A True Accidental Shooting

[Eric Lamberson]

I always have Quickclot, a tourniquet, IBD, etc in my range bag and a full kit in the car.

[remanifest]

What a shame. If it doesn't involve a gunsmith or a drop-in kit, I'm not modifying my guns.

[Charles L. Cotton]

Medical malpractice defense made up about 85+% of my practice for twenty years. I learned a lot of medicine over that time and I'm surprised the ER doctor didn't tell her that compartment syndrome was a very real possibility with that type of injury. The permanent damage could have been caused by the compartment syndrome, the bullet or a combination of both.

This will not be an easy case to prosecute for a plaintiff's attorney. There are a lot of issues, but I'm not going there on the Forum.

Chas.

[The Annoyed Man]

If you have a firearm on you, you should have a tourniquet on you. Period.

Does anyone (everyone) do this? Should we?

I always have a basic first aid kit in all of my vehicles, but I don't think any have a tourniquet.

I do. Any "basic first aid kit" should have a tourniquet in it. It's the first line of defense against exsanguination. In fact, in my medical bag - which is more comprehensive - I have four.

[Acronym Esq]

If you have a firearm on you, you should have a tourniquet on you. Period.

Does anyone (everyone) do this? Should we?
I always have a basic first aid kit in all of my vehicles, but I don't think any have a tourniquet.

I have a couple clean bandanas in my kit. They can be used as bandages, ties for splints, wiping snotty noses, and cutting off blood to an extremity. They are cheap and multi-use. Just thought I would suggest something easily attainable, for those people who don't want to put that much effort into their kits.

I don't carry a tourniquet but every Boy Scout knows how to make one.

My last pass through BSA first aid was a year or two ago, but they don't teach tourniquet use any more. Proper use of a tourniquet requires that it is loosened every once in a while (I don't remember the timing) to reduce the likelihood of loosing the limb. The thinking in the BSA is that boys are very unlikely to encounter the situation of choosing between lethal bleeding and the possible loss of a limb. If the tourniquet is part of their skill set, they may be too enthusiastic about using it.

So, if anyone is pondering adding a tourniquet to their first aid kit, I encourage them to do 10 minutes of research on google or youtube on the proper use. Obviously I need a little refresher too.

Acronym 2/28/2017 9:54 AM

[TVGuy]

If you have a firearm on you, you should have a tourniquet on you. Period.

Does anyone (everyone) do this? Should we?

I always have a basic first aid kit in all of my vehicles, but I don't think any have a tourniquet.

Yes, I have DOKs in all of my vehicles, range bags, and in a cargo pocket while on the range. Nearly everyone I train with does as well.

[KC5AV]

Okay, there are a few acronyms floating around this thread... anybody care to share the meanings?

SOF-T - I figured out this one is a type of tourniquet.
AFAK - Ankle first aid kit?
IBD - ?
DOKs - ?

Lot's of possibilities on a couple of these.

[Mike S]

Excellent video. Thanks for posting, it was worth the time to watch the whole thing.

With modern medical practices and the use of well-designed tourniquets lives and limbs are being saved after having a tourniquet applied for 4-6 hours.

This is key to understand. At one time turniquets were viewed as a last resort measure for bleeding uncontrolled by pressure dressings, & 'would likely result in loss of the limb'.

For over a decade now TCCC has taught tourniquets as an initial control measure for GSWs to the extremities, & unless you're needing to stabilize the patient in an austere setting for awhile there's no need to worry about loosening or removing the tourniquet (to do so incorrectly may blow the clot).

[loktite]

Okay, there are a few acronyms floating around this thread... anybody care to share the meanings?

SOF-T - I figured out this one is a type of tourniquet.
AFAK - Ankle first aid kit?
IBD - ?
DOKs - ?

Lot's of possibilities on a couple of these.

guessing IBD is israeli bandage
something akin to Blow Out Kit for DOK (Downed officers kit)
AFAK could be either Ankle first aid kit or adaptive, more likely ankle in his use.

