQ and you should consider one if you are honestly concerned about it.  

On a side note.  Since your worried about an active shooter.  Consider getting your CCP and then definitely carry a IFAK once you carry a gun daily...


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## STXmedic (Aug 10, 2014)

WildlandEMT89 said:


> I have a cat and a couple of TK4s.
> The TK4 is very compact (even more so than a cat) and fits in the palm of your hand. Both are very intuitive and can be used with one hand. One thing I would consider is that the cat will degrade over time when exposed to the elements, whereas the TK4 comes packaged and will be protect and in my mind last longer.


That TK4 looks absolutely worthless. Would probably stop a decent veinous bleed, but I wouldn't trust it at all for an arterial bleed- especially a lower extremity arterial bleed.


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## mycrofft (Aug 25, 2014)

VENOUS TK (venipuncture) will speed up bleeding as it is designed to do. SHRINK WRAP slows your response, use a sandwich baggie wrapped with a couple strips of scotch tape. CRAVAT is great if you have time and the means to turn it (i.e., a pen or pencil will break) but not as fast or easy to secure. BP CUFF will do *on an extremity it is designed to fi*t,* if* it has strong and clean velcro; it can be used to buy time until another TK can be applied. If it is all you have, pump it til the bleeding stops then tape the cuff around a couple times (duct tape ok); if there's a leak at the bulb or tubing, crimp the tubing shut between the cuff and the leak by firmly doubling it over once or twice and taping it (a hemostat may cut the rubber), or use an umbilical clamp over one wrap of tape to protect rubber. TK and airway are your two items needing fast response, don't bury them in your kit.


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## Tigger (Aug 25, 2014)

We were recently forced to use a BP cuff after it became clear that a single CAT was not going to be adequate (the patient had some serious muscle definition in his arms). Until another tourniquet could be delivered (don't get me started), a cuff was used. While effective, it had to be constantly monitored as the patient had received a makeshift tourniquet very early on after a volunteer EMT that he was with decided it was the right course (she was right). The patient's BP never dropped below 150 systolic. To keep a well used BP cuff blown up higher than continuously is a labor intensive task.


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## MackTheKnife (Aug 25, 2014)

Duct tape rules!


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## OnceAnEMT (Aug 25, 2014)

MackTheKnife said:


> Duct tape rules!



Every ED Doc dislikes you.


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## MackTheKnife (Aug 25, 2014)

Grimes said:


> Every ED Doc dislikes you.


Up until recently, I was teaching TCCC. I told my students not to use medical tape. Duct tape was the cure-all, I told them. Sealing chest wounds, securing dressings/ splints, etc. And taping people's mouths shut. As for ED docs, oh well!


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## OnceAnEMT (Aug 25, 2014)

MackTheKnife said:


> Up until recently, I was teaching TCCC. I told my students not to use medical tape. Duct tape was the cure-all, I told them. Sealing chest wounds, securing dressings/ splints, etc. And taping people's mouths shut. As for ED docs, oh well!



I'm not saying duct tape isn't useless, I'm just saying I wouldn't be securing a tourniquet with tape.


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## MackTheKnife (Aug 25, 2014)

Grimes said:


> I'm not saying duct tape isn't useless, I'm just saying I wouldn't be securing a tourniquet with tape.


In the tactical environment, where you might be carrying or dragging your battle buddy, securing a tourniquet with duct tape might be advisable. Perhaps not on the street.


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## mycrofft (Aug 26, 2014)

Tigger said:


> We were recently forced to use a BP cuff after it became clear that a single CAT was not going to be adequate (the patient had some serious muscle definition in his arms). Until another tourniquet could be delivered (don't get me started), a cuff was used. While effective, it had to be constantly monitored as the patient had received a makeshift tourniquet very early on after a volunteer EMT that he was with decided it was the right course (she was right). The patient's BP never dropped below 150 systolic. To keep a well used BP cuff blown up higher than continuously is a labor intensive task.



True that. In actuality a pneumatic tourniquet such as is used in operating rooms is different than a BP cuff and running a couple turns of good strong tape over the bp cuff to hold the velcro shut is a work-around. It is one expedient alternate measure though. 

I also as a rookie carried a rubber penrose drain as a TK in my first EMT ammo box, but I also had a real one from a first aid kit. Luckily the heat turned the rubber drk brown first.

O.R. pnmeumatic TK:
http://jscvs.umin.ac.jp/syujutusyugitokaisetu_kekkan/images/2_(3)_figure3.jpg
And an article on "Tourniquets.org". (Wow, go figure!)
http://www.tourniquets.org/non_pneumatic.php


T, glad the case you cited worked out.


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## samiam (Aug 30, 2014)

If you want it to fit in a cargo pocket this is kinda cool. Its waterproof too (until you open it)

http://www.globalindustrial.com/p/s...gclid=CIfLxvmku8ACFeg7MgodOCcAJA&gclsrc=aw.ds


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## InNoViSiOn (Sep 10, 2014)

MackTheKnife said:


> In the tactical environment, where you might be carrying or dragging your battle buddy, securing a tourniquet with duct tape might be advisable. Perhaps not on the street.


That's why the Army invented it!
The medics in my company use duct tape as well (one was with the 2nd ranger battalion for 5 years and is very experienced).  They also use tape with 3M adhesive that works pretty well, but duct tape works better...


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## MonkeySquasher (Sep 12, 2014)

As others have said, a normal IV tourniquet wouldn't work.  I've never seen someone apply a cravat one-handed while frightened and bleeding, and I wouldn't expect them to, it's not very practical outside of testing purposes.  Not to mention trying to find a windlass strong enough.  I've attempted CATs a couple times with varied success, never played with the TK4s.  Some units in the military were using ratchet straps, due to needing something heavyduty that could fit around (and pressure through) large muscle mass.  So if you're looking for something to use in all possible situations one-handed and strong, I'd suggest a ratchet or two.


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## mycrofft (Sep 13, 2014)

samiam said:


> If you want it to fit in a cargo pocket this is kinda cool. Its waterproof too (until you open it)
> 
> http://www.globalindustrial.com/p/s...gclid=CIfLxvmku8ACFeg7MgodOCcAJA&gclsrc=aw.ds



If you carry pouches or anything like that in your pockets (or even in those out of the way compartments) over time, first put them in a *freezer ziplock polyethylene "baggie"* then use some tape to seal it and wrap it closely conformal to the inner pouch. You will avoid  breaching the factory seal because the freezer bag (not a regular bag) will take the abrasion. Remember you will be tearing it open, so don't tape it so securely you can't get into it!


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## samiam (Sep 13, 2014)

mycrofft said:


> If you carry pouches or anything like that in your pockets (or even in those out of the way compartments) over time, first put them in a *freezer ziplock polyethylene "baggie"* then use some tape to seal it and wrap it closely conformal to the inner pouch. You will avoid  breaching the factory seal because the freezer bag (not a regular bag) will take the abrasion. Remember you will be tearing it open, so don't tape it so securely you can't get into it!


If I recall correctly the pack I listed was double sealed. So for sterility you should be ok but for water a double bag is a good idea


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## mycrofft (Sep 13, 2014)

samiam said:


> If I recall correctly the pack I listed was double sealed. So for sterility you should be ok but for water a double bag is a good idea


It also keeps the printing from rubbing off. You can put a slip of paper on each side inside your baggie with the date for required inspection or replacement. If you turn in a ticket to central supply off of an opened item to get a replacement, put the ticket in there instead of taping itn to the item.


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