Tourniquet and Hemostatic Agent use by Red Cross First Aid Trained Layperson

[QuackXP]

My first aid training consists of Red Cross First Aid/CPR/AED. As a Boy Scout and in high school I have learned first aid and CPR many times over but this was 15 yeas ago so last year took the Red Cross First Aid/CPR/AED course. I created a first aid kit that contanied gauze roller bandages, medical tape, a triangle bandage, cpr barrier, gloves, as well as band-aids and common OTC medications (Tylenol, ibuprofen, aspirin, benadryl).

More recently I have been reading about IFAK/Blowout Kits. The four basic parts of these seem to be a Tourniquet, Emergency/Pressure bandage, QuikClot Gauze and gloves.

Re-reading the Red Cross First Aid manual I came across this about tourniquets

In most areas, application of a tourniquet is considered to be a skill at the emergency medical technician (EMT) level or higher and requires proper training.

Then the manual goes onto describe the application of the tourniquet.

Similarly the manual addresses hemostatic agents:

Hemostatic agents generally are substances that speed clot formation by absorbing the excess moisture caused by the bleeding. Hemostatic agents are found in a variety of forms, including treated sponge or gauze pads and powder or granular forms. The powder or granular forms are poured directly on the bleeding vessel, then other hemostatic agents, such as gauze pads, are used in conjunction with direct pressure. Over-the-counter versions of hemostatic bandages are available in addition to hemostatic agents intended for use by professional rescuers. Some are more effective than others. However, because some types present a risk of further injury or tissue damage, the routine use of hemostatic agents in first aid settings is not recommended.

From my own research specifically relating to the QuikClot branded hemostatic agents the first generation powder presents specific risks such as burns, trouble cleaning the wound, and irritation of eyes. However based off what I have read about so far with the third generation gauze it is not prone to these issues and can be used in place of traditional gauze to help stop bleeding. Reading and watching some of the documentation about QuikClot gauze use I have notice they emphasize packing the gauze into the wound vs the Red Cross First Aid guidelines of covering the wound.

My question is do I need specific professional training in a tourniquet or QuikClot gauze to be able to use them properly or will the provided packaging instructions and my own research and training be sufficient to use them properly? Also what type of liability could I run into for using them on a third party without specific training?

[markm]

There was a funny story in General Discussion about some retard who'd stabbed himself in the thigh with some fag tactical auto knife in his pocket.... he'd busted out the tourniquet to treat this flesh wound.

I think tourniquets have become a fashion accessory in some cases.... Us civilians don't deal with limbs blode to bits from mines/IEDs. I supposed there's an outside chance that a tourniquet could be a valuable tool... but all that said... I have minimal life saving training, and none of it trauma... so... I'd be interested in what some of the medical trained guys say.

[Hmac]

I think tourniquets have become a fashion accessory in some cases....

[Kyohte]

I have some experience in this field, and I agree with the tourniquet assessment. Poorly applied tourniquets do nothing, and wrongly applied tourniquets do harm. That being said, it does not take that much training (certainly not EMT level) to successfully apply a tourniquet. As with all things, it is a perishable skill.

I agree with you on the quikclot gauze. The powder was nasty stuff; the gauze, on the other hand, work okay.

As far as carrying both items, gauze and tourniquets can both be improvised in an emergency (though the real thing will be more effective). I think the lay person would not likely use either well. Using gauze and pressure to stop bleeding and pack a wound isn't something I see most people doing. It's a very bloody process. We aren't talking just putting a gauze pad over a cut and taping it up, I don't feel the general public would be up to such a task. Tourniquets are less involved, but most people would not know how to use them properly (as shown in Mark's example). I found this out when working with my wife. I grew up in the emergency services community and volunteered for years, she did not. Things that are now second nature to me she had no clue about.

I guess the long and short of my post is this.

I would strongly suggest you get training both a Red Cross style CPR (AED)/First-aid (as this teaches you how to treat a wide variety of maladies), and a more specific class for "tactical" trauma. After you get through your classes, practice. Keep your kit up-to-date, use the stuff that expires for training.