[Bitter Clinger]

Okay, there are a few acronyms floating around this thread... anybody care to share the meanings?

SOF-T - I figured out this one is a type of tourniquet.
AFAK - Ankle first aid kit?
IBD - ?
DOKs - ?

Lot's of possibilities on a couple of these.

guessing IBD is israeli bandage
something akin to Blow Out Kit for DOK (Downed officers kit)
AFAK could be either Ankle first aid kit or adaptive, more likely ankle in his use.

AFAK stands for "Adaptive FIrst Aid Kit". Refers to the ability to mount horizontally / vertically, using molle or other solutions.

[bblhd672]

It's the first line of defense against exsanguination.

I had to google that one...."bleeding out" has less letters!

[bblhd672]

Okay, there are a few acronyms floating around this thread... anybody care to share the meanings?

SOF-T - I figured out this one is a type of tourniquet.
AFAK - Ankle first aid kit? Adaptive First Aid Kit
IBD - ? Israeli Battle Dressing
DOKs - ? Downed Operator Kit

Lot's of possibilities on a couple of these.

[The Annoyed Man]

If you have a firearm on you, you should have a tourniquet on you. Period.

Does anyone (everyone) do this? Should we?
I always have a basic first aid kit in all of my vehicles, but I don't think any have a tourniquet.

I have a couple clean bandanas in my kit. They can be used as bandages, ties for splints, wiping snotty noses, and cutting off blood to an extremity. They are cheap and multi-use. Just thought I would suggest something easily attainable, for those people who don't want to put that much effort into their kits.

I don't carry a tourniquet but every Boy Scout knows how to make one.

My last pass through BSA first aid was a year or two ago, but they don't teach tourniquet use any more. Proper use of a tourniquet requires that it is loosened every once in a while (I don't remember the timing) to reduce the likelihood of loosing the limb. The thinking in the BSA is that boys are very unlikely to encounter the situation of choosing between lethal bleeding and the possible loss of a limb. If the tourniquet is part of their skill set, they may be too enthusiastic about using it.

So, if anyone is pondering adding a tourniquet to their first aid kit, I encourage them to do 10 minutes of research on google or youtube on the proper use. Obviously I need a little refresher too.

Acronym 2/28/2017 9:54 AM

My choice to use a tourniquet is based on a Medic 1 class I took, taught by Lone Star Medics. Course description:

"Medic 1" : 2 DAY

This is our most popular two-day course. This course is perfect for those with little to no previous first aid training. We will cover aggressive first aid for moderate to severe injuries/illnesses. Adult, child, infant CPR w/ AED (American Heart Assoc.) will be taught on the morning of the first day. Throughout class, each student will learn by minimal lectures, plenty of hands-on skills practice, and multiple scenarios involving role players. The students will participate in the skills training as individuals and as a team throughout both days. CareFlite will fly out a helicopter, real life missions and weather pending. Some of the subjects covered in this course:

• Medical & Legal Issues
• Body Substance Isolation; Use of Protective Barrier Devices
• Basic Anatomy & Physiology
• AHA CPR w/ AED
• Patient Assessment
• Penetrating & Blunt Trauma; GSW, Stabbings, Crush Injuries
• Medical Emergencies; Stroke, Diabetic Emergencies, Siezures
• Fractures & Sprains; Broken Bones
• Burns; Thermal, Electrical, etc.
• Environmental Emergencies
• Animal/Insect bites
• Heat & cold injuries
• Dehydration & Prevention (Caleb’s favorite)
• Shock; Management and Treatment
• Tourniquets & Hemostatic Bandages; QuickClot, Celox
• Movement of Patients (how, when & when not to)
• LZ operations; CareFlite provides a helicopter
• 911 Communications
• First Aid Kits & Equipment Selection

The guy who teaches the class also teaches paramedics and ER docs. He is a combat veteran as a medic with the 82nd Airborne. I worked in the ER of a Level 1 trauma center for 6 years. Everything he teaches in that class is consistent with everything I learned while working in an ER.

