Quik Clot Combat Gauze -- is it needed when close to help?

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Originally Posted by Ironman8

Perhaps I misread you over the course of several of these TCCC related threads. I have no doubt that you do what you do in your profession. I guess it just comes off as if you dismiss the "need" for these tools. I'm a big believer in software first, especially when it comes to this "medical stuff", and I realize not everyone takes that stance...but I wouldn't dismiss the "need" as long as requisit skills are acquired. And again, maybe I'm misreading what you're actually saying.

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Originally Posted by Inkslinger

Do you think a bystander with little or no training would have a better chance of stopping the bleeding from a femoral artery by applying a TQ or direct pressure?

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Circumstantial. An 8 year-old can lose a major portion of his circulating blood volume from the femoral artery in the time it takes for even a trained paramedic to fumble that tourniquet on if he/she hasn't applied one in awhile.

But it does kind of highlight the reason for my cynicism about the hardware focus that keeps coming up around here regarding "how do I outfit my IFAK/Blowout/GSW kit?". I see situations in real life where the field efforts become so focused on getting the hardware on that sight is lost of the problem that actually needs to be treated, and immediately. There's a tendency to believe, for example, that getting a HALO chest seal on takes precedence over actually treating a sucking chest wound.

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Originally Posted by Inkslinger

Do you think a bystander with little or no training would have a better chance of stopping the bleeding from a femoral artery by applying a TQ or direct pressure?

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Honestly I would think a bystander with little to no training would have a better chance at direct pressure.

I'm assuming a typical non-medical bystander/general public with no formal training here..... if that's the case then hopefully a basic reflex would be to put pressure and hold. Throwing them a TQ would likely be of no help.

Certainly in very specific situations the addition of a TQ could be of help, say with multiple victims and one rescuer though now to make that equipment useful would require much more training than any typical lay person has.

I think it's safe to say that we all say that training trumps whatever kit or specific item you are able to obtain. It does seem like there can be a somewhat disproportionate amount of energy spent on which item to have as opposed to what specific skill, training or knowledge base to have. I know, or at least hope, that most here understand that and just enjoy talking about the various pieces of kit out of interest after some sort of training has been sought.

I think my bag (if I even have it with me) has maybe a couple pairs of gloves and some gauze at most....

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Originally Posted by Inkslinger

Do you think a bystander with little or no training would have a better chance of stopping the bleeding from a femoral artery by applying a TQ or direct pressure?

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Pressure. Many people applying a TQ for the first time are not going to apply it properly unless supervised.

https://www.ncbi.nlm.nih.gov/pubmed/25388480

People with basic training were successful with a TQ only 69% of the time.

Without solid basic lifesaving including direct pressure, advanced care is next to worthless, and can actually lead to a poor outcome. Why? Because the more a person can do, the lower their sense of urgency. The best trauma practitioner is nothing without his team. Pack up and haul ass, but only after providing sound basics.

If we're talking about a penetrating injury leading to arterial bleeding, the issue is "how do I, as a trauma practitioner without my team, stop this bleeding as quickly as possible?" I contend that, as cool as tourniquets are (for those that know how to use them), applying direct pressure is going to be much more effective and effective more often than a tourniquet and certainly more effective, and more often, than Quikclot.

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Originally Posted by Sensei

Pressure. Many people applying a TQ for the first time are not going to apply it properly unless supervised.

https://www.ncbi.nlm.nih.gov/pubmed/25388480

People with basic training were successful with a TQ only 69% of the time.

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My thought process is that an "untrained", as in knowing there's a major artery in the leg, but not necessarily where, could be more successful in stopping bleeding with a device (even a belt and not a tacticool TQ) that encompasses the entire area more effectively than focusing pressure with the hands in an area they hope is correct.

If the wound is spurting blood, put direct pressure on the spot where it's spurting from until it stops.

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Originally Posted by Inkslinger

My thought process is that an "untrained", as in knowing there's a major artery in the leg, but not necessarily where, could be more successful in stopping bleeding with a device (even a belt and not a tacticool TQ) that encompasses the entire area more effectively than focusing pressure with the hands in an area they hope is correct.

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TQ's have enjoyed a resurgence in popularity largely due to their performance during the GWOT. However, what is good for the goose is not always good for the gander. During the GWOT, the IED introduced an injury pattern ideal for the TQ - massive, bilateral lower extremity trauma with complex vascular injuries. Many times soldiers would lose 25%+ of their blood volume in an instant as both legs were amputated. How is 1 medic going to apply pressure to both lower extremities on 1 patient when there were several other equally critical patients? How about applying pressure on a patient while firing your weapon or reloading? Fortunately, that injury pattern is exceedingly rare in the US.

So, the TQ served as a lifesaving force multiplier that was good enough but far from ideal. Fast forward a decade and people who saw the TQ save lives in the sandbox are now applying those lessons state side. Unfortunately, I'm seeing A LOT of TQ's applied inappropriately or on wounds that do not involve serious bleeding. Are they harming people? Rarely. But they certainly are not helping.

So yes. I keep a TQ along with an Israeli Combat Dressing in my kit. However, I invision it being used when faced with a situation where there are more injuries than hands or all hands are preoccupied trying to prevent further injury. ;)

Need? That's a subjective judgement only you can answer.

As mentioned previously, it takes time (5-8 minutes?) for first responders to get reach the location assuming patient is in an easy to find location that isn't difficult to find or reach. Also assuming there is cellular or landline connection to summon EMS.

From the time they arrive, first responders will assess the patient and stabilize before they move him.

Time will be spent in transport, and even though the hospital received prior notice before arrival, there may not be a doctor/surgeon immediately available to perform the necessary procedure.

Total time before patient is receiving high level care? Hmm...

For the $$$ spent on training and hemostat, the inconvenience of carrying an IFAK on your person daily, it's a screaming deal when it's your loved one that's down.

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Originally Posted by voiceofreason

For the $$$ spent on training and hemostat, the inconvenience of carrying an IFAK on your person daily, it's a screaming deal when it's your loved one that's down.

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Or....you could apply direct pressure until the ambulance arrives. That way you don't have to worry about your SHTF/EOTWAKI/GSW blowout kit wearing a hole in your Gammarelli socks.