[NongShim]

First off, I am not a medic, however I have lots of medical training. I have also treated a LOT (approx a PLT's worth) of people with injuries such as GSW, amputations and other trauma from mine-strike, burns from being caught on fire, etc..

Current rule of thumb for TQ application is that past 8hrs is the point when damage starts happening. That did not used to be conventional wisdom, so lots of people are leery of them. CATs are easy, light, and look super badass on your chest or buttstock-they have numerous drawbacks, however. They were counterfeit a few years ago, and those break incredibly easily. Even the good ones degrade quickly when exposed to UV radiation (sunlight). If the windlass (stick part) is left in the sun, they will have a tendency to snap when wound. I prefer the SOF-T because it has a metal windlass which is immune to this. I still keep my TQs out of the sun, even though it looks way less awesome.

One TQ is often not enough. Apply them as high on the limb as possible AFTER removing the clothing. They work best with direct skin contact. If bleeding has not stopped, apply more as needed, as closely to each other as possible. TQs aren't always necessary, but a big help for arterial bleeds. If the blood is bright red and steady, pressure might solve the issue. If blood is dark and spurting, it should get a TQ. However, when in doubt about wound type, apply a TQ to stop bleeding.

Regarding gauzes, more skill is required. Simply applying a pad over the area is not sufficient for serious trauma. Gauze generally comes in two forms: rolled in a pillow pouch, or z-folded in vacuum pouch (like a little brick). They are the same, but when used to pack wounds your hands need to operate differently to feed the packing hand. Whether using impregnated or normal gauze, it must be shoved ALL the way into the wound, so that pressure may be applied directly to the bleeding artery or veins. Yes, arterial bleeds can be stopped this way, without TQs. Often, one package is not enough. Once internal packing is completed, things like Israeli dressings or ACE wraps are good for keeping things closed with pressure. Anything hard can be pressed against the wound to apply more pressure.

This is a really brief, down and dirty blurb. A lot goes into trauma medicine, that I will leave to more qualified individuals. Bottom line, when in doubt, apply pressure and or TQs as needed to stop bleeding. As far as legality goes, do or don't do what your conscience can handle. Saving a life is usually more rewarding than taking one, and harder.

[SeriousStudent]

NongShim, thanks very much for the practical advice, it is appreciated.

[Kyohte]

I found Celox (granules) in the Wal-mart camping section last week. The picture on the packaging showed someone using it to treat a minor cut on their finger. That worries me.

[markm]

I found Celox (granules) in the Wal-mart camping section last week. The picture on the packaging showed someone using it to treat a minor cut on their finger. That worries me.

You go STRAIGHT to the tourniquet in that case!

[Hmac]

I found Celox (granules) in the Wal-mart camping section last week. The picture on the packaging showed someone using it to treat a minor cut on their finger. That worries me.

There are many things about the current "advanced EMS for dummies" concepts that worry me. I find the beliefs that A) penetrating trauma is common and B) that anyone can do it, to be....uh..."interesting". Last carbine course I took, the guy shooting next to me, a dentist, had a very impressive IFAK on his chest rig. Man, I think I could have taken out someone's gallbladder with that kit. He didn't have a clue how to use the stuff. On the other side of that coin, I'm a trauma surgeon. I had a couple of band aids in my pocket.

[ST911]

There are many things about the current "advanced EMS for dummies" concepts that worry me. I find the beliefs that A) penetrating trauma is common and B) that anyone can do it, to be....uh..."interesting". Last carbine course I took, the guy shooting next to me, a dentist, had a very impressive IFAK on his chest rig. Man, I think I could have taken out someone's gallbladder with that kit. He didn't have a clue how to use the stuff. On the other side of that coin, I'm a trauma surgeon. I had a couple of band aids in my pocket.

Over the years I've found that I carry far fewer widgets, and am more aware of things around me that can serve useful purposes.