The fact is, a bandana will not stop blood flow as effeciently as a tourniquet. It is also a fact that a tourniquet CAN be left on, without permanent damage to the extremity, for longer than an hour.

https://www.naemt.org/docs/default-sour ... f?sfvrsn=2

Recently, a casualty suffered a surgical amputation of the lower limb due to a tourniquet left in place during a long evacuation to a local national hospital with a total tourniquet time of 8 hours; upon surgical exploration of the leg, no major vascular injury was found. If the tourniquet had been converted to a hemostatic or pressure dressing during Tactical Field Care (TFC) or Tactical Evacuation (TACEVAC) Care, it would be reasonable to expect that the amputation could have been prevented. This case illustrates the point that the need for a tourniquet must be re-assessed during both TFC and TACEVAC phases of TCCC, at most 2 hours after initial tourniquet placement, and serves as a reminder that vigilance is required to prevent or minimize tourniquet-related morbidity, particularly when evacuation is long or delayed. There have been no known cases of limbs lost to tourniquet ischemia in U.S. casualties of the Iraq or Afghanistan wars, although there were at least two unpublished cases in Afghanistan of limb loss from tourniquets inadvertently left in place for extended periods in Afghan casualties under Coalition care.

A bandana is at best a poor substitute for a real tourniquet. In fact, they often cause more pain to the patient than a good modern tourniquet. Additionally, whether you are using a tourniquet or a bandana, you should have pressure dressings and clotting agents on hand so that, in the event that the patient does not make it to a trauma care facility within the golden hour, or at most, two hours, then you can re-assess and convert treatment to use of a pressure dressing with clotting agents. But the tourniquet is your FIRST line of defense. And in the event that conversion to pressure dressing and clotting agents fails to stem the hemorraging, then you have two choices: (1) allow your patient to bleed out; or (2) re-apply the tourniquet, even if it risks the loss of the limb. Loss of a limb won't kill your patient, but exsanguination most surely will.

Your IFAK/AFAK should have a tourniquet (C-A-T or SOFTT-Wide preferred), a pressure dressing, clotting agents, a chest seal, an airway, and a ventilation mask. A bandana is good for splinting and making slings, but it isn't a good substitute for a tourniquet. A SOFTT-Wide tourniquet costs about $35.00. A C-A-T tourniquet costs about $30.00. Most of us can afford to spend $30-$35 for something that will save a life, maybe even our own.

It is true that you shouldn't apply a tourniquet of any kind, bandanas included, if you don't know how or when to use it properly. But getting training is easy, if one cares enough to get it.

Just my 2¢......

[Excaliber]

If you have a firearm on you, you should have a tourniquet on you. Period.

Does anyone (everyone) do this? Should we?
I always have a basic first aid kit in all of my vehicles, but I don't think any have a tourniquet.

I have a couple clean bandanas in my kit. They can be used as bandages, ties for splints, wiping snotty noses, and cutting off blood to an extremity. They are cheap and multi-use. Just thought I would suggest something easily attainable, for those people who don't want to put that much effort into their kits.

I don't carry a tourniquet but every Boy Scout knows how to make one.

My last pass through BSA first aid was a year or two ago, but they don't teach tourniquet use any more. Proper use of a tourniquet requires that it is loosened every once in a while (I don't remember the timing) to reduce the likelihood of loosing the limb. The thinking in the BSA is that boys are very unlikely to encounter the situation of choosing between lethal bleeding and the possible loss of a limb. If the tourniquet is part of their skill set, they may be too enthusiastic about using it.

So, if anyone is pondering adding a tourniquet to their first aid kit, I encourage them to do 10 minutes of research on google or youtube on the proper use. Obviously I need a little refresher too.

