TIP OF THE SPEAR

Red, Red Squirty Stuff is Bad When It’s Coming Out of You.

For a moment, ignore all the tactical-Timmy stuff in this photo, and read on. We’ll come back to it, but first, we’re here to talk about bleeding.

By Doc Spears

Medical skills are warrior skills as much as physical conditioning, mindset, weapons proficiency, breaching, etc. As a military sci-fi writer, I splash a variety of all those topics in my books. Among other things in my curriculum vitae, I was a Special Forces Medic and later became a surgeon. So it’s totally cool and natural that I get hit up all the time with medical questions, the most frequent being: Where should you carry a tourniquet (TQ)? What’s the best? What should be in an individual first aid kit (IFAK)? What are the odds I even need any those things?

(The other medical questions I usually get involve descriptions of discharges and burning sensations, which is totally not cool to hit me up with. Go to the damn doctor.)

The short and sweet of it is that what tops the list of conditions most likely to kill you—at least, of things that you can actually do something about yourself—is bleeding. So, yes, you do need some first aid equipment and definitely the training to go with it.

This won’t be a “how-to” blog post, and I won’t provide links to companies or training videos or explanations of any medical nomenclature I drift into; type it in to a search if you want. The advice that follows is based on decades of experience, foreign and domestic, both as a surgeon and a guy causing the things a surgeon has to fix, and also what the science supports.

If you’re a Dark Ops legionnaire, your armor has an autotourniquet at all the limb/body junctions and nano-gel dressings ready to squirt into any wound. As for the rest of us…

To start, let’s go back to the photo. I simply arranged my work gear to try and get everything in one frame. I rolled out the IFAK off my plate carrier to show the contents, with consideration to show the separate TQ pouch on my PC near the center line of my chest. Below to the right, I laid my pistol belt out to emphasize where the TQ lives on it.

(Note that there are two TQs in dedicated carriers in locations where they can be accessed by either hand. Detectives call this a clue about what folks in my tribe think is important in the way of gear.)

Bottom left is a tactical fanny pack (we actually call them n#t sacks, but I’m trying to stay classy) and in it resides a TQ, a pressure dressing, and some wound packing gauze.

At the very bottom of the photo is just a couple of loose TQs; the one on the left is a SOF-T, the other a CAT.

With that out of the way, let me try and answer the most common question I get regarding what you likely need in the way of medical gear—no matter what your day job is—be it you’re a regular Earth-type person, or a tactical police officer whose job is to go after bad guys, and everyone else in between. Here goes…

1. You probably don’t need a complicated IFAK.

At least, most-folks don’t, not unless you’ll seek out real training. A chest decompression needle, a naso-pharyngeal airway, chest seals, s-rolled gauze, a hemostatic agent—and more—are all useless without training. Not to mention, all the items expire, have packaging that cracks over time, and are expensive to replace. It’s not a one-time purchase.

If the goal is to have the essentials on you that Doc will use on you, that’s different, and if you’re a cop or a contractor or the like, it’s a good reason for your agency to provide you an IFAK.

Otherwise, for average-Earth-types, it’s as I stated above.

2. A TQ and training are the best investment of time and money.

Arterial bleeding from a gunshot or knife wound will kill quickly, and no amount of direct pressure will stop it, nor will the belt off your pants. Farm accidents, car accidents, freak accidents; arterial injuries happen in settings other than good guys battling bad guys.

And when bright red stuff is pumping in a pulsatile fashion from a limb, nothing else than a real tourniquet will do.

Like a lot of things, you can learn to use one from a video, but, it’s not the best option.

Which leads me to this often heard statement about TQs…

3. Any tourniquet is better than no tourniquet.

Aw, hell no. Those elastic wraps sold as TQs are trash. You will never, ever stop a femoral arterial bleed with one of those. (Man, do I got stories for you.)

Purchase a TQ recommended by the Committee on Tactical Combat Casualty Care (type in: “CoTCCC recommended devices.” You’re welcome.)

The tourniquets listed have been punishingly tested—both in controlled environments and in the field—to prove they have the capability to compress the arterial blood flow of a limb of even massive girth, and that the device can be used by any reasonably capable person.

4. Put it on high and tight.

Okay, I lied. This is a little how-to. The only disagreement I have with the general TCCC or TEMS doctrine as taught is with the option to put a TQ a few inches above the presumed site of an arterial bleed.

In practice, even a properly applied TQ will slide right the hell off when the casualty is moved, especially if they have to bear weight on the injured leg or use the injured arm.

I’ve seen it so many times—in training and when the bullets are flying (one is just as much “the real world” as the other)—don’t waste a keystroke arguing with me.

I hate resorting to boring anyone with credentials, but I’m also an orthopedic surgeon. A guy who’s put a damn TQ—pneumatic and windlass-type—on a thousand limbs in the very controlled, ideal and clean environment of the operating room. Even there, if you do not put the TQ on as high as it will go, it will not remain, even after it’s fully tightened. Much less, when hustling a casualty off the “X”.

(Ask any a first-year ortho resident his worst moment—it’s probably the horror of watching the TQ slip off the limb he was trusted to prepare for surgery, and the resulting ass-chewing that followed.)

5. Get actual training.

Don’t settle for video learning. Courses in “Stop the Bleed” are offered lots of places. I’ve seen local fire departments and hospitals advertise them for free.

Considering all the above, I’ll tell you how I roll out with what level of medical gear, depending on what I’m doing.

Obviously, if I’m doing stuff in places that requires me wearing all my personal protective equipment, yeah, it all lives on my first-line gear; IFAK, multiple TQs, and often an extra pressure dressing or two in a cargo pocket. If you have to roll like this, your organization is providing the equipment and training.

If you’re an above-average-Earth-type person who wants to be prepared, then that little fanny pack containing a TQ and dressings is something you may want to consider. I have one in my truck, several in my shop, and try to always grab one before I hop on the 4-wheeler with my chainsaw, and always have one on the range.

But at the very bottom of the photo is probably all you really need; a good tourniquet.

These are two of the most common TQs; the SOF-T and the CAT. The CAT is standard in the military, and is a good device. But the plastic windlass will break, it will fatigue if you practice with it, and it will degrade with exposure to sun and the elements.

Among those like myself who’ve experienced the CAT’s failures, is a life-long friend (a special operator and Doc of legendary status) for whom the CAT earned a 1-star review after it snapped… while he treated the .50 caliber gunshot wound to his own leg (courtesy a blue-on-blue incident by a passing reserve unit who failed to appreciate that long-hair, bearded white guys in SUVs are not the enemy).

The SOF-T’s hardware is metal and has none of the faults of the CAT.

This is a big, big topic, and I’ve already put down twice as many words as I set out write.

There’s a popular saying that anywhere you carry a pistol, you should also carry a TQ. I carry a pistol everywhere, but not always a TQ, so judge me as you will. But if you do make a TQ part of your everyday carry, all the more power to you. Because I believe the saying is probably true that, over a lifetime, you’ll likely need a TQ more often than your pistol.