Acronym 2/28/2017 9:54 AM

My choice to use a tourniquet is based on a Medic 1 class I took, taught by Lone Star Medics. Course description:

"Medic 1" : 2 DAY

This is our most popular two-day course. This course is perfect for those with little to no previous first aid training. We will cover aggressive first aid for moderate to severe injuries/illnesses. Adult, child, infant CPR w/ AED (American Heart Assoc.) will be taught on the morning of the first day. Throughout class, each student will learn by minimal lectures, plenty of hands-on skills practice, and multiple scenarios involving role players. The students will participate in the skills training as individuals and as a team throughout both days. CareFlite will fly out a helicopter, real life missions and weather pending. Some of the subjects covered in this course:

• Medical & Legal Issues
• Body Substance Isolation; Use of Protective Barrier Devices
• Basic Anatomy & Physiology
• AHA CPR w/ AED
• Patient Assessment
• Penetrating & Blunt Trauma; GSW, Stabbings, Crush Injuries
• Medical Emergencies; Stroke, Diabetic Emergencies, Siezures
• Fractures & Sprains; Broken Bones
• Burns; Thermal, Electrical, etc.
• Environmental Emergencies
• Animal/Insect bites
• Heat & cold injuries
• Dehydration & Prevention (Caleb’s favorite)
• Shock; Management and Treatment
• Tourniquets & Hemostatic Bandages; QuickClot, Celox
• Movement of Patients (how, when & when not to)
• LZ operations; CareFlite provides a helicopter
• 911 Communications
• First Aid Kits & Equipment Selection

The guy who teaches the class also teaches paramedics and ER docs. He is a combat veteran as a medic with the 82nd Airborne. I worked in the ER of a Level 1 trauma center for 6 years. Everything he teaches in that class is consistent with everything I learned while working in an ER.

The fact is, a bandana will not stop blood flow as effeciently as a tourniquet. It is also a fact that a tourniquet CAN be left on, without permanent damage to the extremity, for longer than an hour.

https://www.naemt.org/docs/default-sour ... f?sfvrsn=2

Recently, a casualty suffered a surgical amputation of the lower limb due to a tourniquet left in place during a long evacuation to a local national hospital with a total tourniquet time of 8 hours; upon surgical exploration of the leg, no major vascular injury was found. If the tourniquet had been converted to a hemostatic or pressure dressing during Tactical Field Care (TFC) or Tactical Evacuation (TACEVAC) Care, it would be reasonable to expect that the amputation could have been prevented. This case illustrates the point that the need for a tourniquet must be re-assessed during both TFC and TACEVAC phases of TCCC, at most 2 hours after initial tourniquet placement, and serves as a reminder that vigilance is required to prevent or minimize tourniquet-related morbidity, particularly when evacuation is long or delayed. There have been no known cases of limbs lost to tourniquet ischemia in U.S. casualties of the Iraq or Afghanistan wars, although there were at least two unpublished cases in Afghanistan of limb loss from tourniquets inadvertently left in place for extended periods in Afghan casualties under Coalition care.

A bandana is at best a poor substitute for a real tourniquet. In fact, they often cause more pain to the patient than a good modern tourniquet. Additionally, whether you are using a tourniquet or a bandana, you should have pressure dressings and clotting agents on hand so that, in the event that the patient does not make it to a trauma care facility within the golden hour, or at most, two hours, then you can re-assess and convert treatment to use of a pressure dressing with clotting agents. But the tourniquet is your FIRST line of defense. And in the event that conversion to pressure dressing and clotting agents fails to stem the hemorraging, then you have two choices: (1) allow your patient to bleed out; or (2) re-apply the tourniquet, even if it risks the loss of the limb. Loss of a limb won't kill your patient, but exsanguination most surely will.

Your IFAK/AFAK should have a tourniquet (C-A-T or SOFTT-Wide preferred), a pressure dressing, clotting agents, a chest seal, an airway, and a ventilation mask. A bandana is good for splinting and making slings, but it isn't a good substitute for a tourniquet. A SOFTT-Wide tourniquet costs about $35.00. A C-A-T tourniquet costs about $30.00. Most of us can afford to spend $30-$35 for something that will save a life, maybe even our own.

It is true that you shouldn't apply a tourniquet of any kind, bandanas included, if you don't know how or when to use it properly. But getting training is easy, if one cares enough to get it.

Just my 2¢......

I took the one day Lonestar Medic course and can confirm the quality and info are top notch.